Sexual Health

Published: June 16, 2014

Sexual Health at Menopause and Beyond

The World Health Organization defines sexual health as a “state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.”

What about Sexual Health during the Menopausal years?

The relationship between menopause and sexual desire continues to be studied.

Sexual feelings and activities are a natural part of living, and continue through our lives.

So menopause means less interest in sex?
No, that is a myth.

About ½ of all women going through menopause report no changes at all in their interest in sex, and less than 20% report a significant decrease in sexual activity.

If there were only one word to describe women’s sexual health, we’d select “complex.”

The factors that contribute to women’s sexual health and satisfaction, as well as to their potential sexual problems are many, and they are often interrelated.

These factors range from physical changes of menopause and aging to a woman’s physical health, her cultural and religious environment, issues in her relationship, her self-image, and stress and lifestyle issues.

Midlife can be an opportunity for growth and transformation for women, yet it also often represents the end of “youth.” In a society that celebrates youth, the menopause transition can cause some women emotional distress regarding how they perceive themselves. Along with being a reminder of time passing, the physical changes of midlife and the end of fertility can take a toll on a woman’s self-concept, self-esteem, and body image. This often impacts a woman’s sexual health.

Despite popular perceptions, many men & women remain sexually active well beyond midlife and into old age.

“Research shows that sexual problems are common for both men and women of all ages.” North American Menopause Society

Menopause Can Introduce Physical Changes That Interrupt a Happy Sex Life

Some of these changes result from estrogen loss which causes:

  • Thinning and drying of vaginal tissue making it more susceptible to irritation and bleeding
  • Less lubrication during sex
  • Slower sexual arousal
  • Painful intercourse

It’s important for you to speak to your clinician to help determine a solution so that you can enjoy sexual intimacy throughout menopause and through your postmenopausal years.

What Impacts Sexual Health

Sex is a form of communication. For many women, the better the communication, the better the sex.

By communicating our needs and limitations clearly with our partners, we are taking steps to improve our relationships’ sex and intimacy. During menopause, the need for communication becomes even more important.

The most obvious physical limitations affecting libido are those that affect the vagina and urinary tract.
The depletion of estrogen can thin vaginal walls, causing dryness and irritation.

The vaginal mucosa can also “shrink” (a condition called vaginal atrophy) as a result of declining estrogen. The urethra also can become thinner and drier as a result of menopause, which can cause reduced bladder control.

Various psychological issues can affect libido, as well.  A few factors which can impact how much sexual desire a person has are:  lack of communication in the relationship, struggles with depression and anxiety, body image, and self-esteem.

Because depression and anxiety can be symptoms of menopause, psychological challenges should be addressed as well as physical issues.

It’s important to recognize when relationship issues are main factors to sexual problems and to focus on the underlying relationship. If necessary, seek counseling; sex therapy can be an important part of counseling for couples.

Sexual Health Issues & Options to Consider

Physical and psychological changes can be addressed and even treated successfully in many cases. Some potential treatments for these issues include:

  • Have a conversation with your healthcare provider. Sometimes the causes of sexual difficulty are medical or medication-related. Antidepressants and high blood pressure medications are two categories of drugs that can put a damper on libido. Talk with your healthcare provider; there may be alternatives to the medications you’re taking that don’t inhibit libido.
  • Sexual activity. A good way to increase lubrication, and promote blood flow (and thus decrease dryness and irritation) is to have sex on a regular basis, or more frequently.
  • Counseling. A good therapist can help sort through issues that may affect sex drive.
  • Physical activity. Getting plenty of exercise helps clear the mind, reduce stress, and improve physical ability to engage in sexual activity.
  • Take time to pamper yourself.  This can be a wonderful aphrodisiac for many women
  • Spice up your sex life – try using erotic materials, change your environment
  • Practice Kegel exercises to strengthen pelvic muscles
  • Practice relaxation techniques – massage, deep breathing exercises
  • Moisturizers and lubricants. There are several over-the counter options including long lasting moisturizers and lubricants.
  • Systemic estrogen therapy. If it’s an appropriate course of treatment for you, systemic estrogen therapy is a proven success in managing vaginal symptoms of menopause.
  • Vaginal estrogen: If systemic estrogen therapy is not an option for you, vaginal estrogen may be the right solution. Vaginal estrogen is available as a cream, a ring, or a tablet. Because it affects the vagina primarily, vaginal estrogen greatly reduces the amount of estrogen that enters the body.
  • There is currently no FDA approved testosterone therapy for female sexual dysfunction but there is a new FDA approved medication for pain during intercourse.

Some techniques to consider for better communication and better sex:

  • Tell your partner what feels good, and what doesn’t. Although trying new things can be fun, it’s a good idea to take the guesswork out of sex as much as possible. If certain techniques feel really good to you, let your partner know.
  • Tell your partner which positions are more comfortable for you.
  • Share any concerns you may have about your how appearance has changed. Talk with your partner about how he or she may feel about those changes.
  • Convey when the best times are for you to relax and enjoy sex. While sex doesn’t have to happen on a firm schedule, it’s really difficult to enjoy it when you’re in the midst of a hectic time.
  • Make plenty of time for sex. It’s normal to need more time to get aroused than you did when you were young. And the fewer the distractions, the better.
  • Try nonsexual physical contact. Massage, for example, can be a wonderful way to connect with your partner.

Safe Sex during Perimenopause

Sex can be wonderful, and you need to remember during perimenopause there is still a chance of getting pregnant.

  • The potential of pregnancy declines (and eventually disappears) as menopause progresses, but it’s still important to be careful if you don’t want to get pregnant.
  • Sexually transmitted infections (STIs) are an ever-present risk of unprotected sexual contact, as well.
  • Any woman who is not in a long-term, strictly monogamous sexual relationship must take care to protect herself from STIs, by having protected sexual relations.
  • Using a latex condom can protect against pregnancy and STIs. Condoms aren’t perfect, but they greatly decrease the risk of getting pregnant or getting an STI.
  • Be sure to avoid using petroleum based products (such as Vaseline and baby oil) with condoms, as these can cause condoms to break.

Some Benefits of Sex

Sex not only feels good, it has benefits beyond the obvious pleasures it can produce:

  • Improved energy
  • Better sleep
  • Healthy weight loss/maintaining weight
  • Pain relief
  • Increased longevity


It’s important for you to bring up sexual changes with your clinician.  Don’t feel embarrassed about your questions of concerns.  If you don’t feel comfortable discussing sexual issues with your clinician, perhaps it might be time for find one that is more engaging.  Red Hot Mamas always encourages women to keep a diary of any discomfort, pain, or discharge they may experience.  Provide this diary to your clinician.  Share with them the level of pain you had, how long it lasted and what activity might have caused it.  There are many ways your clinician can help you.  Remember, there can be Sex in Menopause City.

Resources for Sexual Health Information