Sex After Menopause Can Still Feel Good (And It Shouldn't Hurt)

Maybe you think about sex less than you used to. Maybe it takes longer to get in the mood, or it's started to sting in a way it never did before. For most women, sex after menopause does change, and lower desire, slower arousal and vaginal dryness are all common as estrogen levels fall. But pain is one thing you shouldn't accept as normal. Painful sex is one of the most treatable menopause symptoms, and you don't have to put up with it.

Although we're so proud of our Perimenopause Strong and Menopause Strong programs available in the Sweat app, a good workout plan won't fix this on its own. Most of the solutions here start with a conversation with your healthcare professional. Exercise still has a small role to play, so we'll explain where it helps most.

What happens to sex after menopause?

For most women, something changes. That can mean thinking about sex less often, taking longer to become aroused, orgasms feeling different or sex becoming uncomfortable. Some women don't notice much change at all, and that's normal too. Every woman is different.

Sweat's women's health educator Sheridan Skye is a registered nurse, nutritionist and personal trainer. In our perimenopause and menopause masterclass, she puts it simply: "Changes in your sex life during menopause are incredibly common, but they're also something women often don't feel comfortable talking about."

The numbers back her up. A long-term Australian study, the Melbourne Women's Midlife Health Project, found that 42% of women had low sexual function in the early menopause transition, and that rose to 88% after menopause.

Do women lose their sex drive after menopause?

Many do, but not all, and a lower sex drive is only a problem if it bothers you.

"Sexual desire is complicated," Sheridan says. "Yes, hormones can play a role, but so can sleep, stress, mood, medications, your physical health, how you feel about your body, your relationship and simply what else is going on in your life."

So if you're sleeping badly because of night sweats, feeling flat, or juggling teenagers and aging parents, your libido is reacting to all of that as well as your hormones. A change in libido can be directly related to menopause, but a woman in her early thirties can also notice changes if she's going through a period of stress. That's why it pays to have a conversation with your healthcare professional who can look the whole picture.

If you have noticed changes and are feeling like something in you must be broken, this is where we'd also challenge a lot of the menopause messaging out there. As Sheridan explains, "You can have less interest in sex than you used to and be completely fine with that. There's nothing that needs fixing simply because your libido has changed."

If a loss of desire is affecting your wellbeing or your relationship, talk to your healthcare professional. For postmenopausal women diagnosed with hypoactive sexual desire disorder (HSDD), meaning a persistent low desire that causes distress (distress being the key part), testosterone therapy is an evidence-based option when it's available to you.

Why sex can become painful after menopause

As estrogen drops, the tissues in and around the vagina can become thinner and drier, and you may produce less natural lubrication. For some women, that makes penetration uncomfortable or painful.

It's more common than most people realize. Somewhere between 17% and 45% of postmenopausal women experience painful sex some or all of the time.

"Sex shouldn't be painful," Sheridan says. "If sex hurts, you don't just put up with it."

Pain also affects desire. "If every time you have sex you're expecting it to hurt, it makes complete sense that you might stop looking forward to it," she explains. So if your libido has dropped and sex hurts, deal with the pain first, as desire often follows.

How to make sex more comfortable after menopause

There are three main options, and they do different jobs:

• Vaginal estrogen: Sheridan calls this "one of the most effective options for vaginal dryness and discomfort related to menopause." She explains, "This is a low dose of estrogen that's used locally in the vagina, rather than as a whole-body treatment. It helps improve the health of these tissues and can reduce dryness, irritation and discomfort with sex." Knowing if this is right for you always starts with a conversation with your doctor.

• Vaginal moisturizers: used regularly (not just before sex) to help with ongoing dryness.

• Lubricants: used during sex to reduce friction. If you're wondering about the best lubricant for sex after menopause, start with what feels comfortable for you. Silicone-based lube tends to last longer, and water-based lube is easier to clean up.

Many women use a combination, such as vaginal estrogen for tissue health plus lube during sex.

Why bladder and pelvic floor changes are part of the same conversation

The vulva, vagina, urethra and bladder are all influenced by estrogen. That's why vaginal dryness often shows up alongside needing to wee more often or urgently, burning, or more frequent UTIs. Together, these are known as genitourinary syndrome of menopause (GSM).

"If you're suddenly finding yourself getting one UTI after another, please don't assume that's just something you have to live with," Sheridan says. Vaginal estrogen is recommended in clinical guidelines for peri- and postmenopausal women with recurrent UTIs, when it's appropriate for them.

Urinary leakage affects up to half of postmenopausal women, and some women notice symptoms of pelvic organ prolapse, like heaviness or a bulging sensation. That can understandably make you nervous about exercise, but Sheridan is clear: "Prolapse doesn't mean you need to stop exercising."

Where exercise can help your sex life after menopause

Exercise won't reverse vaginal dryness, but it can support a lot of the other things that affect desire, like sleep, mood, stress, and how you feel in your body.

A simple place to start:

• Train your pelvic floor. The Sweat app also has dedicated pelvic floor education if you want guidance.

• See a pelvic floor physiotherapist if symptoms are bothering you or stopping you from exercising. An individual assessment can make a big difference!

• Keep lifting. Strength training through perimenopause supports muscle, bone, metabolic and mental health. Our programs in the Sweat app are designed to help you lift and progress with confidence!

Sex after menopause can still feel good

Sex after menopause may look or feel different, and that's okay. As women, we are constantly told that our bodily changes are cause for concern, but just because something has changed doesn't necessarily mean it's a problem to be fixed. If things are different but you're happy - as you were!

Seeking support from your healthcare professional is important when changes feel like a problem or cause pain, and they can support you in several ways.