Sexual health changes during menopause are common, though most women do not discuss them. Effective treatments exist.

What changes:

  • Decreased sexual desire (libido)
  • Decreased arousal and lubrication
  • Pain or discomfort during intercourse (dyspareunia)
  • Difficulty reaching orgasm
  • Changes in sexual satisfaction

Why it happens:

Both estrogen and testosterone decline with age. Estrogen is key for sexual tissue health, lubrication, and sensitivity. Testosterone, though present in smaller amounts in women, is important for sexual desire. The SWAN Study has extensively documented these changes, showing that sexual pain is one of the most consistent GSM symptoms across ethnic groups.

The Menopause Society states:

  • Low-dose vaginal estrogen relieves vaginal dryness and sexual pain caused by menopausal vulvar/vaginal atrophy
  • Ospemifene (SERM) is approved to treat GSM
  • Flibanserin is approved for low sexual desire but only in PREmenopausal women, not postmenopausal
  • Postmenopausal women are especially vulnerable to STIs because fragile vulvar tissues allow viruses to enter more easily
  • Regular vaginal sexual activity after menopause stimulates blood flow, maintains vaginal muscle tone, and preserves vaginal length and stretchiness
  • Testosterone therapy (transdermal) is used in Australia and UK for low libido; generally safe in appropriate dosing; not FDA-approved for women in the US

What helps:

  • Vaginal moisturizers and lubricants — immediate relief
  • Low-dose vaginal estrogen — treats underlying tissue changes; very safe
  • Ospemifene (SERM) — oral medication for moderate-severe dyspareunia
  • Pelvic floor physical therapy — can significantly improve sexual function
  • Couples counseling or sex therapy — when psychological aspect is significant

Practical tips:

  • Do not wait for discomfort to become severe before seeking help
  • Extended foreplay helps
  • Silicone-based lubricants last longer
  • Communicate with your partner — silence worsens the issue
  • A 2023 International Journal of Transgender Health study highlights that non-binary and transgender individuals also experience menopause-related sexual health changes and often struggle to find supportive resources