Up to 45% of women experience dysapareunia (painful sex) during menopause.
One cause of pain is small tears in the vagina, caused by a combination of thinning vaginal walls and a lack of lubrication. Pre-menopause, the Bartholin glands that are positioned in the labia minora produce lubrication when you are aroused, but once again, as your estrogen levels change, these glands produce less of these secretions.
While good lubrication is important at any stage of your sex life, it is even more important during and post-menopause as thinner, less elastic vaginal walls are more susceptible to injury, tearing and bleeding.
Thankfully, there are things you can do to improve vaginal comfort and lubrication:
Hormone creams
Topical estrogen creams, or vaginal rings containing estrogen can help improve overall lubrication.
Personal lubricants
Vaginal moisturizers can help relieve dryness sensations of GSM by trapping moisture in the vaginal tissues. These aren’t appropriate for sexual use.
Water-based lubricants
Water-based lubricants are safe to use during sex and with condoms. Make sure you lubricate both yourself, your partner and any sex toys.
Silicone-based lubricants
As with water-based lubricants, silicone-based lubricants are safe to use during sex and with condoms. The only downside is they may stain sheets, so consider laying down a towel.
Lubricants to avoid include any that contain petroleum jelly, or things you may find at home such as olive oil or body moisturizers, as these can increase the risk of infection.
If you are lubricating generously and still finding sex is painful, make sure you talk to your healthcare practitioner, as there may be another cause, such as a shortening of the vaginal canal associated with GSM.
Does sex help menopause?
A little known fact is that having more sex may actually help alleviate some of the vaginal symptoms, and even delay the start of menopause. A ten year study found that women who had sex, at least once a week were 28% less likely to experience menopause symptoms than women who had sex less than monthly.
One school of thought that is regular penetrative sex, or even masturbation with penetration can help keep your vagina feel good for longer through increased blood flow, and toning of vaginal walls.
There are also a number of other health benefits to having regular sex that may have a flow on affect to reducing bothersome menopause symptoms such as hot flashes.
Regular sex has been shown to:
Do I still need to use birth control?
Yes! While pregnancy is less common during perimenopause, it is not impossible. Birth control is recommended until you have ceased your periods for at least 12 months. Even if you have not had a period for a few months, it is still possible to fall pregnant.
The 2018 National Vital Statistics Report showed that in the US, there were 959 births to women aged 50 and over, and 0.9 births per 1,000 women aged 45 to 49.
When considering birth control during perimenopause It’s important to consider which is most appropriate for you (and your doctor can help with this decision). While some hormonal oral contraceptives can provide additional benefits such as more regular periods, they come with an increased risk of blood clots and heart disease for women over 40. They may also mask signs of menopause and may result in menstrual-style bleeding after menopause.
Other options may include:
Irregular periods during perimenopause can make it difficult to know when you are ovulating, for that reason the rhythm method, otherwise known as natural family planning, isn’t recommended.
How can I make sex better during menopause?
Making sex more enjoyable during menopause is a team effort. Your body may respond differently to how it used to, and it’s important to communicate these changes to your partner.
Getting the mood right
If you are experiencing hot flashes, make sure your room is at a consistent, mild temperature. Too hot or too cold may trigger sweating of the non-sexual kind.
Take your time
It may be that you need more time to feel aroused, this is a great excuse to extend foreplay and have some non-penetrative fun.
Lubricate!
As we’ve already discussed, lubrication for you and your partner is vital for ensuring your pleasure.
Find your place
Positions you once loved may not be comfortable for you now, especially if you’re experiencing symptoms of GSM, or prolapse. You may find it’s more comfortable for you to be on top, controlling depth and pace.
Exercise your vagina
The more active your vagina is, the stronger it will feel, the better your orgasms, and the more comfortable sex will be. ‘Exercising’ your vagina doesn’t just mean sex with a partner. You can strengthen your vaginal walls with daily Kegel exercise or using a vibrator (with lubrication!) several times a week to encourage blood flow in and around the vagina.
And while penetration is one form of sex, if that doesn’t feel right for you, there are many other ways to share intimacy with your partner, such as oral sex, massage, or using a clitoral vibrator.
Manage your symptoms
Many symptoms of menopause, such as GSM, mood swings, and hot flashes can be managed with hormone replacement therapy, and natural remedies such as hypnotherapy.
What’s sex like after menopause?
If sex isn’t a great experience for you right now, fear not; research suggests that sexual satisfaction in women increases with age. The majority of women in a 2012 study into post/menopausal health (aged around 67 years old) stated that they could achieve orgasm most of the time or always.
For some women, menopause can see a renewal in their sex drive without the fear of pregnancy. The postmenopause time of life can also see a change in life pressures and a renewed focus on intimate relationships. Children may now be grown and out of home, work pressures may be reduced, and more time for self-care can all contribute to a re-energized sex life.
The Wrap Up
The relationship between menopause and sex, can feel complicated. Sexual desires, and sexual experiences, can all be affected by changing hormones. Lowering estrogen levels can affect mood, physical appearance, vaginal health, and sex drive. Fortunately there are things that can improve libido and make sex pleasurable including: hormone creams, lubrication and open communication with your partner and your doctor.
References
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Arnot M, Mace R. Sexual frequency is associated with age of natural menopause: results from the Study of Women's Health Across the Nation. R Soc Open Sci. 2020 Jan 15;7(1):191020. doi: 10.1098/rsos.191020. PMID: 32218936; PMCID: PMC7029897.
Avis NE, Crawford SL, Greendale G, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015;175(4):531–539. doi:10.1001/jamainternmed.2014.8063.
Cho MK. Use of Combined Oral Contraceptives in Perimenopausal Women. Chonnam Med J. 2018;54(3):153-158. doi:10.4068/cmj.2018.54.3.153
Contraception. You need it longer than you think. North American Menopause Society. Accessed 29 November 2021. https://www.menopause.org/for-women/sexual-health-menopause-online/reminders-and-resources/contraception-you-need-it-longer-than-you-may-think
Ditzen, Beate PhD; Germann, Janine PhD; Meuwly, Nathalie PhD; Bradbury, Thomas N. PhD; Bodenmann, Guy PhD; Heinrichs, Markus PhD Intimacy as Related to Cortisol Reactivity and Recovery in Couples Undergoing Psychosocial Stress, Psychosomatic Medicine: January 2019 - Volume 81 - Issue 1 - p 16-25 doi: 10.1097/PSY.0000000000000633
Elkins, G. 2014, Relief from Hot Flashes: The Natural, Drug-Free Program to Reduce Hot Flashes, Improve Sleep, and Ease Stress, (1), Demos Health, LLC.
Frequently Asked Questions. The North American Menopause Society. Accessed 29 November 2021. https://www.menopause.org/for-women/sexual-health-menopause-online/frequently-asked-questions
Hill K. The demography of menopause. Maturitas. 1996 Mar;23(2):113-27. doi: 10.1016/0378-5122(95)00968-x. PMID: 8735350.
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