Menopause has a funny way of changing things no one warned us about—including what happens in the bedroom. Maybe your libido has gone MIA. Maybe sex suddenly feels uncomfortable. Or maybe you’re more interested in sex than ever, but what worked in your 30s just isn’t doing it anymore. And while everyone seems happy to talk about hot flashes, what happens to our sex lives during and after menopause doesn’t get nearly enough attention. So when things start to change, it’s easy to wonder: Is this normal—and what can I do about it?
The good news? Different doesn’t have to mean bad. Carol Queen, PhD, Good Vibrations Staff Sexologist and Curator of the Antique Vibrator Museum, gets real about what can happen to desire, arousal, comfort, and pleasure during menopause—and why this stage of life might actually be the perfect time to ditch the old rules and figure out what you want from sex now.
What changes during menopause? How can perimenopause and menopause affect sexual desire, arousal, comfort, and overall sexual function?
A lot can change, but one of the interesting challenges about perimenopause and menopause is that it isn’t experienced the same way by everyone. That’s something I always want to emphasize. And one of the other things I call out is that seemingly non-sex-related things can have a huge impact on sexual issues.
Sexual changes can include lower desire, more difficulty becoming aroused, and changes in orgasm. And the orgasm piece is important because orgasm is powered by high arousal. If changes in arousal aren’t recognized or taken seriously, orgasm can become more difficult, too.
Lubrication can change, and over time there can be vaginal changes that affect comfort and pleasure with penetrative sex. The inner mucosal tissue can lose moisture and flexibility, and things can become tighter and more uncomfortable.
But it’s not just about what’s happening to the genitals. Dehydration can be harder to recognize. Vasomotor symptoms—hot flashes and the like—can certainly get in the way. And sleep problems can be huge. I would argue that sleep might be the most important thing to stay on top of, because messed-up sleep affects libido, energy, mood, mental health, and your general sense of wellbeing—or lack thereof. All of those things have a relationship to how you experience your sexuality.
And here’s something I think is worth saying: if you have any interest in ever being sexual in these ways in the future, consider staying in the game through solo stimulation, whether or not you’re partnered. You can get back in the saddle after a spell of no sex, but it may take a more mindful, focused, and time-intensive process to get there.
Are there other factors that can make these changes more challenging?
Absolutely. Menopause doesn’t happen in isolation. Other health issues can affect sexuality, as can problems in a relationship, stress, medications, and changes in mental health.
That’s why I don’t think it’s useful to look at every sexual change and simply say, “Well, that’s menopause.” Sometimes the things that aren’t obviously sexual are actually the things having the biggest sexual impact.
Is there anything that can actually get better during or after menopause?
Definitely. And, somewhat ironically, the changes themselves can open doors.
Menopause can prompt you to ask whether you’ve actually been living a sexually satisfying life. It’s a known time of life for changes in partnering and sexual practices, and sometimes those changes are overdue.
It can also inspire you to put a much greater focus on your health and wellbeing. And that will have sex-related effects.
I really like the idea of beginning or deepening a masturbation practice at this stage. When your body is changing, “know thyself” becomes super-important. You want to understand what’s happening, but you also want to focus on pleasure, not just on gathering information about your body.
And sex toys? They’re not just for young people. Vibrators can be particularly useful when you’re exploring changes in arousal or discovering that the stimulation that used to work for you isn’t quite enough anymore.
Lubricant is another big one. There are people who have never used lube until menopause who suddenly realize, “Oh my God, I wish I’d been doing this all along.” A lubricant that your body responds well to can be a sexual miracle.
Communication becomes super-important, too, especially if you have partners in your life. “Same old, same old” sex may start to be less enjoyable—or, in some cases, simply not work anymore. Your partner probably isn’t going to automatically know what has changed, what feels different, or what you need now. They have to go on a learning journey with you.
And partners who won’t go on that journey may not be the best partners for you at this time.
Sex that is deeply communication-based is almost always better sex. If you’ve never learned how to do that, sex therapists are standing by. And if there are things you want to try, add, or change, you’re going to need to be able to talk about them. Mind-reading is a great skill, but almost no one is actually endowed with it.
What can help make sex more comfortable and enjoyable during and after menopause?
Start with a lube you like. You may find that you prefer something formulated specifically with menopausal bodies in mind, and you may have to try a few before you find one that feels right for you. That’s completely normal.
I’d also encourage people to experiment with vibrators. Try external stimulation and see how much more arousal you may be able to access. Insertive toys can also be useful for maintaining vaginal readiness and pleasure, particularly if penetrative sex is something you want to continue or return to.
And remember that there are tons of sexy things that aren’t even genital. Erotica and porn, kink and roleplay, erotic talk, mutual masturbation—there’s a lot to explore. Menopause can be a good time to get curious about what else turns you on.
The health basics matter, too. Stay hydrated, eat well, get your checkups, move your body, and maintain your flexibility. And don’t hit the alcohol too hard. Your overall physical and mental wellbeing is connected to your sexual wellbeing.
If you have partners—even a one-night stand—you need to communicate about your wants and boundaries and about the way your body responds now. Don’t accept painful or otherwise unsatisfying sex. This is a time of life when you can and must think in terms of your wellbeing.
And if you find that you can’t prioritize yourself, get some help. Therapists are standing by.
Hormone therapy can also be part of the conversation with your healthcare provider. Systemic hormone therapy, such as pills or patches, tends to have a more favorable risk-benefit profile when started earlier in menopause, and doctors may be more cautious about starting it when someone is more than about 10 years past menopause. Local vaginal estrogen is a different conversation and may be appropriate for some people later in menopause. It can make a substantial difference in vaginal comfort and, for some people, make penetrative sex much more comfortable.
How does partnered sex compare with masturbation during menopause?
There can be huge differences, especially if you haven’t spoken with a partner about the changes you’re experiencing.
Masturbation gives you the chance to explore, evaluate, and focus on what’s most pleasurable for you. It can genuinely keep you in the game. And it teaches you things you can then share with a partner.
It doesn’t have to be either/or, either. You can use toys together. You can masturbate during partnered sex. You can explore alongside each other. There are lots of ways to bring solo sexuality into partnered play.
With partnered sex, you either have someone who is willing to do this exploration with you—or you don’t. And sometimes you have a partner who doesn’t want to hear about your menopause changes. That’s a signal to advocate for yourself, masturbate more, or, yes, call in the therapists.
One other thing people should keep in mind is sexual health. Vaginal changes during menopause can make tissue more vulnerable to irritation and small injuries, which matters if you’re having condomless sex. Depending on your circumstances, some people may choose prevention strategies such as PrEP, and regular STI checkups are important.
Make sure your doctor knows you’re sexually active and that you want sexual healthcare. If they’re not cool with that conversation, get another doctor.
The larger point is that menopause doesn’t have to mean the end of your sex life. It can mean that your sex life needs to change. And that can be an invitation to become more knowledgeable about your body, more intentional about pleasure, and more honest about what—and who—you want.
Carol Queen, PhD
Good Vibrations Staff Sexologist & Curator of the Antique Vibrator Museum
Sometimes rediscovering your sex life means rediscovering yourself, too. Read one woman’s very honest account of reclaiming her sexuality and desire in midlife.
