How to boost libido and have better sex after menopause, according to OB-GYNs

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How to boost libido and have better sex after menopause, according to OB-GYNs
It's normal to have less sex after menopause, but that doesn't mean you can't enjoy it or still be intimate with your partner.Fuse/Getty Images
  • You may have less sex after menopause due to a decrease in libido, discomfort during sex, and reduced bladder control.
  • To have better sex after menopause, you should consider hormone replacement therapies, trying kegel exercises, and openly communicating with your partner.
  • Overall, if you're experiencing trouble with sex after menopause, talking with a doctor or sex therapist can help you find the best individual treatment options for your health.
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Menopause is a stage women usually enter in their early to mid-50s, when there is a decrease in estrogen production. This can affect your sex life and bladder function. In fact, over 50% of postmenopausal people experience genitourinary syndromes of menopause (GSM), a condition that encompasses genital, sexual, and urinary problems associated with the aging process.

Here's how sex changes after menopause and tips to improve your sex life during this stage of your life.

Menopause may cause sex to be uncomfortable

Due to a decrease in estrogen during menopause, it's common for people to start feeling pain during sex.

"This decrease in estrogen causes vaginal tissue to become thinner and reduces the production of lubrication," says Peace Nwegbo-Banks, MD, an OB/GYN at Serenity Women's Health & Med Spa in Pearland, Texas.

An average of 20% to 30% of postmenopausal people report experiencing painful vaginal sex. As the vagina becomes increasingly dry and thinner, additional issues can occur.

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"This may not only lead to pain but also tearing and bleeding, which can be very traumatic to the woman," says Renee Wellsenstein, MD, an OB/GYN in Cooperstown, New York. "Her pain with sex may increase even more if past traumatic experiences with sex cause her to contract her pelvic muscles during sex in anticipation of pain."

How to treat it: If you're experiencing pain during sex, there are a few treatment options that fall into two main categories:

  • Hormonal options. These increase estrogen levels and include low-dose vaginal estrogen therapy or estrogen supplements, says Nwegbo-Banks.
  • Non-hormonal options. These include water or silicone-based lubrication and topical anesthesia or vagina-safe moisturizers, says Nwegbo-Banks.

You can also experiment with sex to see what feels good — taking it slow or trying different positions may help make you feel more comfortable.

Menopause may lower sex drive

It's normal for one's sex drive to decrease during menopause for a few reasons. If sex has become painful due to issues such as dryness, their desire for it may reduce.

"Dryness can lead to painful sex, and indeed if one has painful sex, it is very common for women to lose their libido because it hurts," says Mary Jane Minkin, MD, OB/GYN, a clinical professor of obstetrics and gynecology at Yale University.

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Other symptoms of menopause such as hot flashes and night sweats can also lead to distress and lower a person's sex drive, says Nwegbo-Banks.

The natural decrease in estrogen and testosterone experienced during menopause may also negatively affect a person's libido, as sex hormones are positively correlated to sex drive. In some cases, Nwegbo-Banks says this may lead to hypoactive sexual desire disorder (HSDD), which is when you have no desire for sex, rarely think about it if at all, and avoid a partner's sexual advances.

How to treat it: To increase your sex drive after menopause, take the time to explore what excites you about sex, and change your sexual routine. While there is absolutely nothing wrong with not wanting to have sex, if you experience HSDD, possible treatment includes:

  • Stress reduction
  • Masturbation
  • Open communication with your partner
  • Stopping the use of alcohol or drugs
  • Speaking with a sex therapist

Additionally, a 2019 report summarizing 36 different trials showed that testosterone therapy could positively affect a postmenopausal woman's sex drive.

Menopause may reduce bladder control

According to a 2015 report, over 50% of postmenopausal people experience urinary incontinence, which is when you are unable to control urination.

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"Decreasing estrogen levels cause thinning of the tissue of the urethra, which is the tube that connects to the bladder and allows urine to leave the body," says Nwegbo-Banks. As a person ages, their pelvic floor muscles — which support the bladder — can also weaken, leading to less bladder control, she says.

A lack of complete bladder control can impact a person's sex life. A 2017 study of women, about two-thirds of whom were incontinent, examined the effect of bladder control on sexual desire. While the frequency of sex was similar between the two groups, incontinent women expressed lower sexual desire, comfort, and satisfaction.

How to treat it: If you're having trouble controlling your bladder, you should:

  • Avoid drinking large amounts of liquid, especially alcohol, coffee, tea, and carbonated drinks.
  • Train your bladder by holding your urine slightly more each time if possible and stick to a schedule.
  • Try kegel exercises which can strengthen your pelvic floor and the body's ability to hold urine.

Additionally, certain medications such as high blood pressure drugs and muscle relaxers can reduce bladder control, so speak to a doctor if you think your medication may be exacerbating the problem.

Sometimes simple surgical procedures or medical interventions are necessary to improve incontinence. Meet with a doctor about your options if postmenopausal incontinence is disrupting your life regularly.

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Insider's takeaway

Menopause can change your sex life. You may notice a decrease in libido, more pain during sex, and less control over your bladder. If you're experiencing any of these symptoms after menopause, Nwegbo-Banks recommends visiting your gynecologist. It's normal to have less sex after menopause, but that doesn't mean you can't enjoy it or still be intimate with your partner.

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