Menopause and Intimacy: What Changes and What Helps

Menopause changes a lot, and intimacy is often one of the things women feel least prepared for. Maybe sex has started to feel uncomfortable. Maybe your desire has gone quiet. Maybe you just don't recognise your body the way you used to. None of that means your sex life is over. For many women, it's the start of a different, often more honest, chapter.

Here's what's actually happening, and what helps.

What's happening in your body

Menopause is officially the point when you've gone 12 months without a period, usually somewhere in your late 40s or early 50s. The years leading up to it, called perimenopause, can start much earlier and bring their own ups and downs.

The big change is a drop in estrogen. Estrogen helps keep vaginal and vulvar tissue thick, stretchy and well-lubricated. As levels fall:

• Tissue can become thinner, drier and more fragile.
• Natural lubrication decreases, and it may take longer to get wet.
• The vagina can become a bit shorter and less elastic.
• Vaginal pH can rise, which can make infections more likely.
• You might need to pee more often, or get more UTIs.

Doctors call these changes genitourinary syndrome of menopause, or GSM. It affects a large share of women after menopause. Unlike hot flashes, which often ease over time, GSM tends to continue or get worse without treatment. The good news is that it responds well to care.

What about desire?

Libido during menopause is complicated. Hormones play a role, but so do sleep (night sweats aren't sexy), mood, body image, stress, relationship dynamics and whether sex has been painful. If sex hurts, your brain understandably stops looking forward to it.

Some women find desire dips. Others find it rises, often because pregnancy is no longer a worry, kids are older and there's finally a bit more time. Many experience something in between.

Comfort first

Use a good lubricant, every time

This is the simplest, quickest improvement for most women. Choose something gentle and fragrance-free, and use more than you think you need. Reapplying is normal.

• Oils give long-lasting glide, which many menopausal women love. Our Soothe intimate oil was made for dry, tender days, and our original Intimate Oil is just coconut oil and CBD. Oils aren't safe with latex condoms.
• If you use condoms or prefer something that washes off easily, a pH-balanced water-based formula without glycerin, like Hydro Glide Relief, is a good pick.

Add a vaginal moisturiser

Lubricant helps during sex. A vaginal moisturiser, used regularly a few times a week, helps keep tissue hydrated day to day. Many women with GSM use both.

Take your time

Arousal takes longer after menopause. That's not a problem, it's just a change. Longer foreplay increases blood flow and natural lubrication, and helps tissue relax.

Stay sexually active, if you want to

Regular arousal, alone or with a partner, encourages blood flow to the vaginal tissues. “Use it or lose it” is a little harsh, but there's some truth in it. It doesn't have to be penetration. Any kind of arousal helps.

Try different positions

Positions where you control depth and speed tend to feel better. Pillows under your hips or knees can take pressure off sore joints too.

Skip the irritants

Scented soaps, bubble baths, wipes and douches can make dryness and irritation worse. Warm water on the vulva is enough.

Talk to your provider

Too many women never mention these changes to their doctor, or mention them and get told it's just part of getting older. You deserve better. There are good medical options, including:

• Low-dose vaginal estrogen (cream, tablet or ring). It works locally, and very little reaches the bloodstream. It's considered safe for many women, including some who can't take systemic hormone therapy, though you should discuss your own history.
• Systemic hormone therapy, which can help with hot flashes and other symptoms too.
• Other prescription options such as vaginal DHEA or ospemifene.
• Pelvic floor physical therapy, especially if muscles have become tight or painful.

If your provider isn't helpful, it's okay to ask for a referral to a menopause specialist. Bring notes about what you've noticed and when.

Talk to your partner

A partner might notice you're avoiding sex and assume it's about them. Explaining what's going on, physically and emotionally, can bring you closer. Try: “My body's changing and sex has been uncomfortable. I still want to be close to you. Can we figure this out together?” For more ideas, see How to Talk About What You Want in Bed.

Redefine what good sex means

Many women find that menopause invites them to slow down and widen the definition of sex: more touch, more massage, more oral, more toys, less pressure to follow the same old script. Some of our customers say their sex lives are better now than in their 30s, because they finally know what they want and aren't shy about asking.

When to see a doctor sooner

• Any vaginal bleeding after menopause.
• Pain with sex that doesn't improve with lubricant.
• Itching, burning, unusual discharge or frequent UTIs.
• Low mood, anxiety or sleep problems that are affecting your life.

Keep reading

For a deeper dive, read Menopause and Sex: Reclaim Your Sexual Confidence and Healthy Sex After 40. Or take our homepage quiz to find the right formula for where you are now.

This article is general information and not medical advice. Please talk to your healthcare provider about your own symptoms and options.