In the years during and after menopause, you may experience changes in your sexual life. Some women say they enjoy sex more, while others find they don’t enjoy it as much.

What’s responsible for these changes? How can you have a better sex life after menopause?

Changes in sexuality at this time of life have several possible causes, including:

• Decreased hormones can make vaginal tissues drier and thinner, which can make sex uncomfortable.
• Decreased hormones may reduce sex drive.
• Night sweats can disturb a woman’s sleep and make her too tired for sex.
• Emotional changes can make a woman feel too stressed for sex.

It’s important to remember that a lack of interest in sex is not necessarily something that requires treatment. However, if sexual changes are bothersome, don’t be hesitant about getting the help you need.

An online survey of more than 1,000 women aged 35 and older found that nearly six out of 10 reported vaginal changes including dryness, pain, discomfort or “tightness” during sex, as they approached or passed menopause.

Medical Conditions Associated With Menopause

Dyspareunia. The medical term for painful sex, this is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. This is one of the main reasons that between 25 and 45 percent of postmenopausal women find sex painful. Painful intercourse can occur for a variety of reasons — ranging from structural problems to psychological concerns, and many women experience painful intercourse at some point in their lives.

Vulvovaginal Atrophy. The thinning and inflammation of the vaginal walls due to a decline in estrogen. Vaginal atrophy occurs most often after menopause, but it can also develop during breastfeeding or at any other time your body’s estrogen production declines. Estrogen is to your genital area what moisturizer is to your face – critical for keeping everything lubricated and healthy. Less estrogen can result in the genital tissue becoming dry and less acidic, increasing your risk of infection. It can also take longer to get lubricated for sex, even when you’re in the mood.

Over time, estrogen deficiency can lead to more significant changes in the entire urinary/genital area, including reduced blood flow to the vagina. This can affect the vagina’s ability to secrete lubricant, to expand and contract and to grow new cells. Eventually, blood flow to the vulva and vagina diminishes, and tissue in this area can atrophy, or shrink, as cells die off and aren’t replaced. The result: soreness, burning after sex, pain during intercourse, and, sometimes, post-sex bleeding.

Simple Steps To Take

The following ideas may help with sexual issues you face at this time:

• Get medical problems treated. Your overall health can affect your sexual health. For example, you need healthy arteries to supply blood to your vagina.

• Exercise. Physical activity can increase your energy, lift your mood, and improve your body image — all of which can help with sexual interest.

• Quit smoking. Cigarette smoking can reduce both the blood flow to the vagina and the effects of estrogen, which are important to sexual health.

• Give your body time. Allow time to become aroused during sex, since moisture from being aroused protects tissues. Also, avoid sex if you have any vaginal irritation.

• Practice pelvic floor exercises. These can increase blood flow to the vagina and strengthen the muscles involved in orgasm.

• Avoid irritating products. Bubble bath and strong soaps might cause irritation. Don’t douche. If you’re experiencing vaginal dryness, allergy and cold medicines may add to the problem.

Treatments

Discuss your symptoms and personal health issues with your doctor to decide whether one or more treatment options are right for you.

If vaginal dryness is an issue:

• Using an over-the-counter, water-based vaginal lubricant like K-Y Jelly or Astroglide when you have sex can lessen discomfort.
An over-the-counter vaginal moisturizer like Replens can help put moisture back in vaginal tissues. You may need to use it every few days.

• Prescription medicines that are put into a woman’s vagina may increase moisture and sensation. These include estrogen creams, tablets, or rings. If you have severe vaginal dryness, the most effective treatment may be menopausal hormone therapy.

When Sexual Interest Is A Problem

• Treating vaginal dryness may help. Talking with your partner or making lifestyle changes also may help.

• You may wonder about Viagra. This medication has helped men with erection problems, but it has not proven effective in increasing women’s sexual interest.

• Some women try products like pills or creams that contain the male hormone testosterone or similar products. The U.S. Food and Drug Administration (FDA) has not approved these products for treating reduced female sex drive because there is not enough research proving them safe and effective.

• The FDA has approved menopausal hormone therapy (MHT) for symptoms like hot flashes, but research has not proven that MHT increases sex drive.

Why You Should Talk To Your Partner

Talking with your partner about your sexual changes can be very helpful. Some possible topics to discuss include:

• What feels good and what doesn’t
• Times that you may feel more relaxed
• Which positions are more comfortable
• Whether you need more time to get aroused than you used to
• Concerns you have about the way your appearance may be changing
• Ways to enjoy physical connection other than intercourse, like massage

Talking with your partner can strengthen your sexual relationship and your overall connection. If you need help, consider meeting with a therapist or sex counselor for individual or couples therapy.

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