As a menopause care specialist, I hear almost daily from women who are surprised that sex is painful or less satisfying. Their stories vary, but the theme is the same: “I thought having reached this point in my life— empty nest, career success or retirement— my partner and I could enjoy intimacy in a new, more leisurely way. But my body has betrayed me!”
It’s for these women that I have developed the “secret recipe” for sex after menopause, in hopes that the recipe is “secret” only until we’re as comfortable talking about midlife sex as we are about teenage sex. The recipe is for any woman— and her partner— starting around age 40, when perimenopause begins to effect changes in hormones, and genital tissues and circulation change as a result. This recipe stays relevant for women through menopause, which is clinically defined as one year without menses, and beyond.
These are the ingredients to improve your sex life after menopause:
● Knowledge: You’ve probably heard a lot of jokes about hot flashes, but, from my experience, many women are unaware of the range of changes that occur with the absence of estrogen, as well as other hormonal fluctuations. It’s important for women and their partners to understand the natural physical evolutions that come with menopause because this way they can feel empowered to compensate— similar to when we use glasses to improve age-related vision loss.
● Vaginal comfort: Progressive dryness is one of those normal, expected changes, and we can compensate with vaginal lubricants and moisturizers. When sex isn’t comfortable, of course women will avoid it. There are also localized estrogen options and some prescription drugs that can help keep vaginal tissues healthy.
● Pelvic tone: You likely already know how important muscle tone is for maintaining strength in various parts of the body, like the upper arms. But the muscles in the pelvic floor also need care because they help prevent incontinence and keep organs in place. Pelvic muscles are also involved in the pleasurable aspect of sex: A stronger pelvic floor means stronger orgasms. Kegel exercises, which many women may have learned during their first pregnancy, are easy to do, with or without a device to help focus the muscle contractions.
● Genital sensation: The absence of estrogen affects arousal. Namely, the loss of blood supply to the genitals delays arousal and can diminish the orgasm. In addition to keeping vaginal tissues healthy, women can use a vibrator to get the increased stimulation they may need.
● Emotional intimacy: Women in perimenopause and menopause need what every woman needs at every age for sex to be good. Sex needs to be intimate. It needs to mindfully create and reinforce a real connection. In my medical practice, many women experiencing changes in sexual health aren’t sure how to bring their partner along. They don’t know how to have the conversation. Sex is often habit and routine, and if the routine is no longer working, whether because of pain or decreased libido, it’s hard to talk about. Women tell me their loss of desire is interpreted by their partners as “You don’t love me anymore.” In any of those cases, a sex therapist can be helpful to discovering the language and opening the dialog.
By having a foundational understanding of the recipe, I’m hopeful that women will be more vocal with their health care providers. My experience in the exam room tells me women are reluctant to raise issues of sexual health at midlife or later. And traditional medical education doesn’t really prepare doctors— even gynecologists— to feel comfortable asking about a patient’s current experience with sex. Only about 17 percent of patients are typically asked by their provider, which means it’s up to women to bring it up.
With knowledge, some simple tools, and the awareness that they’re following an expected, natural path, women can remain sexually active just as long as they choose to. And that’s important not only to the women themselves, who want to feel vital and whole, but to the health of their intimate relationships.
Dr. Barb DePree, a gynecologist in practice for over 25 years, specializes in midlife women's health. She is the founder of MiddlesexMD, a website that shares practice-tested, clinically sound information and products for women, including guidance for working with partners and caregivers. Dr. DePree is the author of Yes You Can: Dr. Barb's Recipe for Lifelong Intimacy, and is a frequent spokesperson for women’s sexual health.