Sex used to be so simple. Maybe all it took between you and your partner was a simple code word, back scratch, or booty squeeze to show you were in the mood. Now that you’re less worried about checking into the Red Roof Inn, getting pregnant, and having kids walk in on you (yikes!), you’d think your sex life would be on fire, right?! But just when you’re ready to get a little sugar in your bowl, menopause decides to throw a little twist and shout into your dirty dancing. The sexual changes during menopause may feel overwhelming but, believe it or not, they can make sex even better. Score! (In this post, when we yell “score,” we mean it in the *wink wink nudge nudge* way.) As our perimenopausal friend, Diana, shares:

“My husband and I had a great sex life. We’re talking about getting it on every day with great and regular orgasms and no problems with penetrative sex. Then, two years ago, perimenopause hit and I completely dried up. My libido was next to nothing, my vagina started cracking and bleeding, and I got horrible yeast infections on the regular. I turned into a totally different person who was scared and grieving the loss of my sexual identity. At first, I thought our relationship was in for a rude awakening. And, I wasn’t wrong. These changes took both of us some getting used to. But, it wasn’t the nightmare I imagined it would be. As it turns out, there isn’t only one way to make love—even if you’re in a routine that rocks your and your partner’s world. Discovering new options has been fun and exciting, breathing new life into the bedroom. Also, after visiting with my health team, I learned about treatments that could decrease my symptoms—both topical (local) options and those that would address the whole body (systemic). As my husband and I are getting used to our new normal, we’re discovering new ways to connect sexually. Our emotional connection alone is deepening our relationship. And wouldn’t you know it? I’m not the only one in the relationship who is experiencing changes due to aging. We’re being open and honest about what works, what hurts, what’s hard (or not, LOL!), and how to navigate this life phase together. Who knew such serious and unplanned life changes could strengthen your sex life!?” 

As you can see from Diana’s example, sex may not be the same as in your pre-M days. You (and your partner(s)) are physically and emotionally changing, so let’s chat about how to have an awesome but different sexual life when you can no longer go with the flow. Also, let’s dive into sexual changes during menopause.

What Is Sex?

The menopausal journey brings a lot of changes that can affect your sex life, which is completely normal. Let me repeat: It is completely normal to experience sexual changes during menopause.

Before we dive into the “sex during menopause” talk, what do we even mean by “sex”?

I know! I know! We all were taught the birds and the bees way back in the 5th grade. (And then in 6th grade, we learned that birds and bees do not in fact have sex with each other.) Don’t worry! I won’t make you relive those red-faced, giggly moments. 

The problem with popular sex ed is that what we learned there (or on the playground) coupled with blockbuster movie love scenes, and the social stigmas that stem from them, would have you think that sex is limited to heterosexual, penis-in-vagina (PIV) penetrative intercourse initiated by men and the generally submissive women who can experience orgasm with little to no foreplay. While this may work in the movies, this limited representation leaves out a heck of a lot of people. I’m talking about those who are trans and/or non-binary, those who are not in heterosexual relationships, those in the disability community, those who have experienced sexual trauma, those who may be unable or choose not to have penetrative sex. Because of the images and scenes we’re exposed to, we end up with a narrow view of what “sex” is. And for many, this leads to a sense of disempowerment, making it harder to seek treatment, let alone voice their feelings, thoughts, and concerns.

For the purposes of this blog post, we’re broadening the definition of sex to be more inclusive, borrowed from the fine folks over at Law Insider: “Sexual activity means any direct or indirect physical contact by any person or between persons which is intended to erotically stimulate either person or both or which is likely to cause such stimulation and includes sexual intercourse, fellatio, cunnilingus, masturbation or anal intercourse. Sexual activity can involve the use of any device or object and is not dependent on whether penetration, orgasm or ejaculation has occurred.” 

For another viewpoint on why it’s important to broaden the definition of sex, check out this EverydayFeminist post.

What’s the Key Ingredient for a Great Sex Life? 

Regardless of your definition of sex or your experiences with sexual changes during menopause, midlife doesn’t have to wreck your sex life. You can fight back and reclaim your sexual self. Your sexual interests might change. Your desires might be different. Your needs might shift. That’s totally OK! Work on figuring out what you like, including what feels good and what feels less-than-good. Don’t be afraid to think outside the box (pun intended) and get creative. It’s time to rethink what’s good for you and your partner and come together (fingers crossed!) and COMMUNICATE. Communication is indeed the key ingredient for better sex, but it comes with a bonus prize: a stronger emotional connection!

Attitude Is Everything

Before we take even a wee baby step forward, let’s check our attitude. Since actions stem from our internalized beliefs, let’s talk about two critical components of embracing sexual changes during menopause: isolation and grief.

1. You’re Not Alone!

First things first: you’re not alone! Not only are millions of people going through menopause in the US every single year, but a large number of them experience vaginal changes, including painful sex. So if you’re experiencing sexual changes during menopause, you are in good company.

Specifically, this article shared that “Research shows that 30 percent of women report pain during vaginal sex, 72 percent report pain during anal sex, and ‘large proportions’ don’t tell their partners when sex hurts.” Additionally, I read that “a study in women with certain vaginal changes after menopause showed that around 40% of them reported painful sex.” 

But how is knowing there are millions of menopausal women in pain helpful to you and your journey? The key is awareness coupled with connection.

Not to get all research-y on you, but in a study from the Association for Psychological Science it states that: “ … Despite its unpleasantness, pain may actually have positive social consequences, acting as a sort of “social glue” that fosters cohesion and solidarity within groups … Pain is a particularly powerful ingredient in producing bonding and cooperation between those who share painful experiences,” says psychological scientist and lead researcher Brock Bastian of the University of New South Wales in Australia. “[This sheds] light on why camaraderie may develop between [people] who share difficult and painful experiences.”

In short, vulnerability met with empathy leads to connection. So, when we share our own painful symptoms  with candor and empathize with those who share with us, we connect. This helps us feel less alone and more hopeful. So, open up about your sex changes, discomfort, and pain with those in your support network, and feel those oxytocyn levels rise. 

2. It’s OK to Grieve!

Change is a part of life. It can also be a particularly sucky part of life. That’s why change and grief go hand in glove. Whether you consider yourself a sex goddess, are in a routine that rocks your world with your partner, or are used to life “as is” and aren’t fond of change (especially when it’s painful), give yourself permission to grieve any sexual changes during menopause. 

The experts over at the University of Washington put it like this: “Grieving … losses is important because it allows us to ‘free-up’ energy that is bound to the [loss]—so that we might re-invest that energy elsewhere. Until we grieve effectively we are likely to find reinvesting difficult; a part of us remains tied to the past.

Grieving is not forgetting. Nor is it drowning in tears. Healthy grieving results in an ability to remember the importance of our loss—but with a newfound sense of peace, rather than searing pain.”

To move through grief, the article suggests doing four things: 1) accepting, in this case, sexual changes during menopause, 2) expressing the full range of feelings those changes bring, 3) adjusting to life after loss, and 4) saying goodbye to your old normal and accepting your new normal.

The Facts About Sexual Changes During Menopause

The good news is that however scary the stats may sound, menopause is definitely not the time to think that your sex life is on a sinking ship. Data shows that people in every stage of the menopause journey are still getting it on and are giddy about it. 

In Heather Corinna’s book, “What Fresh Hell Is This?”, they state: “Not only is menopause itself unlikely to doom anyone’s sex life, it can potentially be a bridge to the best sex lives some people have yet experienced.” Fresh Hell yes, Heather!

We can send out our own  S.O.S. (save our sex-lives) and be our own life preserver. So grab your cocktail/mocktail and let’s dive right into the menopausal sex life waters with a little Q&A sesh.

Q: What on earth is happening “down there” and why?

The loss of estrogen—and even testosterone—during menopause can lead to changes in a person’s body and sex drive. Estrogen helps keep vaginal walls lubricated. With lower levels of estrogen, vaginal walls can become dry and inflamed and the lining can shrink, causing the walls to thin. The results? Cracking, bleeding, and tearing. These changes can make penis-and-vagina intercourse painful. I know it doesn’t sound fun . . . because it isn’t.

And, if that’s not enough, many people experience a lagging libido, hard-to-achieve arousal, and low blood flow to the clitoris, leading to atrophy which impacts orgasms. 

Q: How does menopause affect sex drive?

Menopausal and postmenopausal people may notice that they’re not as easily aroused. In other words, you may be less sensitive to touching and stroking. That can lead to less interest in sex. What else might impact your sex drive during menopause?

• Bladder control issues: I get it. You’re already worried about peeing your pants, now you have to worry about peeing while not wearing pants?! Totally understandable.
• Sleep problems: There’s nothing like trying to rock your partner’s world while feeling like a zombie. Although if you ever felt aroused watching The Walking Dead, this might be an opportunity to try out a new sexual fetish.
• Depression or anxiety: A Repeated Friendly Reminder: Seek help if you need it. Mental health is so vitally important at all stages and phases of life.
• Stress: Who wants to butter their biscuit, shuck an oyster, or bake their potato when stressed beyond belief? And if cooking is that stressful, who could possibly be in the mood for sex?! 
• Medications: Be sure to keep an open dialogue with your medical provider.
• Weight fluctuations: Gaining a few lbs is a natural part of the menopausal transition and it shouldn’t suck. But we live in the world we do, and one part weight gain mixed with two parts of societal beauty standards is a recipe for lowering one’s self esteem. When self esteem decreases, so does sexual drive.
• Pain. Yes, sex can be painful during menopause. There’s no delicate way to say this, so I won’t bother with the funny wordplay on this one.

Q: Does every menopausal person experience sexual changes?

The short answer? No. And, if you’re one of those lucky few, then 🎶 do a little dance, make a little love, get down tonight. 🎶 Get this, some people have said that they have a better sex life thanks to good ‘ole menopause. With no fear related to pregnancy and less worry about child-rearing, it might be easier for some to *actually* enjoy sex during menopause and postmenopause. There’s hope … just keep scrolling to the treatments section below.

Q: Why don’t women voice their pain?

Get this: “Many women don’t realize that painful sex can result from vaginal changes that happen as they get closer to or past menopause.” What do I always say about menopause? You need to track, track, and track some more. Tracking your changes and symptoms will help you piece everything together and realize that the reason sex might be getting more painful is due to your menopausal stage. But of course, other factors are at play when it comes to pain. Though while tracking will make you more aware, the reason women don’t voice pain has way more to do with things like people raised with the sex definition society shares (it’s the PIV intercourse way or the highway!) but who haven’t/can’t/don’t want to have PIV sex, may feel like something is wrong with them. Some people were taught that if they haven’t or can’t have this type of sex, they aren’t fulfilling their duty. If they feel they are in the wrong, and then don’t feel safe talking about it ( because so many people simply don’t talk about these taboo topics), they may feel shame. Shame coupled with isolation is HORRIBLE. If you’re going through that, then please reach out to a friend, family member, or healthcare provider. Shame is a spiral and keeps people in it. Once there, they don’t realize they’re not alone and that they have the freedom to share and that through sharing, they’ll connect, which will wipe out their shame and drive bonding. 

The reasons why people don’t share are many. (I mean vulnerability is terrifying, especially if you don’t know how other people will respond, right?!). But, the positive side of that risk is connection. And, according to Brene Brown,

“Connection is why we’re here. We are hardwired to connect with others, it’s what gives purpose and meaning to our lives, and without it there is suffering.” 

In short, we need connection physically, emotionally, and socially. The antidote to fear of sharing is connection, which requires our vulnerability being met with empathy. 

I mean, come on. We’re always seeing commercials for ED, but what about painful sex during menopause?! It’s time to kick the taboo to the curb and start making sex less painful. And if it continues to be painful, we sure as heck need to start talking about it. It’s like my first grade teacher, Mrs. Reader, always said, “Sharing is caring. And sharing things that make us feel vulnerable is super-extra-double caring.” (I may have added that last part.)

How to Have a Great Sex Life During Menopause

Can couples achieve intimacy without penetrative sex?

Heck freaking yes! If you take away nothing else from this article, remember this: 👏 PIV 👏 sex 👏 is 👏 not 👏 the 👏 only 👏 or 👏 even 👏 necessarily 👏the 👏 best 👏 way 👏 to 👏 have 👏 sex. There are other things that feel really, really (I mean really) good. How do you find out what feels good? Trial and communication! It cannot be overstated how important Communication with a capital C is here. If you have a difficult time talking to your partner about sex, I humbly recommend going to couples therapy or even one-on-one therapy. Hey, we’re busting through all the stigmas here, so let’s toss in an aversion to therapy. Therapy can help you start to talk your way through things and figure out a healthy way of discovering the new you, potentially the even sexier you.

As much as society wants us to think that penetrative sex is the only way to go, if you feel pressured in that way, reread the sex definition section above. I’m here to tell you to be adventurous. Look at intimacy through a different lens, explore more options, be open to changing your sexual routines, and have open and honest conversations with your partner to amp up the emotional connection in your relationship.

How can I treat vaginal dryness?

Lube is going to be your new BFF (if it isn’t already). And, if you’re too embarrassed to buy it at the store, then let online shopping be your other BFF. When buying lube, make sure you buy the water-soluble kind. You could also just look in your pantry! Regular old coconut oil works fantastically, and tastes better than most artificial lube options. It’s the ultimate *all natural* for when you’re going au naturale, aka naked. If you don’t, then your lube might weaken latex*. Weakened latex means weakened condoms, which can result in STDs (and potential pregnancy if you aren’t officially menopausal). See the math there? It’s best to play it safe. 

*Note that there are also non-latex condom options for those with an allergy or sensitivity! We’re not talking your grandmother’s non-latex options. Many major brands, including Trojan, Durex, and Lifestyles (called SKYN) have non-latex options! Even some without an allergy prefer the non-latex options for a “closer feel.”  

According to my friends over at WebMD, “Vaginal moisturizers like glycerin-min oil-polycarbophil (Replens) and Luvena can also be used on a more regular basis to maintain moisture in the vagina. You can also talk to your doctor about vaginal estrogen therapy. An oral drug taken once a day, ospemifeme (Osphena), makes vaginal tissue thicker and less fragile, resulting in less pain for women during sex. The FDA warns that Osphena can thicken the endometrium (the lining of the uterus) and raise the risk of stroke and blood clots.”

As I always say, it’s best to speak to your healthcare provider if you go the medication route. You need to find a product that works for you.

Q: How can I keep my sex life alive and kickin’?

Trust me, sexual satisfaction is possible. But, I need to be honest: Your usual way of doing the horizontal tango might start looking more like a vertical tango. And, hey, changing things up a bit might be more exciting. Don’t knock it ‘til you try it even if you were taught otherwise. As always, go with your gut! In this case, the gut inside your sex parts!

Here are some ways to help spice things up a bit if you’re stuck in a painful rut due to sexual changes during menopause:

• Broaden your definition of sex until you find what works for you and your partner. For example, if intercourse is all you know and what you were told was “right,” determine if it’s still right for you, given your sexual changes during menopause. 
• Treat your sex life like your Netflix subscription. Binge on it, figure out what works, and when you find out what works, then it’s time to Netflix and chill.
• You do you (literally). Spend some quality time alone and don’t be afraid to be adventurous and figure out what you like, what hurts, and what feels amazing. Then share it loud and proud with your partner.
• Increase intimacy with some non-sexual faves. Try out the classics like holding hands, hugging, and giving back rubs.
• If you feel comfortable, experiment with erotic videos or books to help get you in the mood and to change up sex routines.
• Consider roleplay.
• Mix it up with  activities like sensual massages and oral sex.
• Decrease any pain you might feel by using lube or finding new positions.
• Communicate with your partner to share what’s comfortable, both during and after. Remember that vulnerability met with empathy leads to connection. Oxytocin can result in the best sex you’ve ever had, even if you do little physically to arouse each other.
• Challenge the norms. For example, as crazy as it sounds, celibacy is an option to painful sex. Who wants to leave their hand on a hot stove over and over when they know the feeling of being burned? But, let’s challenge the traditional definition of being celibate. Celibacy, as most people are talking about it, simply means no more penetrative sex. But, since we now know that sex means arousal and sexual feelings and deeper connection with our partners, then unless we avoid all sexual relations, the definition of celibacy as it has been used for this stage of life is outdated. Have fun trying to think of new ways to have sex outside of the same ‘ole PIV.
• Masturbate. With yourself, and with your partner. This can be a touchy (pun intended) topic, but it can also be super hot (no pun necessary, it’s just the truth) As always, do whatever you feel right about and whatever works for you and for your partner!
• Talk to your healthcare provider, therapist, or other professionals to get the help you need.
• Commit to a healthy, balanced lifestyle since it can make a big difference in menopause and improve sex life.
• Embrace the new and improved version of you. Confidence is sexy!

Q: Are there treatment options available?

The two key players when it comes to sexual changes during menopause are vaginal dryness and decreased libido. If you’re struggling with either one of these, talk to your healthcare provider or specialist to get on a treatment plan that works for you. The plan might include changes in medicine, lifestyle, or diet. Consider these effective ideas:

• Vaginal lubricants: They can be bought in a drugstore without a prescription. They are available as creams, gels, or suppositories. Water-based products are the best choices.
• Topical estrogen: The estrogen products can help make sex more comfortable for menopausal people who have vaginal dryness or sensitivity.
• Clitorial therapy device: According to WebMD, “The Eros clitoral therapy device has been approved by the FDA to treat women with disorders of sexual arousal. The device consists of a small suction cup, which is placed over the clitoris before sex, and a small, battery-operated vacuum pump. The gentle suction provided by the vacuum pump draws blood into the clitoris, increasing pressure on the clitoral nerve. This device increases lubrication, sensation, and even the number of orgasms in many women who have used it. The device is available by prescription.” 
• Medication: Check out the options below:
  • According to WebMD, “Osphena, makes vaginal tissue thicker and less fragile, resulting in less painful sex for some women. Osphena — taken orally once a day — can thicken endometrium (the lining of the uterus) and raise the risk of stroke and blood clots.”
  • Based on information found on Healthline, “Hormonal replacement therapy can come in various forms, like pills, foams, patches, and vaginal creams. The goal of this therapy is to help vasomotor symptoms and vulvovaginal atrophy. HRT is an effective treatment for vaginal changes and libido, but discuss your needs in detail with a medical professional before starting a regimen. They can ensure that no medical risks are overlooked.”
  • Another option, as seen on Healthline, is testosterone. “While the U.S. Food and Drug Administration (FDA) hasn’t approved this option yet, some clinicians do administer it. A few studies have shown that it’s led to a noticeable improvement in sexual dysfunction. Testosterone therapy options include pills, patches, creams, and oral therapies. All of these should be monitored carefully. There’s specific dosing for each type of transdermal testosterone product.”
• Therapy: As I always say, communication is a key player in your health. Talk things out with a therapist to help you figure out what you need. Therapy is not only a place to communicate, it’s a place to get better at communication. Therapy is like the turducken of communication!
• Supplements: Soy, black cohosh, and red clover might help increase libido. As always, check with a doctor before adding supplements into your diet. Click here for more comprehensive information on supplements for menopause.
• Sexual counseling: Whether you go to a counselor by yourself or with your partner, this type of counseling can be very successful, even on a short-term basis.
• Engage in mind-body activities: Try activities like acupuncture, tai chi, or yoga to help release the symptoms that interfere with sexual intimacy and desire. 

It’s a Wrap!

Be the champion of your new you. Many people don’t account, anticipate, or plan for the changes that come with menopause, especially the sexual changes during menopause. Finding ways to address vaginal dryness, painful sex, and low libido are available. Tackling the issues with knowledge can minimize many negative impacts on your quality of life, emotional satisfaction, and sexual intimacy.

Remember: “Menopause is the journey of recreating balance and discovering new beginnings in the relationship with yourself”—including sex. You might feel like your sex life is sinking faster than the Titanic, but there’s no need for James Cameron to make any Oscar-winning movies about your menopausal journey. it’s time to S.O.S. and embrace yourself and your sexual needs.

Book Recommendations

For more detailed information about sexual changes during menopause, treatment options, and sex-related information, consider reading these books:

• “Sex, Lies, and Menopause” by T.S. Wiley
• “The Menopause Manifesto” by Dr. Jen Gunter 
• “The Queen V” by Dr. Jackie Walters
• “What Fresh Hell Is This?” by Heather Corinna (Check out Chapter 12 on page 217 called: Sex and Sexuality.)

Sources

• https://www.menopause.org/for-women/sexual-health-menopause-online/frequently-asked-questions
• https://www.hopkinsmedicine.org/health/wellness-and-prevention/how-sex-changes-after-menopause
• https://www.webmd.com/menopause/guide/sex-menopause
• https://www.webmd.com/menopause/guide/menopause-sexual-problems
• https://www.healthline.com/health/menopause/sex-after-menopause#Become-your-champion-for-the-new-you
• https://www.pfizer.com/news/hot-topics/painful_sex_and_menopause
• https://www.sciencedaily.com/releases/2014/09/140909113340.htm
• https://www.washington.edu/counseling/resources-for-students/healthy-grieving/
• https://www.medicalnewstoday.com/articles/clitoral-atrophy#causes
• https://www.lawinsider.com/dictionary/sexual-activity
• https://everydayfeminism.com/2016/07/broadened-my-definition-of-sex

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