Sex and Menopause Problems and Causes

The loss of estrogen following menopause can lead to changes in a woman’s sexual functioning. Menopausal women may notice that they are not as easily aroused, and may be less sensitive to touching and stroking, which can result in decreased interest in sex.

Further, the emotional changes that often accompany menopause can add to a woman’s loss of interest in sex and/or inability to become aroused.

In addition, lower levels of estrogen can cause a decrease in blood supply to the vagina. This decreased blood flow can affect vaginal lubrication, causing the vagina to be thin, pale, and dry.

The lower one-third of the vagina can shrink, leading to painful sexual intercourse.

A lower estrogen level is not the only culprit behind a decreased libido; there are numerous other factors that may influence a woman’s interest in sexual activity during menopause and after. These include:

  • Bladder control problems
  • Sleep disturbances
  • Depression or anxiety
  • Stress
  • Medications
  • Health concerns
  • Relationship issues with a partner

Painful sex after menopause is common

A survey suggests that 84% of menopausal women find sex painful. In the survey, nearly 70% said their relationships had suffered as a result.

Women’s health expert and GP, Dr Sarah Jarvis, says women should overcome their shyness and seek help.

“It always seems sad to me that so many women suffer in silence with common menopausal symptoms such as vaginal dryness, because they are embarrassed to speak to their GP.

“We see these problems regularly and entirely understand how much impact they have on quality of life. There are so many effective treatment options and we’re more than happy to offer them.”

Do all menopausal women experience a decrease in sexual desire?

No. In fact, some post-menopausal women report an increase in sexual satisfaction. This may be due to decreased anxiety associated with a fear of pregnancy.

In addition, many post-menopausal women often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.

What can I do to treat vaginal dryness?

Vaginal dryness can be treated with over-the counter water-soluble lubricants such as Astroglide® or K-Y Liquid®. Do not use non-water soluble lubricants such as Vaseline® because they can cause irritation and weaken latex (the material used to make condoms).

Some women prefer silicone-based lubricants. Silicone lubricants should not be used with sexual stimulating devices made from silicone (sex toys), as it can make it hard to keep them clean.

Condoms should continue to be used to avoid pregnancy until your doctor verifies you are not producing any more eggs and also to prevent contracting sexually transmitted infections. Estrogen may be used to improve the integrity of the vaginal tissue.

This can be prescribed to be used in low doses directly inside the vagina (including creams, pills, and vaginal rings).

Hormone therapy can also be taken at higher, systemic doses, where it can have additional benefits and risks. Ospemifene (Osphena) is a non-estrogen pill that is taken by mouth.

Its benefits to the vagina are similar to that of estrogen. Serious but uncommon side effects can include blood clots, and stimulation (thickening) of the lining of the uterus.

Some women may also notice more hot flashes, vaginal discharge, and muscle spasms, though the majority of women will have no symptoms.

Lubricants help vaginal dryness

According to Dr Jarvis, it’s worth trying self-help options in the first instance. There are a variety of ways to relieve vaginal dryness and thus make sex easier and pleasanter:

  • Avoid intimate washing with soap, bath oils and shower gels – they can aggravate dryness. Instead, use lukewarm water alone or with a soap-free cleanser.
  • Try using a lubricant such as KY Jelly, Astroglide, Sylk, Senselle or Replens. These are available from pharmacies without needing a prescription.

How can I improve my sex drive?

Currently, there are not any good drugs to treat sexual problems in women. Estrogen replacement may work, but research has yielded conflicting results regarding its effectiveness.

Estrogen can, however, make intercourse less painful by treating vaginal dryness.

Although sexual problems can be difficult to discuss, talk to your doctor; there are options to consider, such as counseling. Your doctor may refer you and your partner to a health professional who specializes in sexual dysfunction.

The therapist may advise sexual counseling on an individual basis, with your partner, or in a support group. This type of counseling can be very successful, even when it is done on a short-term basis.

What can I do to increase intimacy with my partner?

If your sex drive isn’t what it once was but you don’t think you need counseling, you should still take time for intimacy with your partner.

Being intimate does not require having intercourse–love and affection can be expressed in many ways. Enjoy your time together–you can take long romantic walks, have candlelit dinners, or give each other back rubs.

To improve your physical intimacy, you may want to try the following approaches:

  • Educate yourself about your anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and responses. This may help you overcome your anxieties about sexual function and performance.
    stimulation through the use of erotic materials (videos or books), masturbation, and changes to sexual routines.

Use distraction techniques to increase relaxation and eliminate anxiety. These can include erotic or non-erotic fantasies; exercises with intercourse; and music, videos, or television.

Practice non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage. These activities can be used to promote comfort and increase communication between you and your partner.

Minimize any pain you may be experiencing by using sexual positions that allow you to control the depth of penetration.

You may also want to take a warm bath before intercourse to help you relax, and use vaginal lubricants to help reduce pain caused by friction.

Do I still have to worry about sexually transmitted infections?

Yes. Just as you must use protection if you do not want to become pregnant during perimenopause, you must also take measures to protect yourself against sexually transmitted infections (STIs) during menopause and postmenopause.

It’s important to remember that your risk of contracting STIs is a possibility at any point in your life during which you are sexually active, and this risk does not go down with age or with changes in your reproductive system.

Medical treatments for painful sex

If these measures don’t help, your doctor can prescribe hormone treatment.

Hormone replacement therapy alleviates dryness, but if you can’t or don’t want to take HRT, you can use oestrogen applied “locally”, that is just to the vagina, to increase the flow of natural lubrication.

There are different options including an oestrogen cream (applied using an applicator), pessaries, small tablets (again inserted with an applicator) or an oestrogen-releasing vaginal ring which stays in place for three months at a time.

Tips for sex drive problems

Some women find that they lose their desire for sex after the menopause. It’s normal for sex drive to reduce over the years, but it can be made worse by depression, menopausal symptoms, relationship problems and stress.

These problems are often temporary and being able to talk things through with an understanding partner may be all that’s needed.

But if symptoms of the menopause or of depression persist, then it may be best to see a doctor for treatment.

Treating menopausal symptoms may boost your sex drive indirectly by improving your general well-being and energy levels, but restoring your hormone levels can also improve sensation.

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