How to Navigate Sex and Menopause

As a therapist specializing in sexual health, I work with a diverse array of clients, each bringing their own unique concerns to our sessions. No two days are the same, and each individual presents a different perspective. Over time, however, I’ve learned to recognize patterns in their experiences.

I’ve become attuned to their non-verbal cues, the nuances of their tone, and the emotions that linger in the room after a session ends. These micro-patterns are critical, but I also observe larger trends in the world around us. One recurring theme I’ve noticed, both in therapy and beyond, is the damaging belief that sex has an expiration date, particularly for women, who are often perceived to become sexually irrelevant after menopause.

This notion is not only problematic in the therapy room; it reflects broader societal attitudes that warrant our attention.

Shame, Sexual Retirement, and An Uneducated Medical Community 

So, is this true? Do we just retire our sexual selves after menopause?

In 2023 a study was conducted to explore the relationship between shame, stigma, and menopause. The researchers found that 37% of menopausal women experienced shame in regards to menopause, and 83% of women reported a stigma in regards to menopausal symptoms, including vaginal dryness, heat flashes, night sweats, atrophy of vaginal tissue, and decreased interest in sex.

I share this information because shame is often the first barrier we come across when exploring sexuality. It is not just the symptoms associated with menopause that create an obstacle, it is the societal impressions that can lead to “sexual retirement.” 

As I often say to clients, the opposite of judgment is curiosity. Offsetting shame includes normalization and education. However, in a 2021 a study was conducted regarding menopause education in U.K. Medical schools, and 40% of students do not receive any form of menopause education. In these schools, this stage of life is entirely ignored.

You may wonder, what is the outcome of lack of menopause education? Well, another 2021 study found that despite an average of 79% of women visiting their general practitioner for treatment of menopause symptoms, 44% of these women did not receive treatment for over a year! 

Common Sexual Changes 

Due to the lack of education surrounding menopause, it makes sense that many women will often experience sexual challenges, but ignore their symptoms that interfere with pleasure and stop engaging in sex entirely, eventually leading to an un-fulfilling sex life.

According to a survey taken at John Hopkins Medical Center, more than a third of women in perimenopause report a decrease in sexual activity due to discomfort associated with hormonal changes. Below are the most common symptoms associated with menopause and the physiological functions behind these concerns:

Vaginal Dryness

Lower levels of estrogen can cause vaginal dryness during menopause, as well as thinning of the vaginal tissue (known as vaginal atrophy). Vaginal dryness impacts more than half of post-menopausal women, and 90% of them do not seek treatment for it, despite the fact it makes sex uncomfortable, or even painful. This shows that treating vaginal dryness still has a significant stigma attached to it.

Decreased Libido and Difficulty Orgasming

Lower levels of estrogen can also cause a decrease in libido, sexual desire/sex drive, and arousal. As we age, our body’s blood flow to the genitals happens slower, which leads to needing more time to become aroused. Reaching orgasm may also be more difficult, and requires more stimulation of the clitorous. 

Painful Intercourse

Due to the thinning of the vaginal tissue, intercourse can be painful. Imagine constant friction against rice paper – it will easily create tears. If you continuously have painful intercourse it can create a pain cycle (your body associates intercourse to pain) which can lead your pelvic floor muscles to tighten and create greater discomfort upon insertion. 

So, Can I Still Enjoy Sex After Menopause?

The short answer is – 100% yes. You just may need to incorporate a few steps prior to sex, get curious about your body’s needs, and identify medical providers that are educated in this area. In the meantime, here are a few ways you can begin supporting yourself during this transition. 

Incorporate Lubricant 

As mentioned above, vaginal dryness is one of the most common concerns when it comes to sex and menopause. Lubricant during sex is essential, which can be utilized by using safe vaginal lubricants to counter vaginal dryness.

Due to the decrease in estrogen during perimenopause, menopause, and post menopause, the body does not produce as much natural lubricant during arousal which is where vaginal moisturizers can be beneficial. It is important to use a lubricant that will not irritate you. For vaginal sex, water based lubricants are best, as they have the closest pH to the body.

Communicate Needs 

When your body begins to change, it’s important that you can communicate it to your sexual partner(s). Perhaps prior to menopause, you could go from 0 to 10 in a few minutes, and now you need at least 20 minutes of foreplay. Feeling comfortable expressing this to your partner is essential, so you can get your needs met. This may include pausing to lube-up, sharing the changes around your level of sexual interest, asking for more oral sex rather than penetrative sex, or implementing more clitoral stimulation. 

Find the Right Positions for YOU

If you’re struggling with painful penetration due to your menopause symptoms, it can be helpful to change up positions. Below are a few sex positions that support thinner vaginal tissue and any muscle tightening.

1. Be on top. This can mean classic cowgirl or chest to chest embrace with penetration. Being on top allows you to control the speed and depth of the penetration, which can reduce anxiety surrounding painful penetration. 
2. Tiny Spoon. Allowing your partner to penetrate you from behind in a cuddle position can decrease friction against thinning vaginal tissue. 
3. Elevated pelvis. This can work for various different positions – just place a pillow under your lower back to elevate your pelvis. By elevating your pelvis, penetration from your partner or with a toy is more shallow.

Create Your Care Team 

This part may feel overwhelming, especially when there is an apparent lack of education regarding menopause, however, here are a few suggestions for specialists you can Google in your area.

1. NAMS (North American Menopause Society) Clinician or MSCP (Menopause Society Certified Practitioner)
2. Speak with a Sex Therapist to support you in navigating these changes and all the emotions that come with it. 
3. Consider consulting with a Pelvic Physical Therapist to address pelvic muscle tension due to painful intercourse.

Navigating sex and menopause can be a journey filled with both challenges and opportunities for growth. While the physical and emotional changes may initially seem overwhelming, they also offer a chance to explore new dimensions of intimacy and self-discovery.

Embracing open communication with your partner, seeking support from healthcare professionals, and prioritizing self-care can make a significant difference.

Remember, this phase of life can be an invitation to redefine your sexual well-being on your own terms, allowing for a deeper understanding of yourself and your desires. By facing these changes with curiosity and compassion, you can transform this period into a time of renewed connection and personal empowerment.