Let’s Talk About Sex (and Menopause): Solutions for a Healthy Body and Love Life
Menopause is a natural transition in your life as a woman, but it’s a wily beast that often brings unexpected changes—including those that affect sexual health. During menopause, many women experience shifts in desire, discomfort during intimacy, or other forms of sexual dysfunction that can leave them feeling isolated or frustrated. The good news? There are practical solutions available. With the proper knowledge and support, you can navigate these challenges and regain confidence in your sexual well-being.
Dys-What? A Doctor's Definition of Sexual Dysfunction
Before you shy away from the word dysfunction, we want you to know that nothing is wrong with YOU. Sexual dysfunction is a broad term that encompasses various difficulties related to sexual activity. Medical professionals define it as a persistent issue that causes distress or affects a woman’s ability to engage in satisfying sexual experiences. Not ready to open up about bedroom woes with yourself or your partner? Don’t fret. The key criteria doctors consider when diagnosing sexual dysfunction include:
Lack of Sexual Desire (Hypoactive Sexual Desire Disorder, HSDD): This could mean a simple lack of desire for sex or sexual activities. The clinical definition is broader, including a persistent or recurrent absence of sexual thoughts, fantasies, or interest in sexual activity that causes distress.
Arousal Disorder: Difficulty becoming physically aroused despite adequate stimulation, often due to reduced blood flow or hormonal imbalances.
Orgasmic Disorders (Anorgasmia): Difficulty or inability to achieve orgasm, even with sufficient stimulation.
Painful Intercourse (Dyspareunia or Genitourinary Syndrome of Menopause, GSM): Persistent pain before, during, or after intercourse, often linked to vaginal dryness and thinning of vaginal tissues.
If you follow us on social media, you may have heard us refer to menopause as reverse adolescence—and we meant it. Your body is transitioning from reproductive mode to (hopefully) full-blown R&R (rest and recreation), so it is dialing down the energy for baby-making and redirecting it back to the rest of you.
Internal Medicine doctors, OB-GYNs, and Menopause Society Certified Practitioners, like Dr. Shannon Cothran, assess these conditions by discussing symptoms, evaluating medical history, and sometimes conducting physical exams or hormone level tests. It’s important to speak openly with your healthcare providers to determine the best course of treatment. If open talk about sexual dysfunction or changes makes you cringe, one option is to write it down. Reading something you wrote may help you to share your experiences during your appointment openly.
Causes of Sexual Dysfunction During Menopause
Sexual dysfunction during menopause is common, but it’s not always openly discussed. The underlying causes are often a combination of hormonal, physical, and psychological factors:
Hormonal Changes: If you haven’t heard, your hormones change during menopause. What you might not know, however, is that as estrogen levels decline, vaginal tissues become thinner, drier, and less elastic, leading to discomfort or pain during intercourse (dyspareunia). Decreased testosterone can also contribute to lower libido. Estrogen also affects blood flow and sensitivity, which can impact arousal and orgasm.
Reduced Blood Flow: Estrogen helps maintain blood flow to the vaginal area. When levels drop, so does natural lubrication and sensitivity, making arousal more difficult. Reduced blood flow can also lead to an increased risk of urinary tract infections, further complicating sexual health.
Psychological Factors: Menopause can bring about mood swings, anxiety, and depression, all of which can affect sexual desire. Stress and body image concerns may also play a role. Many women struggle with feelings of aging, loss of fertility, or changes in their bodies, all of which can impact self-confidence and intimacy. It’s said that the brain is the biggest sex organ, so if your mind isn’t it, probably neither are you.
Other Health Conditions: Conditions like diabetes, high blood pressure, and pelvic floor disorders can also impact sexual function. Medications used to manage these conditions, such as antidepressants or blood pressure medications, may also contribute to sexual dysfunction.
Relationship Dynamics: Emotional intimacy and communication with a partner play a crucial role in sexual satisfaction. If a relationship is strained, or if partners are not on the same page about aging and intimacy, it can lead to a further decrease in sexual desire.
Now more than ever, finding a doctor you feel comfortable talking to is essential. Today, most doctors are well connected to a wealth of resources, so if they can’t help you in a clinical setting, they will be sure to find you someone who can.
“You’re not alone in experiencing changes in your sexual health—and you don’t have to just live with them. Your doctor is the right person to talk to. From hormonal shifts to pain, low libido, or difficulty reaching orgasm, there are real solutions available. With the right care, you can feel like yourself again.”
Common Symptoms of Sexual Dysfunction
Every woman experiences menopause differently, but some of the most frequently reported issues related to sexual health include:
Decreased Libido: A decline in sexual desire or interest, sometimes leading to frustration or relationship challenges.
Vaginal Dryness: Lack of lubrication leading to discomfort and increased risk of tearing during intercourse.
Pain During Intercourse: Thinning vaginal walls make penetration painful, leading some women to avoid sex altogether.
Difficulty with Arousal or Orgasm: Changes in sensation and blood flow can make it harder to achieve orgasm or feel pleasure.
Emotional Barriers: Feelings of frustration, embarrassment, or relationship strain due to sexual changes can create an emotional distance between partners.
Solutions and Treatment Options
Sexual dysfunction isn’t something that you have to accept as an inevitable female experience during menopause. There are many effective ways to restore comfort and pleasure. Below are some you may or may not have heard of.
Medical Treatments
Vaginal Estrogen Therapy: Available as creams, tablets, or rings, localized estrogen can help restore vaginal health and alleviate dryness. Unlike systemic hormone therapy, these treatments specifically target the vaginal area and have minimal impact on other body systems.
Hormone Replacement Therapy (HRT): Systemic HRT can help with overall menopausal symptoms, including sexual dysfunction. However, not all women are candidates for HRT, so resist the urge to self-diagnose and self-help when it comes to hormones and OTC solutions. If warranted, a healthcare provider will determine the best approach and dose for you.
Non-Hormonal Lubricants and Moisturizers: Water or silicone-based lubricants ease discomfort during intimacy, while vaginal moisturizers help with daily hydration and long-term vaginal health.
Testosterone Replacement Therapy (TRT): In some cases, low-dose testosterone therapy may help with libido, though it should be used under medical supervision. Women naturally have lower testosterone levels than men, but some research suggests supplementation can be beneficial in specific cases. A Menopause Society Certified Practitioner (MSCP) will not only be able to prescribe the hormone, but they will also be able to monitor how your body responds to it–something we deem the most crucial element of hormone therapy.
Ospemifene (Osphena): A non-hormonal medication that can help with vaginal dryness and pain during intercourse by acting on estrogen receptors in vaginal tissue.
PRP (Platelet-Rich Plasma) and Laser Therapies: These emerging treatments aim to improve blood flow and stimulate tissue regeneration, which may help with arousal and vaginal health.
Lifestyle and Holistic Approaches
Pelvic Floor Therapy: Strengthening pelvic muscles through Kegel exercises or guided therapy can improve blood flow, support bladder control, and enhance sensation. At Meno-Start, we’re a huge proponent of movement and strength training for longevity and feel-good health.
Mindfulness and Stress Reduction: Practices like yoga, meditation, and deep breathing can help reduce anxiety and enhance intimacy. Stress plays a significant role in sexual dysfunction, so managing it can have positive effects.
Regular Exercise: Physical activity increases blood circulation, boosts energy levels, and releases endorphins that enhance mood and libido. Consider a personal trainer if you find making time for body-focus fitness challenging. When you start a new habit, being accountable to someone can help you reinforce it. Once regular fitness becomes part of your routine, it’s easier to maintain on your own.
Dietary Changes: Eating a balanced diet rich in phytoestrogens (found in soy, flaxseeds, and whole grains) and omega-3 fatty acids (found in fish, nuts, and seeds) may support hormonal balance and improve overall well-being. Meno-Start offers fitness and nutrition coaching to start fresh with a new grocery list and meal plan, or get help integrating 1:1 tips and tweaks to your favorite go-to dishes. Sometimes an ingredient swap or an add makes all the difference.
Open Communication: Talking with a partner about concerns and desires can improve emotional intimacy and satisfaction. If you’ve already tried that, or feel that is too big of a lift right now, start with you. While many couples benefit from seeing a sex therapist or counselor to work through challenges together, 1:1 therapy or discussions with your MD are a good jumping off point.
“Many menopausal women are unaware or have misconceptions about conditions that may adversely impact their sexual life, which is why it’s really important to have regular care from an expert provider.”
Seeking Help is a Sign of Strength
Seeking help with sexual dysfunction is a sign of strength. One more time for the people in the back: Seeking 👏 help 👏 is a sign 👏 of strength. Congrats for taking the first step by exploring in-person and virtual solutions in Northern Virginia. Sexual dysfunction during menopause is common, but it’s not something you have to endure alone. Seeking help from a menopause specialist, gynecologist, or pelvic health expert can provide guidance and tailored solutions. As a woman, you may feel hesitant to discuss these issues, but healthcare providers are well-equipped to offer solutions that can significantly improve your quality of life. Better yet, what you share is confidential between you and your provider. Thanks to HIPAA, sharing personal health and wellness details comes with a worry-free guarantee.
If you are experiencing sexual dysfunction, know that you are not alone. Millions of women go through similar struggles, and many find relief through a combination of medical treatments, lifestyle changes, and open communication.
The key is to advocate for yourself, explore options, and remember that menopause does not mean the end of a satisfying sex life. It really doesn’t.
