Tips for sex after menopause

Aging concept. Comparison of young and old. Real result achieved with work of professional makeup artist. Not CGI.

Jennifer Huizen  
by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT
Physical effects | Emotional
effects | Reducing sexual complications | Treating sexual complications
Menopause can cause physical
and emotional side effects that interfere with a healthy sex life.
Perimenopause happens in the
years before periods stop and is characterized by hot flashes and other
symptoms. Menopause begins when the menstrual cycle has stopped for at least a
While every woman’s experience
is different, an estimated 17-45 percent of menopausal women say sex can be
Luckily, there are options to
help treat the most common complications. In this article, we look at menopause
effects and some helpful treatments.
During perimenopause, the
hormones that bring about fertility and pregnancy decrease, including the
hormone estrogen. This produces changes in the blood vessels and tissues of the
vagina and vulva, making the organs more vulnerable to damage.
Most sexual complications of
menopause stem from vulvovaginal atrophy, a condition marked by a loss of elasticity,
moisture, and thickness of the vulva and vaginal tissues.
During perimenopause, tissues
of the vagina and vulva receive less estrogen. As a result, these tend to thin,
lose their folds, and dry out. Thinner tissues are more easily broken, bruised,
and irritated.
The tissues also receive less
lubrication, which intensifies the friction they are exposed to during
intercourse, so increasing the risk of damage.
Other physical symptoms of
menopause include:

  • decrease in vaginal tone or
    loss of stretch in the vaginal wall
  • pain, bleeding or burning
    during sex
  • a feeling of tightness during
  • decreased libido or sexual
  • difficulty becoming or staying
  • repeated urinary tract
Some women also experience
atrophic vaginitis, which causes inflammation of the vaginal tissues. Again,
atrophic vaginitis stems from reduced estrogen levels and can cause pain,
swelling, itching and burning.
Not all women see the same
physical changes during menopause, and the severity of symptoms can vary. Women
should see their doctor if symptoms begin to interfere with daily life or
reduce the quality of life.
The physical symptoms of
menopause can cause emotional side effects as well. Changing hormone levels can
interfere with sleep and mood, causing tiredness, anxiety, irritability, and
Decreased sex drive or
inability to enjoy sex can also lead to loss of self-esteem and intimacy.
What menopause represents can
also cause emotional problems. These side effects can be just as debilitating
as physical effects, especially when it comes to sex.
During times of stress or
sadness, people often lose interest in activities that would otherwise bring
them pleasure. In this respect, pain and discomfort can make it difficult to
enjoy sex.
Many of the physical changes
that occur with aging can also intensify the emotional symptoms of menopause.
If sexual arousal or
sensitivity is also affected, some women will shy away from sexual activity altogether,
which can worsen symptoms.
The most common emotional side
effects that interfere with sex include:

  • anxiety, nervousness, or
  • irritability
  • lack of concentration and
  • fatigue
  • depression or sadness
  • sense of loss or regret
  • loss of sexual desire or
  • loss of self-confidence
  • loss of intimacy
  • feelings of worthless or
One survey found that 70
percent of menopausal women who experienced pain during sex said the problem
also caused tensions with their partner.
Not all women experience
negative emotional symptoms linked to menopause. Some women gain additional
wisdom, confidence, and ability to speak for themselves. Those who do
experience negative symptoms should talk to a doctor if they interfere with
healthy sexual activity or everyday life.
Reducing sexual complications

couples feet at end of bed
The sexual complications of
menopause may be reduced by maintaining an active sex life.
Staying sexually active is one
of the easiest ways to lessen the sexual complications of menopause.
The physical and emotional
side effects of menopause cause many women to reduce or refrain from sexual
activity. However, the vagina needs consistent use to remain healthy,
especially after menopause.
Regular sexual stimulation
helps promote blood flow to the vagina. It also helps maintain the vagina’s
elasticity, depth, and overall shape.
Behavioral changes and
over-the-counter products are often the first recommended treatments. In worse
cases, a doctor may prescribe hormone therapies to help reduce vaginal dryness
or hormonal creams to apply to the tissues.
Simple tips and treatments for
the sexual side effects of menopause include:

  • engaging in regular sexual
  • vaginal lubricants applied
    before intercourse
  • vaginal moisturizers applied
    regularly and before intercourse
  • avoiding detergents, soaps,
    oils, or washes that can cause vaginal dryness
  • using lukewarm versus hot
    water for cleansing
  • increasing foreplay or
    activities that promote sexual arousal
  • engaging in couple bonding or
    strengthening activities
  • regulating or reducing stress
    through exercise and therapies
  • talking to a therapist or
  • finding ways to rekindle
    passion or repair partner relations
  • trying new or varied sexual
  • treating vaginal irritation,
    infections, and inflammation
  • keeping hydrated
  • avoiding materials that
    irritate the skin
Treating sexual complications

Around 55 percent of women do
not seek medical treatment for menopause symptoms, although most side effects
lessen over time and eventually go away.
For some women, however,
menopause symptoms are intense and persistent, so medical treatment is advised.
Doctors may prescribe medications or creams that are composed of estrogen,
progesterone, or both.
Individual treatment plans
depend on a variety of factors, including additional health complications.
Women who no longer have a uterus will not require extra progesterone, for
Medical treatment options for
managing the side effects of menopause include:

  • Topical estrogen or progesterone
    Prescribed rings, tablets, creams, or suppositories put directly
    on vaginal tissues to help reduce dryness.
  • Low-dose oral contraceptives:
    Mainly prescribed to reduce vaginal dryness, moodiness, and hot flashes. May
    also come in transdermal patches.
  • Menopausal hormone replacement
    Prescribed to help reduce vaginal dryness, discomfort, and associated
    pain during sex. MHRT may also help reduce hot flashes, mood swings, and mild
    depressive symptoms.
  • Medications meant to treat
    other conditions:
    Some management medications used to treat depression,
    anxiety, epilepsy, and high blood pressure may help reduce hot flashes and
Additional health
complications may rule out the use of hormonal treatment options, such as:

  • high blood pressure
  • personal or family history of
    heart disease or stroke
  • cigarette or tobacco use
  • family or personal history of
  • diabetes
  • high blood cholesterol
  • alcoholism or heavy alcohol
  • liver or kidney disease
  • history of chronic bleeding
  • blood clots or clotting
  • those over 60 or who have
    already undergone menopause
Alternative treatments options

Though many herbs and spices
are praised as cure-alls for menopause symptoms, little research has affirmed
their benefits. Some menopause supplements have even proven harmful with
continual use.
Commonly promoted though scientifically
unproven menopause supplements include:

  • black cohosh
  • evening primrose
  • wild yam creams
  • kava
  • red clover
  • DHEA
  • dong quai
  • plant estrogens found in
    legumes, such as soybeans and chickpeas, and some whole grains, seeds, and
The United States Food and
Drug Administration do not monitor herbal medications and supplements for
purity or quality. People should choose products from a reputable source.
Many of the above herbs can
also interact with medications, so a woman should speak to her doctor before
self-prescribing herbs or supplements.
Furthermore, pharmaceutical
companies have created bio-identical hormone therapies in response to the
cardiovascular and cancer risks associated with traditional hormone therapies.
Unlike traditional hormone replacement
therapies that rely on synthetic hormones, these medications use hormones from
plants. These may be better tolerated by the body, but they are not identical
to human hormones.
There are many approved
bio-identical medications that are proven safe and effective.
According to the North
American Menopause Society, individuals should avoid custom-compounded
bio-identical hormone medications. These medications are mixtures of hormones
prepared by pharmacists and tailored to individual needs.
Drug mixtures prepared by
pharmacists, doctors, non-governmental laboratories, or at home are not subject
to regulation, so there is no guarantee that they are safe or effective.
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.