Can you have great sex after menopause?
It’s one of the most common questions that I get when I’m giving my Girl Talk–my evening event where I come into churches and talk sex & intimacy. We do an anonymous Q&A session during the event, and invariably someone asks about sex and menopause.
I give some generic answers, that I’ve read about, because quite frankly I’m not there yet. But I’m researching it because I certainly don’t want menopause to be where sex goes to die. And from what I’ve been reading, it really doesn’t look like it has to! Hormones certainly affect our libidos, as I’ve written about before. And I had a really rough time with perimenopause (the 10 years leading up to menopause) before I had a uterine ablation surgery (which was a godsend). But I know the hormonal changes aren’t over. And the problem with menopause that many women find is that the hormonal changes can steal our libidos and make sex uncomfortable.
But it doesn’t have to be that way! A while ago Dr. Carol Peters-Tanksley, an OB-GYN, guest posted on how women need to “flip that mental switch” to make sex fun. And since I’ve been wanting to write about menopause, but never really felt qualified to since I’m not there yet, I jumped at the chance to ask her to write another piece for me, since she actually knows what she’s talking about.
She said yes, and I’m thrilled to have Dr. Carol back today:
“Is there even such a thing as sex after menopause? And can it actually be great?”
As much as many women under 50 may try to ignore the fact, every single one of us will pass, is passing, or has already passed through the menopause transition. There’s a common stereotype going around that women who have gone through menopause are neither interested nor interesting when it comes to sex and sexuality. But that’s just not true.
I’m a member of the over-fifty club myself, and I can assure you I’m not old! And if you ask other fifty-plus-somethings, many of them would tell you the same thing. There’s a lot of truth to the adage, “You’re only as old as you feel,” especially when it comes to intimacy.
There’s no reason women cannot continue to enjoy great sex and satisfying intimacy during and after menopause, through your fifties and beyond.
But stereotypes usually come from somewhere. It is true that during and after menopause many women experience changes in libido, sexual arousal, and sexual satisfaction. Not all these changes are negative. So it’s helpful to be aware of how your current season of life affects you so that you can maximize the benefits and address the challenges.
As an OB-Gyn physician I’ve been helping women deal with these menopausal changes for over 20 years. And I know that with the right frame of mind, and occasionally a little help, sex and sexuality can be wonderful.
Let me point out five useful things to know that will help you continue to enjoy sex, and perhaps enjoy it more than ever before.
1. Be grateful for the increased freedom to be spontaneous that menopause brings.
With menopause a number of the frustrations affecting intimacy are removed. Just think how nice it is not to have to worry about periods, pads, tampons, PMS, birth control, and all the other associated “stuff.” Whether or not you engaged in sex during your period before, that’s one issue you don’t have to worry about ever again!
And that’s not all. It’s likely you also don’t have to worry about changing diapers, soccer practice, or PTA meetings. Rather than being asleep in the next room, your kids are either in high school (and spending more evenings and weekends away from home), or moving out. Let’s just say that the impending empty nest often makes spontaneous intimacy simpler. Why not enjoy?!
The freedom to be spontaneous doesn’t always mean you or your husband will naturally take advantage of that freedom. Satisfied mature couples include sexual intimacy as part of their regular priorities, and make sure to engage in sex regularly.
2. Enjoy your maturing relationship.
If your marriage has been a reasonably good one, you’ve probably stopped trying to change each other by now. How refreshing! Hopefully you’ve learned how to forgive each other well, and how to work through conflicts. You’ve gone through enough of life together that there are few surprises. You know what pleases each other, and what hot buttons to avoid.
That may sound like sex is becoming boring and predictable, but it doesn’t have to be that way. There’s a certain safety in a long-term marriage that can pay great dividends when it comes to intimacy. Good sex can bring benefits beyond excitement – benefits such as comfort, relaxation, connectedness, reassurance, and spiritual closeness. And the safety of a strong marriage may also give you the freedom to explore new ways of experiencing pleasure.
If your marriage is not so great, this is a good time to focus on your relationship and take steps to make it better. With a little more maturity you’ve got more emotional tools to draw from. As long as you and your husband are people of good will, your relationship can just now be entering the best years of your lives together.
3. Slow sex down a little.
As women become more mature, it often takes more time to become fully aroused sexually. Your lubrication may be less and slower, and it may take longer to reach a climax. Many men will also experience a slower sexual response as they become older. If you and your husband are willing to slow down a little, it’s likely you can experience as much or even more satisfaction.
Many menopausal women will find the increased foreplay as satisfying as sex itself. Talk with your husband about what you find enjoyable and stimulating. (That’s right; talk about sex! And here are 6 foreplay ideas that can help, too!) Come from a position of desiring to mutually please the other. Hopefully you’ll spend as much time listening to what he desires as you do in sharing your own wishes.
While your life as a mature woman can be complicated, carve out dedicated time each week to focus just on one another. You may be pleasantly surprised at the stimulating results!
4. Appreciate the hormonal changes of menopause.
Some of the changes in sexuality that you experience around menopause may be hormonally related. The drop in estrogen will eventually decrease the lubrication and elasticity of the vagina, making intercourse uncomfortable or painful. For some women this happens right away; for others it happens years after menopause.
If you are easily aroused but find intercourse uncomfortable, lubricants such as Replens or Astroglide may be sufficient. If that doesn’t resolve your discomfort, please talk with your doctor about prescription vaginal estradiol. Within a few weeks you’ll notice a major improvement. Pain is a major mood killer for women, and with the discomfort resolved you may desire intimacy much more.
And if your ovaries have been removed, talk with your gynecologist or endocrinologist about the possible benefits of very small amounts of testosterone. (Yes, women need a little of that too!)
5. Take the initiative.
For some women, your libido may actually increase around the time of menopause or thereafter. The freedom from having to deal with periods or raising small children may be part of that. But testosterone does not decrease as much as estrogen does at menopause (as long as you still have your ovaries), and the different balance in hormones may increase libido also.
Whether or not your desire has increased, take some thought about the ways in which you can inspire your husband to be sexual. If he has difficulties with sexual performance, encourage him to get a medical evaluation. Take a conscious mental step in his direction, and invite intimacy.
Many husbands will welcome you creatively asking for sex. He may not say it, but he may think “Where have you been all my life?!” By now you probably know what gets his engines revved up. Take a risk. You may pleasantly surprise yourself – and him.
This has been a positive look at how you can enjoy great intimacy even after menopause. There are many ways in which your investments in a strong marriage during the years can now pay great dividends. And if you don’t have a long track record of a happy marriage, don’t give up; I married for the first time at age 48, and it was wonderful in every way. If you face challenges related to sex during menopause, I’d love to hear from you.
I believe sex can continue to be great for as long as you’re together!
Dr Carol Peters-Tanksley is a licensed OB-Gyn physician and ordained Christian minister, sometimes known to her friends as “Doctor-Doctor.” Her new book Dr Carol’s Guide to Women’s Health: Take Charge of Your Physical and Emotional Wellbeing is available wherever books are sold. Dr Carol invites you to connect with her at her ministry website www.drcarolministries.com, Twitter, or Facebook.
Thanks, Dr. Carol!
Now it’s YOUR turn: what have been your biggest challenges with sex and hormone changes? How did you handle them? Let’s talk in the comments!
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I’m not great in the morning, and he’s not great at night. Early afternoon “naps” are perfect!
I love the idea, Jane. Carving out creative time to “be” together – in every sense of the word. That’s part of the freedom of this season of your life. That’s perfect.
There certainly is much more freedom in this stage of life. With the responsibilities of raising a family behind us, we can focus on our relationship more which overflows into the bedroom. Thank you for this very encouraging list!
After getting a total hysterectomy I had no libido at all. My husband became so frustrated that he started researching for ways to increase it. I’m so thankful he did because our sex life is better than ever. This is due to me getting on bio-identical hormone replacement therapy (BHRT). I’ve never felt better and now he can’t keep up with me! ???? We love being empty-nesters & are enjoying this time in our lives.
How to stop the pain? I told the NP at the office about it. I suspected it was dryness. She gave me a blank stare and said “you’re not dry” then shrugged. I guess thats true since the pain occurs even with gobs of coconut oil, silicon, it doesn’t matter what. Pain. Why? Anyone else have that?
Ouch! Pain is definitely a mood killer!
If your NP gives you a blank stare, I think it’s time to see a gynecologist. Sometimes the vaginal tissue looses its elasticity even when it’s not “dry”, and when the vagina can’t expand to accommodate intercourse the tissue can tear – and HURT!
A gynecologist can evaluate for possible estrogen deficiency. Small amounts of natural estradiol cream may do wonders for you if that’s the case. There are also other physical causes for pain with intercourse. If your first “provider” doesn’t give satisfactory answers, don’t give up!
Oh wow- thank you SO MUCH for taking the time to respond. this was so encouraging. I’m only 30 and this happened b/c of chemo for an autoimmune disease. 🙁 I’ve been curious about creams and such to replace what was lost. I also still wish I could have kids. This post just confirmed… I really need a gyn! 🙂
Dr Carol please help me
help my DIL. We have a good relationship and we are very open with each other, for which I am so grateful. She and my son have been married over 4 yrs. She recently shared with me that she has never been able to climax. She’s not sure who to ask for help. What do u suggest?
Some women have an easy time climaxing, and some don’t. There isn’t anything necessarily wrong. Some women find that taking more time with stimulation that varies between gentle and stronger may allow them to climax. Her gynecologist may be helpful; some are better than others at addressing these kinds of issues. I have a section on this in my book Dr Carol’s Guide to Women’s Health (available on Amazon or my website). And I’d be happy to hear from your DIL also, and respond individually.
Dr. Carol,
Thank you! I have been concerned about this season of marriage because so many women don’t want to think about it before they’re full-blown into the battle. This is dangerous for any struggle–to be caught unaware. I did a survey recently asking men and women to chime in about the changes they’ve experienced physically through menopause and the effect it was having on their marriage. (You can see it on our website in the top toolbar). While it doesn’t offer help to those suffering it does allow them to see that they are not alone and that these struggles are most likely easy to remedy. Having made it through menopause, I’m finding this season to be our best yet when it comes to sexual intimacy, and I thank God for it. I’m grateful for your practical advice and plan to share it with our readers. What a gift you are to us! Thank you Sheila for allowing this alarm to be sounded.
Blessings,
Debi
Debi, so glad it’s the best season yet! I’m believing for that myself. Just a little worried about hot flashes!
Awesome, Debi! I’m so grateful you found this information helpful, and that you plan to share it! Blessings to you, your marriage, and your ministry.
I have been in a difficult marriage, even went through a period of emotional/verbal abuse by my husband. In an effort to “keep him happy” I would offer sex and agree to sex but basically just “let him have his way.” Now I find I have no interest in sex. I had a total hysterectomy a year ago and now sex is a bit uncomfortable. I don’t know how much is mental/emotional and how much is a result of menopause. I try to think positive thoughts about sex, but I really struggle to want it. My husband still has angry outbursts and I find it very difficult to “desire him.” Any advice would be very appreciated.
Stephanie,
My heart goes out to you. A woman’s sexual response is very “integrated” – the physical, emotional, and relational aspects all effect each other. I’d recommend a “both-and” approach; see your gynecologist and optimize any physical issues going on. It seems you could also use some support for your marriage. And I’ll be praying for you as well.
For Vaginal dryness that coconut oil or other lubricants do not seem to help, I would ask your OBGYN about perscribing a vaginal e ring, which dispenses hormones to the vagina, it fits like a diaphragm, it has truly changed my life!
For pain I suggest The Unveiled Wife blog. She suggests avoiding hormone alterating chemicals, e.i. Parabens, etc. Worked for me too. I would rather make my body healthier and stronger with supplements FIRST, than “buy” into the medical establishment that we need surgery or a prescription automatically. Wake up people – thats how doctors make money.
None of this was very helpful for me. I just entered pre-menopause, erratic periods, and little to no libido. I have a great husband, and used to not have a problem getting aroused. Now I cringe sometimes just from being kissed or hugged, and have anxiety thinking about having sex because it’s very unpleasant being touched sexually when you aren’t aroused at all. I just want to get it over with. Scared of hormone therapies that can increase risk of breast cancer. I feel like I’m having to choose between improving my libido or reducIng my risk of breast cancer, which I do have a family history of.
I have this problem too. I had my one remaining ovary removed 3 years ago and the effect has been profound. I am also high risk for breast cancer and am followed by a high risk breast cancer clinic with annual MRI’s in addition to mammograms. I take HRT – switched to bio identical about a year and a half ago. My docs are ok with it and I’m followed very closely. I would encourage you to see a menopause specialist who also specializes in HRT and prescribes testosterone. I had to look outside my then-current OB-GYN practice. And don’t let your current doctors dissuade you from investigating this further. If HRT is not for you, or doesn’t help, the next step is a marriage counselor or sex therapist who can help you (and your husband) work on cognitive/behavioral ways to increase your libido & tolerance/enjoyment of physical touch and intimacy. Don’t just put up with it – it will hurt your marriage and your quality of life in the long run. You deserve better. This is a very common problem and there are people out there who specialize in helping you with it.
Hot flashes can be so embarrassing. I snuggle up to my husband at night, and kaaa-pow! I break into profuse sweat: face, chest, legs, everywhere. My PJ’s are damp. That’s a mood-killer for me. (I finally asked him and he said he almost never notices.)
My OB/GYN told me to try Pro-Gest cream, and I’ve been using it the past few weeks. It has cut down my hot flashes by 70%. (Hey, it’s not a cure, but I will take that!) Now when I snuggle up with my sweetie, I don’t sweat. It’s much more comfortable for me.
BUT, I am concerned about my libido. I love sex, and I seem to be a bit off recently. I still desire it, but am not having orgasms as frequently or as strong.
The academic literature seems to conflict on progesterone and libido. What is your opinion, Dr.?