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Menopause and Intimacy

We share real solutions to challenges that can get in the way of a healthy and satisfying sex life
Written by 
Kelly Mickle
Canyon Ranch Reviewer: 
Updated on: 
August 11, 2015

For many women, the transition to menopause and the years that follow it can present challenges—and intimacy issues are often high on the list. Sex may feel different now, both physically and emotionally. Plus, it’s not just you: Your partner is also dealing with the changes you’re going through, and navigating them together can be hard on both of you and on your relationship.

Every woman experiences the menopause transition differently. For some, it’s purely physical. But while declining estrogen and its impact on vaginal dryness is one factor that can impact a woman’s sex life in menopause, there are often life transitions—children leaving home, caring for aging parents, reevaluating your career and relationship—that can affect the desire for sex. Stress and sleep deprivation can take a toll, as well.

That said, “it’s neither inevitable nor universal that a woman’s sex life is going to disappear,” says Cindy Geyer, M.D., medical director at Canyon Ranch in Lenox, Mass. In fact, you may experience positive changes to your sex life during menopause. “If you’re like some women, no longer having to think about birth control or menstrual supplies and having the freedom and flexibility of your house to yourself can reinvigorate your relationship with your partner and increase the spontaneity of your intimate life.”

Try to remember that any changes now will likely take patience (and perhaps a sense of humor) from both you and your partner to overcome, but you might find that the renewed focus on your love life brings you closer than you were before. Here are some common challenges women may experience with libido and suggestions for addressing each:

Challenge: Vaginal Dryness

Estrogen drops during menopause, causing the skin that lines the vagina to become thinner, less elastic and less lubricated. Declining hormone levels also affect the vagina’s pH balance. For many women, these changes can make sexual intercourse more painful than pleasurable, especially when dryness causes symptoms like itchiness, discomfort, bleeding and urinary tract infections.

How to Overcome It:

It sounds counterintuitive, but having more sex can actually ease vaginal dryness. Increasing your sexual activity—solo or with your partner—will encourage the production of your body’s natural lubrication. Store-bought lubricants can also keep things moving smoothly, and you can use vaginal moisturizers on a daily basis to eliminate dryness. If over-the-counter aids aren’t enough, ask your doctor about vaginal estrogen therapies, which come as a topical cream, a tablet or a ring inserted into the vagina. These release estrogen in small doses to alleviate dryness and irritation, but won’t significantly affect blood hormone levels. You can also consider using vaginal DHEA, a hormone the body uses to make estrogen. “In a couple of small studies, vaginal DHEA was just as effective as estrogen and it didn’t raise blood levels of hormones,” Dr. Geyer says.

Challenge: A Lagging Libido

Declining estrogen levels and age-related changes to your circulation can translate into less blood flow to your genitals. The result? It can take a lot longer to feel aroused. This can create a vicious cycle of self-doubt: You may anticipate problems being intimate, which can stir up other worries and make it even more difficult to relax and tap into your desire. For some women, the disrupted sleep that can accompany menopause means less interest in and energy for intimacy. “Changes in your body, transitions with work and relationships and not feeling emotionally connected to your partner can all take a toll on libido,” too, Dr. Geyer says.

How to Overcome It:

Because sex drive is a function of what’s going on in your body and your mind, there are many drug-free approaches you can try to reignite your interest in sex. Practicing mindfulness—not just during sex but any time you get the chance—promotes growth in the part of the brain associated with awareness of physical and emotional sensations, so you can focus on being in the moment with yourself and your partner instead of paying attention to the negative chatter in your head. You and your loved one can start by gently touching each other in both sexual and non-sexual ways, which will help take some of the pressure off and ease back into things. “It’s less about pressure to perform intercourse than about reconnecting,” Dr. Geyer says. You can also experiment with engaging your senses in ways that enhance sensuality—with silky fabrics, beautiful flowers, enticing aromas and delicious food.

You might also want to ask your doctor if any of the medications you’re taking, such as beta blockers, antidepressants or antihistamines, could be contributing to your decline in libido. While at the doctor’s, consider asking about hormone replacement therapy; small doses of estrogen may boost brain function associated with sexual response and increase blood flow to the vagina.

More: Maintaining the Spark in Your Relationship

Challenge: Hot Flashes

Menopause’s signature symptom—hot flashes—are typically described as a sudden warm feeling in your face, chest and neck. These heat spells (and their companion symptom, night sweats) leave some women drenched in perspiration, sleepless and anxious—all of which can make the thought of having sex less than appealing.

How to Overcome It:

Rhythmic breathing (slow, deep breaths in through your nose and out through your mouth) and regular exercise can help manage hot flashes so they don’t derail your sex life. It also helps to keep your core temperature cool, so set your bedroom thermostat a bit lower and sleep in lightweight clothing to reduce your likelihood of night sweats. Use a fan or air conditioning to keep air circulating and the temperature cool. For more advice on how to deal with hot flashes, read our article, Get Relief from Hot Flashes (Finally!). Both acupuncture and the herb valerian may help with hot flashes and sleep issues, Dr. Geyer says; ask your physician about them.

Challenge: Bladder Control Problems/Urinary Incontinence

Fears of leakage and an overactive bladder can interfere with even the most passionate relationship. Estrogen keeps the lining of the bladder and urethra (the tube that funnels urine out of the body) healthy, but as hormone levels drop pelvic floor muscles tend to weaken. Pressure on the bladder from coughing, sneezing or carrying heavy objects can then force urine through the weakened muscle, resulting in embarrassing leaks known as stress incontinence. As we age, bladder muscles may also squeeze at the wrong time, causing leakage known as urge incontinence, and urination may become painful or too frequent.

How to Overcome It:

“Start by cutting down on common bladder irritants, such as caffeine, alcohol, carbonated beverages and artificial sweeteners,” Dr. Geyer suggests. Maintaining a healthy weight and exercising regularly (30 minutes of biking, walking or swimming, for example) at least five days a week can also help, along with Kegel exercises. If you’re still having trouble with incontinence, talk to your doctor to find out if medication or surgery should be the next step.

If your libido has changed during the menopause transition remember that for women in midlife, sex drive and desire are influenced by a variety of factors beyond hormonal shifts. “There are many strategies to address potential challenges to your intimate life, but if you still have concerns it’s important to have a dialogue with someone you can trust,” Dr. Geyer says. “Your physician or health care practitioner is a good place to start.” You can also consider talking to an expert on sexuality who is trained to deal with the issues you’re experiencing; you can find one in your area through the American Association of Sexuality Educators, Counselors and Therapists.

Cancer Epidemiology, Biomarkers & Prevention (January 2008)
Cleveland Clinic
Mayo Clinic
National Sleep Foundation
Psychosomatic Medicine (November/December, 2011)
University of Maryland Medical Center
About the author 
Kelly Mickle was an editor at SELF magazine for eight years. She lives in Southern California.