Estrogen’s Role in Vaginal Health
But the most challenging change those who go through menopause deal with has to do with the vagina. According to an article on vaginal dryness, published in October 2020 through The American College of Obstetricians and Gynecologists (ACOG), estrogen keeps the vaginal lining elastic and moisturized. Without estrogen, vaginal tissue atrophies, dryness sets in, and arousal can be challenging. Sex may become painful and even cause tearing inside the vagina.
“I see women who’ve gone years being told that a normal part of aging is to have pain with sex,” Lisa M. Valle, DO, an ob-gyn and medical director of Oasis Women’s Sexual Function Center in Santa Monica, California, said. “By the time they come see me, that’s what I hear. The fact is, there’s a lot you can do.”
Not all individuals experience painful sex after menopause. Some say they’re more relaxed during intimacy without the fear of pregnancy. And at this point in life, they often don’t have young kids placing demands on their time, so there’s more opportunity to enjoy sex.
But if sex after menopause is uncomfortable or downright painful, there are options. Here are what you need to know about menopause and sex—and six ways to help sex after menopause be comfortable.
Find a Lubricant You Love
“Vaginal dryness is totally treatable,” Mary Jane Minkin, MD, clinical professor of ob-gyn at Yale School of Medicine, said. One option is an over-the-counter vaginal moisturizer designed to be used regularly, say two to three times a week, rather than just before sex. Take a walk through your local drugstore, and you’ll see many different brands.
Then when you’re ready to hit the bedroom, apply a water- or silicone-based lubricant intended to be used at the moment to get even more of an assist. You’ll be amazed at all the varieties if you’ve never checked out lubricants. There are many options depending on your personal preferences, including natural, additive-free versions and some that come in single-use packets for when you’re on the go.
Have More Sex
Sure it seems counterintuitive. But having more sex can help prevent vaginal tissue from thinning and becoming irritated. That’s because arousal causes increased blood flow to your genitals, keeping vaginal tissues healthy. No partner when the mood strikes? Masturbation works, too.
Try a Prescription Cream
If you’ve tried over-the-counter options and still experiencing vaginal dryness—or your sex drive isn’t where you want it—talk to your healthcare provider about medical treatments that can help. One possibility is low-dose estrogen vaginal creams that contain the hormone DHEA.
Applying a cream isn’t your only option. Tablets and rings that go into the vagina and are absorbed via the skin are also available. Also, a once-a-day, hormone-free drug, Osphena, has been approved that helps thicken vaginal tissue, so pain and tearing are less likely. However, Osphena isn’t for everyone, so if you’re considering it, check in with your healthcare provider and find out if you’re a candidate to take it.
Ask Your Healthcare Provider About Testosterone
Testosterone replacement has long been used as a solution for men with a waning libido—and it can also help rev up your sex drive. Still, not all healthcare providers are OK with prescribing synthetic versions of this hormone (which females also make in small amounts). In addition, testosterone is not a cure-all and can come with side effects like acne and thinning hair. Luckily, “newer remedies to enhance libido are being worked on even as we speak,” Dr. Minkin said.
Talk It Out With Your Partner
Even if it’s just the physical changes of menopause that make sex painful, talking it out with your partner can help alleviate the stress and anxiety surrounding the topic. If you’re single or need someone to talk to other than your partner, your healthcare provider is a good resource. “I always encourage women to have a good, trusted gynecological healthcare provider to speak with,” Dr. Minkin said. “A doctor, nurse-midwife, or nurse practitioner can be a valuable source of advice.”
You may also want to talk to a sex therapist, who can help you be more open about what you need and want from your partner and remind you that the changes you’re experiencing are perfectly normal.
What is most important if the changes of menopause challenge you is to find a method of help you feel comfortable with. This could mean starting with your healthcare provider, a sex therapist, other counselors, or therapist, or seeking out in-person or virtual support groups.
Let Yourself Experiment Sexually
The National Institute on Aging lists many common symptoms of menopause, such as hot flashes, changes in bladder control such as incontinence, trouble sleeping, mood changes, and all the changes to the vagina. Let’s state the obvious: None of these symptoms set you up to feel your best or in the mood. Before these side effects affect your self-esteem, talk to your healthcare provider about ways to manage them.
“Just come in right away,” Dr. Valle said. “As time goes on, some problems can get worse and worse.”
Realize that you may have to work harder than usual to increase your libido and get in the mood. That can mean more foreplay, watching porn (with or without your partner), trying out sex toys—or just learning to relax. Part of this may be due to discomfort, and it could also be due to estrogen’s role in libido. According to Johns Hopkins Medicine, not only is the decrease in estrogen responsible for many of the physical effects of menopause, but it also plays a role in decreased sex drive.
“Don’t think your sex life ends once you go through menopause,” Dr. Valle said. “I know an 80-year-old woman who still has sex with her partner. It’s a different stage of life, but a good sex life is still possible.”
