Menopause may cause changes in your sex life, or you may not notice any changes at all. Here are some possible changes:

• Lower hormone levels can make your vaginal tissue drier and thinner. This condition, called vaginal atrophy, can make sex uncomfortable or painful.

• Lower hormones may lower your sex drive. It may take you longer to get aroused.

• Night sweats can disturb your sleep and make you tired.

• Emotional changes can make you feel stressed or irritable.

Being less interested in sex as you get older is not a medical condition that requires treatment. But if changes in your sexual health bother you, talk to your doctor or nurse about ways to help, such as treatments to relieve vaginal dryness.

You can steps to improve your sexual health during perimenopause and after menopause:

• Be active. Physical activity can boost your energy levels, lift your mood, and improve your body image. All of these can help increase your interest in sex.
• Don’t smoke. Cigarette smoking can reduce blood flow to the vagina and lower the effects of estrogen. This can make it more difficult to get aroused.
• Avoid drugs and alcohol. They can slow down how your body responds.
• Have sex more often. If you choose to have sex, it can increase blood flow to your vagina and help keep tissues healthy.
• Allow time to become aroused during sex. Moisture from being aroused protects tissues and makes sex more comfortable.
• Practice pelvic floor exercises. These can increase blood flow to the vagina and strengthen the muscles involved in orgasm.
• Avoid products that irritate your vagina. Bubble bath and strong soaps might cause irritation. See your doctor or nurse if you have vaginal itching or irritation as it may be a sign of infection.
• Talk to your doctor or nurse about products to increase your sex drive if you are bothered by a low level of interest in sex. Some women try products like pills or creams with the male hormone testosterone or similar products. The Food and Drug Administration (FDA) has not approved these products for treating low female sex drive. But, the FDA has approved flibanserin, a medicine to treat low sexual desire. If you take flibanserin, you cannot drink alcohol because of its risks for serious low blood pressure problems and loss of consciousness. Flibanserin can increase the number of times you have a satisfying sexual experience by once a month or once every two months. Talk to your doctor about the benefits and other risks of taking any medicine.

Some women have vaginal dryness when their bodies experience the menopausal transition. This can make sex painful. Women may also experience a tightening of the vaginal opening, burning, itching, and dryness (called vaginal atrophy). Fortunately, there are options for women to address these issues. Talk with your doctor, who can suggest treatment options.

Having Sex Is Becoming Painful: What Can I Do?

Pain during sexual activity is called dyspareunia. Like other symptoms of the menopausal transition, dyspareunia may be minor and not greatly affect a woman’s quality of life. However, some women experience severe dyspareunia that prevents them from engaging in any sexual activity without pain.

Many find relief from vaginal dryness during sex by using a nonprescription, water-based lubricant, a variety of which can be found at most grocery and drug stores.

Other women try over-the-counter vaginal moisturizers, which are used regularly and not just during sex to replenish moisture and relieve dryness.

Your doctor might suggest prescription hormones. Local vaginal treatments (such as estrogen creams, rings, or tablets) are often used to treat this symptom. These treatments provide lower hormone doses to the rest of the body than a pill or patch.

The U.S. Food and Drug Administration has approved two nonhormone medications, called ospemifene and prasterone, to treat moderate to severe dyspareunia caused by vaginal changes that occur with menopause. Your doctor can tell you about the risks and benefits of these medications.

For vaginal dryness that causes mild discomfort during sex:

• Use an over-the-counter, water-based vaginal lubricant when you have sex.

• Try an over-the-counter vaginal moisturizer to help increase moisture. You may need to use it every few days.

For more severe vaginal dryness, your doctor might prescribe medicines that you put into your vagina to increase moisture and sensation. These may include:

• Vaginal estrogen creams

• Estrogen tablets or rings for insertion into the vagina

• A non-hormonal medicine called ospemifene

Discuss your symptoms and personal health issues with your doctor or nurse to decide whether one or more treatment options are right for you.

Yes, you still need to use condoms after menopause if you are not in a monogamous relationship. In a monogamous relationship, you and your partner have sex only with each other and no one else. Also, you have both been tested for sexually transmitted infections (STIs, or STDs) before having sex without a condom.

Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get some STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. After menopause you may be more likely to get an STI from sex without a condom. Vaginal dryness or irritation is more common after menopause. This can cause small cuts or tears during sex, making you more likely to get an STI.

Talking with your partner about your concerns can strengthen your relationship. Getting older and chronic health problems like heart disease or diabetes can affect your sexual health and how you feel about sex. Some possible topics to discuss include:

• What feels good and what doesn’t

• Times that you may feel more relaxed

• Which positions are more comfortable

• Whether you need more time to get aroused than before

• Concerns you have about the way your appearance may be changing

• Ways to enjoy physical connection other than vaginal intercourse, such as oral sex or massage

You may want to also consider meeting with a therapist or sex counselor for individual or couples therapy if changes in your sex life bother you.

Most health professionals now understand that sexuality remains important in later life. If you are not satisfied with your sex life, don’t just assume it’s due to your age. In addition to talking about age-related changes, you can ask your doctor about the effects of an illness or a disability on sexual function. Also, ask your doctor about the influence medications or surgery may have on your sex life.

If you aren’t sure how to bring the topic up, try saying: “I have a personal question I would like to ask you...” or “I understand that this condition or medication can affect my body in many ways. Will it affect my sex life at all?”