How Menopause Impacts Your Sex Life

For years, I’ve planned to tackle the issue of menopause.

But I’ve chickened out. Who was I talk about menopause when I hadn’t been through it? When there were so many resources out there on the topic? When others had dealt with the issue better than I expected I could?

Mind you, not experiencing something personally hasn’t stopped me from thoroughly researching and writing about all kinds of issues. But for some reason, menopause loomed large in my mind. I’d heard the horror stories of loss of desire and sexual activity.

Menopause, the Marshmallow Monster

To me, menopause became the Stay Puft Marshmallow Man—innocent in theory, but it might end up rampaging through my town and tearing up my satisfying sex life.

Well, I’ve reached the other side now! And my sex life is still here.

So it’s time, or rather past time, to talk about what menopause does to a woman’s sexuality.

Is it Menopause or Perimenopause?

Menopause refers to the cessation of ovulation and thus the end of menstruation. What we refer to as menopause, however, is often perimenopause—the 4–10 year period during which a woman’s body transitions.

The average age of menopause itself, among women in the United States, is 51 years. That means that perimenopause starts for many women in their 40s, though it can begin sooner or later.

Perimenopause symptoms include:

• Hot flashes
• Tender breasts
• Irregular periods
• Mood swings
• Fatigue
• Vaginal dryness / sexual discomfort
• Urine leakage (like when you cough or sneeze) or urge to pee more often
• Sleep disruption
• Lowered sex drive

Let me demystify a few of those. I won’t cover all of them, because some like “fatigue” speak for themselves. But others are unusual in how we experience them and how they impact our sexuality.

Hot Flashes

Given the word “flash,” I anticipated a rush of heat barreling toward me. But that’s not how it felt.

What we’re experiencing is a heat flush. It’s just like when you exert yourself so much you get overheated, and a wave of warmth slowly rises until you suddenly realize that you’re really hot.

Only with menopause, you didn’t exert yourself. Rather, hormonal changes affect our body’s temperature control; that is, perimenopausal women accidentally overheat sometimes because the system is re-calibrating. These waves of heat tend to pass within a few minutes, and the flushes usually subside or go away altogether once you reach menopause.

How do hot flashes affect your sex life? Well, it may impact your desire for skin-to-skin contact. If you’re in the middle of a heat flush, you’re unlikely to be all: “Cuddle up close, my beloved, so I can sweat all over you!”

And then there’s the possibility that you’re right in the middle of sexual activity with your husband, and the heat comes over you like an ocean tide. Suddenly, you do as I’ve done—push away with an “Oh my gosh, I’m so hot. Hang on. I need a break.”

But that tide ebbs, the wave subsides, the heat passes. The lovemaking continues.

So yeah, hot flashes can be a challenge. But I’ve yet to talk to any wife who says hot flashes killed her sex life.

Vaginal Atrophy (Dryness / Discomfort)

The #1 issue with perimenopause/menopause and sexual intimacy is the changes in your vagina. Sorry to break it to you, but your hooha is aging—like the rest of you—and it may need extra care to remain spry and sex-capable.

As you move toward or reach the end of ovulation, your estrogen levels go way down. That means your vagina doesn’t secrete moisture as well, but you also experience vulvovaginal atrophy.

Before menopause, when the vagina is well supplied with estrogen, its lining is thicker and has more folds, allowing it to stretch with intercourse and childbirth. After menopause, when levels of estrogen are low, the vaginal lining is thinner and has fewer folds, which makes it less flexible.

Changes in the Vagina and Vulva, Sexual Side Effects of Menopause | The North American Menopause Society, NAMS

So you’re drier and less flexible. Given that sex requires lubrication and stretching, it’s not surprising that many women then experience discomfort during intercourse.

How prevalent are these symptoms? In a 2015 self-report study of over 1,500 women aged 55 and above, 45% of sexually active women aged 55 and above reported pain or discomfort during sex “usually” or “always.” Ouch.

Does that mean you should halt sex? No, because (1) there are varied ways of addressing estrogen deficiency and vaginal atrophy, and (2) not having sex can worsen the condition:

When a woman doesn’t have intercourse or other vaginal sexual activity on a regular basis following menopause, her vagina may also become shorter and narrower. Then, when she does try to have intercourse, she is likely to experience pain, even if she uses a lubricant…. Continuing to have regular vaginal sexual activity through menopause helps keep the vaginal tissues thick and moist and maintains the vagina’s length and width. This helps keep sexual activity pleasurable.

Changes in the Vagina and Vulva, Sexual Side Effects of Menopause | The North American Menopause Society, NAMS

What can you do? Among your options are:

• Generous lubricant use during sexual activity
• Locally applied estrogen cream
• Vaginal suppositories of estrogen
• Vaginal moisturizer, like Replens or KY Liquibeads
• Pelvic therapy
• Vaginal dilators
• Local numbing agent
• DHEA supplements (but see caveat below)

I included that last one because it’s often suggested as a fix, but I’d be remiss if I didn’t note my own reluctance. Mayo Clinic and other well-established medical communities do not currently recommended supplemental DHEA, and you can read about their concerns here.

Regardless, study your options and discuss them with a knowledgeable health care provider who can tailor advice to your situation. Please don’t suffer with vaginal dryness or sexual discomfort when there’s so many ways to get around that hurdle.

If you experience ongoing or intense pain, see a specialist. Chris Taylor of The Forgiven Wife has an excellent post on pursuing that course.

Lowered Sex Drive

So you’re supposed to be having sex, with a few adjustments, to keep your vajayjay in good health—but what if you don’t feel like it? What if your desire or sexual responsiveness has taken a nosedive with the arrival of perimenopause or menopause?

According to one study of 2,020 Australian women, ages 40–65 (cross-sectional, nationally representative, community-based sample), low desire was an issue for 69.3% of middle-aged women. That’s really high, y’all. Though the study doesn’t say how many experienced low desire before, the researchers did correlate vaginal dryness and pain during intercourse as factors affecting desire.

Well, of course. If something really hurts, why would you want to do it again and again? But remember that sex is not supposed to hurt! God created it to feel good.

In addition, other symptoms mentioned above—fatigue, mood swings, sleep disruption—can play into lowered sexual interest. If you don’t feel good overall, it can be difficult to pull together the oomph needed to engage in physical intimacy.

That said, some wives report higher sexual interest during perimenopause or after menopause. That could be due to a few different factors:

• Lack of concern about getting pregnant (aka “Freedom!”)
• No more contraception planning
• Kids older or grown, so sex can happen without disruption
• Testosterone spike (when estrogen drops, testosterone gets freed up a bit)
• Husband’s older-age ability to last (for some, when he goes longer, her interest’s stronger)
• Accumulated knowledge of her body and what arouses and satisfies her (“Face it, girls, I’m older and I have more orgasms.”)

Menopause can thus lower or increase sexual interest. If the former is happening, tackle the underlying causes. That may require talking to a doctor, adjusting your schedule, changing your diet, etc. But face that issue head-on.

And if you’re one of those with a sudden surge of desire, you may simply hang on and ride the roller coaster with your hubby, assuming he’s willing and able. But a warning: Your surge may come with more sexual temptation than before. Sadly, some middle-aged woman with new-and-improved sex drives have fallen into affairs.

Talk to your husband about what you’re dealing with, actively embrace healthy sexual thoughts and actions (revisit Philippians 4:8 for inspiration), and stay focused on the right outlet for your increased interest. “I am my beloved’s and my beloved is mine” (Song of Songs 6:3).

Menopause, the Marshmallow from Mars

So what’s menopause really done to my sex life?

Thankfully, it hasn’t been the Stay Puft Marshmallow Man terrorizing my neighborhood. It’s been more like the marshmallow analogy from the TV show Veronica Mars (of which I’m a huge fan, by the way).

Teen detective Veronica Mars puts out a tough, don’t-mess-with-me vibe, just like menopause. But as her best friend Wallace puts it: “Underneath that angry young woman shell, there’s a slightly less angry young woman who’s just dying to bake me something. You’re a marshmallow, Veronica Mars. A twinkie!”

Menopause has its challenges, its moments, its angry old-woman shell, but it’s soft underneath. It just means I’ve reached that age when sexual intimacy no longer has the potential for procreation, and yet God continues to bless our marital union with pleasure and intimacy.

With a few adjustments here and there, you too can embrace all the blessings God still wants to give your marriage bed.