Sex after menopause 

What to expect from sex postmenopause and how to get help with any hurdles along the way

Low sex drive after menopause 

Painful sex after menopause

Sex after menopause – what women say

Sex after menopause - tips and more

Hormonal changes may make your body feel different or affect your libido but menopause doesn’t mean your sex life is over, just different. Here’s what to expect from sex with your partner – after the menopause.


With no more periods to worry about and your days of getting pregnant behind you, sex after menopause (once you’ve had no periods for 12 months and you’re no longer ovulating) should be something to look forward to and enjoy. Even if it does feel a little different. [Find out more about postmenopause](/health-library/conditions/perimenopause). 

But hormonal changes and lingering symptoms put many women off sex altogether, leaving them wondering if they’ll ever want it again, let alone enjoy it, as Dr. Ann Nainan, family doctor and Healthily expert explains.

“Even though your periods have stopped, low levels of hormones can still cause symptoms that can affect you both physically and mentally, just as they can do in the lead up to the menopause. This can mean sex is off the menu for many women, for a whole host of different reasons from vaginal discomfort to zero appetite for it – but it doesn’t need to be that way," she says. 

Seeking help, treatment and understanding what’s causing sex to feel different is key to getting things back on track. So if your sex life has taken a nosedive this can help.


## Low sex drive after menopause 

Whether or not sex is uncomfortable is a moot point if you’re not in the mood for it in the first place. Take some comfort from the fact low libido can be pretty common among women in their 40s and 50s. Although everyone’s sex drive is more likely to slow down with age, it’s more than twice as likely to do so in women compared with men.  

Lack of hormones, in particular testosterone, can affect your sex drive, but there are other causes too.

“Physical factors like painful sex and vaginal discomfort can be enough to put anyone off sex,” says Dr. Ann. “And other symptoms like anxiety, low self-esteem and confidence issues can also be responsible for reduced libido,” she says.

### What can help? 

Lots of people find [hormone replacement therapy (HRT)](/health-library/treatments/hormone-replacement-therapy) helpful in relieving a range of menopause symptoms, including low libido. [Talk to your doctor](/sexual-health/sex-after-the-menopause/#when-to-see-a-doctor) about the best options for you.

Although testosterone gel or supplements have been found to help restore sex drive in postmenopausal women, these are not yet approved by the Food and Drug Administration (FDA) for use in women. Testosterone is also not licensed for use in women in the UK, although some doctors and menopause specialists will consider prescribing it, especially if standard HRT has not helped with libido'also not available as a licensed product in the UK. 

Talk to your doctor about using it but be aware that long-term safety data is still lacking.

Get help with this

## Painful sex after menopause

Vaginal dryness caused by low levels of estrogen can make sex uncomfortable or even painful – during and afterwards too. This condition is called dyspareunia and it’s more common than you may think. 

The North American Menopause Society (NAMS) reports that up to 45% of postmenopausal women find sex painful. If you’re one of them, talk to your doctor to rule out anything else that may be causing it, such as an illness or infection. 

### What can help?  

"It always seems sad to me that so many women suffer in silence with common [menopausal symptoms](/health-library/conditions/menopause/#symptoms) such as painful sex because they are embarrassed to speak to their doctor,” says Dr. Ann. "We see this problem  regularly and entirely understand how much impact it has on quality of life. There are so many effective treatment options we can offer," she says.

Things that can help make sex more comfortable after menopause, include:

- Lubricants – available over the counter, these help by avoiding friction during sex, making penetration smoother and more comfortable for many. 
- Vaginal moisturizers – applied every few days can help moisturize the lining of the vagina and keep tissues healthy. 
- Local estrogen – a low dose of hormone replacement therapy (HRT) either  as a ring, cream or tablet applied directly into the vagina helps by improving blood flow and repairing damage to vaginal tissue. Because this is low dose and applied directly to the vagina,people who are unable to use systemic HRT may be able to use this, after consulting their doctor. 
- Ospemifene – the only FDA-approved non-hormonal treatment for painful sex due to menopause. It mimics estrogen to help thicken the vaginal lining. Consult your doctor before taking this.  

Knowing the best sex position after menopause can also mean less thrusting and less pain for you. [Find out more](/sexual-health/sex-after-the-menopause/#tips-and-more). 

### Other postmenopause symptoms affecting sex

Other symptoms such as hot flashes, night sweats, low mood and disturbed sleep can all linger after menopause. Any one of them can sap the energy from you to function during the day, let alone to have sex.

### What can help?

HRT can help reduce most menopausal symptoms, such as hot flashes, night sweats and mood swings (as well as vaginal discomfort and low libido, as mentioned above). Once these symptoms are under control, you’re more likely to sleep better too. 

Non-hormonal treatments are also available, such as antidepressants. [Read more](/health-library/conditions/perimenopause) about how these could help you. 

Ironically, having sex can actually help keep some menopausal symptoms at bay by stimulating blood flow and keeping your vaginal muscles toned and healthy. 

Not sure if your symptoms are menopause-related or something else? Use our [Smart Symptom Checker](https://www.livehealthily.com/symptom-checker) to find out what they might be and what’s the best next step for you.

### When to see a doctor

“If symptoms are affecting your sex life in any way, talk to your doctor about getting the right treatment for you,” says Dr. Ann.

'If you wish to try HRT this will need to be prescribed by your doctor.  Based on your medical history they will advise on whether it is suitable for you to take and recommend the best form and dose for you to start on. Or if you’re already on it and aren’t noticing changes, they may recommend trying a more localized form to help vaginal dryness, for instance.

Always see a doctor if you experience:
- bleeding after sex
- pain during or after sex

Although rare, bleeding can be a sign of cervical or vaginal cancer so it’s always a good idea to get checked out. 

If your relationship is being affected, you may benefit from relationship or couples’ counseling. You can also find a menopause-certified practitioner via [NAMS](https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx).

## Sex after menopause – what women say

In a recent survey, only a small amount (12.5%) of people asked said menopausal symptoms affected their sex life – but this could be down to embarrassment or unwillingness to talk about what is still considered a taboo topic. 

If you are suffering in silence, you aren’t the only one: 

“As a doctor I’ve seen patients who have physical symptoms affecting their sex life post menopause but it’s the emotional symptoms that can be harder to spot. I urge women to talk to their partner, their doctor or a counselor if their sex life isn’t what they want it to be after menopause” says Dr. Ann.

Denise, 53, said she definitely noticed a decreased interest in sex after the menopause but didn’t seek help.
“I would be quite happy, as they say, with hugs and cuddles but that’s about it, It’s one of those things you think, oh, dear, do you go to the doctor for it, what do you do? So it’s a difficult area because not everyone’s content or happy with talking about it.”

Jackie, 50, did see a doctor and took her husband along too.
“He was scared and worried with me. Definitely. He came to the doctors with me a few times, he even came into the surgery when I was at my worst where I was so overly emotional as well. We’ve been together such a long time we’ll always work on finding ways to get over those challenges and so far we’ve managed that.” For other women, sex after menopause is liberating. Jade, 53, got help from her Ob-gyn and went on an estrogen patch, “and then it was like the sexual Olympics!” 

Michéle, 60, noticed better orgasms after menopause. ‘I have longer, more full-bodied, increasingly bigger orgasms now. They are often downright spiritual,” she says. 

## Sex after menopause - tips and more

So how can you prepare for sex after menopause and what tips can help you with everything from orgasming to enjoying it again? 

“The most important thing is not to put yourself under too much pressure to have sex if you don’t want to,” says Dr. Ann. Your body has gone through significant changes, so do what’s right for you, talk to your partner and seek help if you need it,” she says.

Then take your time to try new things. Exploring and learning what feels comfortable and pleasurable for you can be part of this new phase of your life and sex life, agree health experts. Starting with sex positions.

### What’s the best sex position after menopause?

There’s no one answer for this but any position that lets you feel more in control is often a good choice. Try sitting on top or lying on your side so you can control penetration . 

Also, sex doesn’t necessarily mean penetration, so experiment with [oral sex](/sexual-health/what-is-oral-sex), genital stimulation or mutual [masturbation](/sexual-health/what-are-the-benefits-of-masturbation), as these can give you as much pleasure.

### Can women orgasm after menopause?

Despite what you may have read or heard there is no evidence to suggest orgasms are impossible once you reach menopause.

“This misconception probably stems from the fact sex is less appealing, less frequent or less comfortable for some women. If you’re having less sex or are trying different positions then there’s a possibility climaxing won’t happen as often or could be more of a challenge,” says Dr. Ann.

To help you get there if you are struggling, try:
- lots of foreplay
- lubricants
- direct stimulation (try vibrators)
- communicating with your partner (finding out or telling them what works and what doesn’t)

And take your time, says Chris Kraft, Ph.D., director of clinical services at the Sex and Gender Clinic at Johns Hopkins Medicine, who says reaching orgasm can take longer as you age. “Doing things like rubbing and touching instead of intercourse may be what you like best at this stage of life,” he says. 

### Do I need to worry about safe sex after menopause?

Yes. It’s  important to use protection for two reasons during this phase.

Firstly, although the risk of pregnancy is low after menopause, it can still be possible. Women can usually stop using contraception after 1 year of no periods if over 50, or after 2 years if under 50.  For women who don't have periods (often because they are using hormonal contraception) this can be difficult to know – but the general advice is that all women can stop using contraception by age 55.

Women are also advised to stop using combined hormonal contraceptives aged 50 and switch to a progesterone only or other method of contraception, for safety reasons. 

Secondly, you’re still at risk of sexually-transmitted infections (STIs), which are possible to pick up during unprotected sex, whatever your age or menopausal status. 

“Menopause offers no protection against sexually-transmitted infections (STIs) so it’s important to use condoms or a dental dam with any new partners or one-night stands,” says Dr. Ann.

### Self-care tips to improve your sex life after menopause

The North American Menopause Society (NAMS) recommends yoga, sex therapy and counseling to help restore libido. Read more about [how to increase your sex drive](/sexual-health/how-to-increase-your-sex-drive). 

Cognitive behavioral therapy can also be helpful in changing negative thought patterns and behaviors associated with painful sex.

error

 There was an error when submitting your feedback – have a screen break then try again in a few minutes.

Oh no, something’s gone wrong

ANY COMMENTS OR SUGGESTIONS?

initial

This isn’t helpful

This isn’t relevant

Something is wrong

This isn’t accurate

Please select one.

loading

success

We're listening – we use your feedback to improve your experience, and make our content more helpful.

Thank you for your feedback

References

Juliet Blank

Jo Wheatley

Dr Rebecca Thomas

Article information

All of Healthily's articles undergo medical safety checks to verify that the information is medically safe. View more details in our <a href="/safety" target="_blank" rel="noopener noreferrer">safety page</a>, or read our <a href="/legal/editorial-policy-principles" target="_blank" rel="noopener noreferrer">editorial policy</a>.