Sex After Menopause

Mature woman

You finally made it through menopause. The problem is along with no more periods you also seem to have no more desire for sex. Take heart. You’re not alone.

Blame it on hormones

Here’s a simplified medical explanation of why your libido may have hit a low point. In women, the sexual response is due to estrogen and testosterone. “When we stop ovulating and having periods, both hormones drop — estrogen quite precipitously,” explains Susan Doughty, a women’s health nurse practitioner. Susan founded the New England WomenCenter, which recently merged with Coastal Women’s Health Care in Scarborough. 

Our testosterone levels lower more gradually after menopause says Susan, along with another hormone called DHEA, which converts to estrogen and testosterone. A man’s testosterone levels decrease with age, but much more gradually, which is why they are usually more interested in the sexual act than women. And why there can be a lot of tension in some postmenopausal relationships.

Problem solving

When a woman comes into her office with sex-related issues, Susan says the first thing they talk about is the relationship with her partner. She asks, “Is it intimate? Is it trustworthy? Is there any abuse or exploitation? The second thing — is it comfortable?”

By comfortable, she means does it hurt to have intercourse? Estrogen triggers a natural lubricant and without it, the vagina becomes drier and less flexible. Thankfully, there are solutions to the problem. “We supply local estrogen to the vagina that stays put and doesn’t get absorbed into the body,” says Susan. “There are lots of different forms of local estrogen, from creams to rings to tablets to suppositories.”

Another solution: Use a lubricant. “We recommend that women lubricate their partner as well as themselves,” she states. “Coconut oil is a wonderful lubricant. It’s easily accessible, has no petroleum products and smells good.”

Testosterone in the form of a transdermal cream or drops is also used to treat some women, although it is not yet FDA approved. Two testosterone gels and a patch are currently in line for FDA approval, as is a vaginal DHEA suppository. Both testosterone and DHEA are compounded and not available at other pharmacies.

Put sex on your calendar

What if your vagina is responding well to your treatment of choice, but you’re still not feeling responsive to your partner? Counseling may be appropriate, but if the relationship is strong and you’re both willing to work together on the issues, Susan suggests trying to make regular sexual contact a priority. Put it on your calendar! “Plan a time during the day when neither person is tired,” she recommends. “Plan for privacy and for when you can take the time with each other.”

Taking the time is important because you might need to re-teach your partner what feels good and what doesn’t. That’s partly because your body may not react to touch the way it used to. For instance, after menopause some women no longer enjoy having their nipples stimulated. It’s likely that many men would also appreciate more time and sensitivity from their partners. They may still produce plenty of testosterone, but some may have trouble sustaining an erection.

And speaking of erections, good sex doesn’t always mean intercourse. Many couples, for instance, are satisfied with mutual masturbation. But, how about having an orgasm? “If that’s the goal, then it can be a disappointment,” says Susan, “because sometimes the orgasm is elusive. Rather than look for that as the ultimate, look for ways of feeling close, feeling stimulated, and feeling pleasure from each other.”

Finally, how often should you have sex after menopause? Of course, it’s a personal decision, but the research shows that twice a week is optimum, once a month the minimum. Otherwise, you’re likely to lose your momentum. We certainly wouldn’t want that to happen.

If you’d like to learn more about sex after menopause, Susan suggests checking out the website MiddlesexMD.

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Diane Atwood

About Diane Atwood

For more than 20 years, Diane was the health reporter on WCSH 6. Before that, a radiation therapist at Maine Medical Center and after, Manager of Marketing/PR at Mercy Hospital. Now she writes the award-winning blog Catching Health with Diane Atwood.