Should I Have Sex During Menopause?

Some women experience menopause and do not notice any change in their sexual desire, pleasure or performance, and some women notice profound changes in their sexual response and capacity. As with everything about menopause, each woman has her own story to tell.

As estrogen diminishes, and as your body ages, you may see some changes that affect your sexual response. Some of these changes are because hormones are waning, and some of them could be psychological or emotional in nature. You may not notice at first that something has changed, and you may or may not be distressed by those changes. During and after menopause you might notice:

• Vaginal dryness
• Pain during sex
• Lower sexual desire
• Difficulty becoming aroused
• More vaginal or bladder infections
• Less sensation in the genital area

Remember, many women don’t have any of these symptoms, but at least half of women have one or more of them.

Before you worry that your sex life is over, first take stock of what is happening and what you want. If sexual activity and your own sexual attractiveness are an important part of your identity, any change can be distressing. On the other hand, if sex has been an enjoyable—but not central—part of your identity, you may take these sexual changes in stride.

For many women, a lowering in the priority of sexual activities means more room for other things that they value as much—like putting that time and energy into their job or a hobby. For others, any change in their ability to have or enjoy sex is a major threat to their self-esteem. Where do you fall on that continuum? How important is sexual activity to you? To your partner? Do your symptoms interfere with closeness or shared experiences that you value?

If you decide that these sexual changes are something you want to address, decide how you would like to go about it. If you have a partner, talk it over with him or her. Do you want to discuss it with a medical provider? A counselor? A sex therapist? Are there books or resources you’d like to read before you see a professional? After you have decided how you want to approach a solution, you have many choices. One (or several) of them may make a difference.

What will help depends on what is causing the problem. If diminishing hormones are the most likely cause of your symptoms, you can try:

• Vaginal lubricants used liberally during intercourse
• Extending foreplay to allow for maximum arousal and lubrication
• Masturbating and increasing the frequency of sex to bring circulation to the genital area and maintain sensation and response
• Prescription oral or transdermal (the patch) estrogen and/or progesterone therapy, which will address sexual and other menopausal symptoms
• Vaginal estrogen. There are several forms that your medical provider can prescribe. These do not work systemically and do not usually help with other symptoms, but they can be very effective on vaginal symptoms
• Plant estrogens, taken as oral supplements or in vaginal formulations (Wild yam extracts have the best anecdotal reputation, but research is mixed on their effectiveness.)
• Testosterone taken orally or applied to the skin with a patch or cream.

If other factors such as relationship dissatisfaction, stressful life situation, grief and loss issues, or self-perception are playing a role in your diminishing sexual satisfaction, you may want to try:

• Talking frankly with your partner about what you both want from the relationship
• Getting help from a counselor, with or without your partner
• Discussing with your medical provider the use of antidepressants to improve your enjoyment of life in general as well as sexual activities
• Learning relaxation and stress reduction techniques so that stress isn’t taking such a bite out of you
• Exercising more to improve energy levels and mood
• Getting enough sleep, which helps with stress, weight loss, and energy level

If your sexual complaints are a side effect of a medication, discuss them with your medical provider. There may be a suitable substitute without that side effect.

Drugs from the PDE-5 inhibitor category (such as Viagra or Cialis) have not been as successful in treating sexual dysfunction in women as they are in men. These drugs are sometimes helpful for women who are taking SSRI antidepressants since they counteract some of the physiological effects of the antidepressant and allows women to become aroused and reach orgasm.

Emotional and psychological factors are highly involved in female arousal, and studies have shown that women may report high sexual arousal even when they are not showing physical signs of it, and may show physical signs of arousal and report no “feelings” of arousal. So it’s not as simple as getting the blood to flow to the right places (using PDE-5 inhibitors) unless other factors are also in play.

Sex during and after menopause can be exciting, spontaneous, and deeply satisfying. Some women find that they have the best sexual experiences of their life after the age of fifty, and some report that they have little or interest in sexual activity. The best predictors of sexual function and pleasure after menopause are:

• How much you enjoyed it before menopause
• How highly you set it as a priority
• How healthy you are

Sex can continue to be a vital and rewarding part of your life. Take some time to decide what you want and don’t give up until you get there.