Sexuality During Menopause: Desire, Dryness, Pain and Ways to Get Help

The Menopause Society stresses that there is no standard to meet for desire or frequency. Hormones are only part of the picture. Hot flushes and night sweats that disturb sleep, stress, life changes (children leaving home, caring for ageing parents), the relationship, body image, some health conditions and certain medicines, such as some antidepressants, all play a part.

According to ACOG, the average age of menopause is 51, but changes can start earlier, during perimenopause. For a broader view of this stage of life, read our page on sex education in later life.

With less oestrogen, vaginal tissues become thinner, drier and less elastic, ACOG explains. This can mean less lubrication, stinging, pain with penetration and urinary symptoms such as urgency or repeated urine infections. Together these are called genitourinary syndrome of menopause.

The Menopause Society's 2020 position statement says it affects between 27% and 84% of women after menopause, and that it is underdiagnosed and undertreated. If pain is your main concern, there is more in pain during sex.

• Lubricant: applied just before or during sex to reduce friction. It can be water-based or silicone-based; see how to choose a lubricant and check it is compatible with condoms.
• Vaginal moisturiser: used regularly, even when you are not having sex, to keep tissues hydrated.
• Everyday care: the NHS advises washing with unperfumed products and avoiding douches.

ACOG lists both products, which are available without a prescription, as options to relieve dryness and pain during sex.

The Menopause Society's 2020 statement concludes that over-the-counter products give enough relief to most women with mild symptoms. For moderate or severe symptoms there are effective treatments to discuss with a professional:

• Low-dose vaginal oestrogen (for example, a cream or gel). The NHS explains it can take up to three months to work fully and carries less risk than other forms of hormone therapy.
• Vaginal DHEA (prasterone) and ospemifene, an oral medicine.
• Systemic hormone therapy, if you also have other menopause symptoms.

On vaginal laser, the same statement says there are not yet enough controlled trials to recommend it. If you have had breast cancer, decisions are made together with your oncology team.

If there is also tension or pain in the pelvic area, our pelvic health and pain relief guide brings together positions that reduce pressure and depth.

While periods are still coming, even irregularly, pregnancy is possible. The NHS recommends using contraception until 2 years after your last period if you are under 50, or 1 year if you are over 50. Note that some oestrogen creams and gels can damage condoms.

Sexually transmitted infections do not depend on age. With a new partner, condoms are still the best protection; see how often to get tested for STIs.

Pain can dampen desire because the body starts to expect an unpleasant experience. Poor sleep and exhaustion have the same effect. That is why treating pain, dryness or sleep problems often helps more than focusing only on "boosting libido".

Make an appointment if you notice:

• pain during sex that does not improve;
• bleeding after sex or any bleeding after menopause;
• unusual discharge or significant irritation;
• repeated urine infections;
• dryness that has not improved after a few weeks of trying things yourself.

It is also worth asking simply to find out which options suit your health and history.

Menopause can be a good time to adapt pace and ways of enjoying sex: more time for arousal, lubricant, non-penetrative touch and clearer communication. If you also live with arthritis, a joint replacement or joint pain, our reduced mobility, arthritis and age guide suggests comfortable positions.

The goal is not to go back to an earlier version of your sex life, but to find one that feels comfortable, wanted and satisfying now.