In 2019, Joanne LaMarca Mathisen, co-executive producer and co-producer of the PBS documentary The M Factor: Shredding the Silence on Menopause, started experiencing “very painful sex.”
Later, at lunch with friends, she asked if anyone else was dealing with the same issue. The answers were sobering. Between pain and lack of desire, many women had stopped having sex, and most were okay with that.
“I didn’t know it was menopause,” Mathisen says. But talking to other women was illuminating and, eventually, this conversation led to her working on the documentary.
Not every person with a uterus will go through childbirth, but they will all go through menopause, yet there is little attention paid to it. Society places an emphasis on women during the reproductive years, experts say. “I do find that there is a decrease in valuing women when they are menopausal. The whole sexy thing—is kind of taken away,” says Dr. Jessica Shepherd, MD, chief medical officer at HERS, and author of Generation M: Living Well in Perimenopause and Menopause. It’s a well-known fact that women’s bodies change during menopause, sure, but what’s often overlooked is how those changes impact these women’s sex lives.
The loss of estrogen, progesterone, and testosterone can have dramatic effects, says Dr. Shepherd. Your libido may be damaged from loss of testosterone, and the vagina loses elasticity as the tissue thins and loses lubrication (moisture), due to a decrease in estrogen and progesterone.
It’s a perfect storm of decreased sex drive and increased vaginal dryness—the latter of which tends to lead to irritation, and, ultimately, painful sex. Without enough lubrication in the vagina, there will be friction during sex, further contributing to the pain.
Not to mention, there may be a direct relationship between desire and sex as well, says Dr. Stephanie Faubion, MD, medical director at The Menopause Society, and director of Women’s Health at the Mayo Clinic. Desire can be affected by pain, depression, vaginal dryness, or plain exhaustion. “If you offer a woman a platter of sleeping or a platter of sex, she’ll take the sleep,” says Dr. Faubion.
Too many women experiencing menopause either suffer in silence or sacrifice their sex life to avoid pain. If you’re one of them, know that you don’t have to—and, in fact, you shouldn’t. “Nobody should have painful sex,” says Dr. Faubian. “You should never grin and bear it.”
Ahead, experts share options to help you make the most of your post-menopausal sex life.
1. Ask your doctor about hormone replacement therapy.
In the early 2000s, women were warned against hormone replacement therapy (HRT) was potentially dangerous, due to a study that showed an increased risk for heart attack, stroke, and breast cancer. But that study has largely been debunked in the years since, and a 2007 update to the study actually found that women in their 50s who took hormones had a 30 percent lower risk of dying than those who didn’t. Many other reports, including one in 2018 with long-term safety data, have also found HRT to be safe for women who begin treatment before 60.
Not only is HRT perfectly safe, but “in terms of sexual health, it improves blood flow, elasticity, and lubrication when given in low doses to the vulvar and vaginal tissue,” Dr. Faubion says. Plus, arousal-enhancing options abound. “If you do need help from a medical perspective, there are really some fascinating tools and modalities that are out there for libido and also for vaginal dryness,” says Dr. Faubian. “We have things such as vaginal estrogen, which can be used in the form of hormone replacement therapy and can be applied to the vaginal tissue in the form of cream, vagina ring, vaginal tablet, or vaginal insert.”
Technological advancements have created non-hormonal treatment options, too. “We also have lasers that actually stimulate the tissue in the vaginal space,” says Dr. Shepherd. “The stimulation of tissue helps regenerate the elasticity, and also the flexibility of the tissue, which helps decrease any pain with intercourse.” Discuss your symptoms with your doctor (don’t be shy, please!), and together, you can figure out the best treatment plan for you.
2. If you’re wary of hormone creams, try over-the-counter lube.
Still not sold on HRT, or simply want to try an OTC fix first? “Lubricant is a good way to start addressing vaginal dryness, and because dryness happens where there isn’t enough lubrication (moisture) in the vagina, this can help decrease friction,” says Dr. Shepherd. “If lubricant, however, does not work, this is when vaginal estrogen can be more helpful to replenish dry vaginal tissue.”
3. Try different positions and techniques.
Due to the depth and angle of penetration, some sex positions can be more painful than others. “Women should experiment with different positions to see what is comfortable for them,” says Dr. Faubion. “To be clear, sex should not be painful. If it is, women should seek help.”
Solo sex may also be a comfortable way to achieve orgasm and can have an overall positive impact on your sexual health. Over a third of women going through menopause (36.2 percent) said that they had an improvement in their symptoms when they masturbated, according to early research from the Kinsey Institute at Indiana University in September 2024. “Masturbation has been shown to improve mood, improve sleep, and promote vaginal health,” women’s health expert Jennifer Wider, MD, previously told Women’s Health. “This is why it may help alleviate some of the symptoms of menopause.”
And while it may come as no surprise, it’s also worth noting that masturbation offers different benefits to women experiencing menopause than penetrative sex. “In [women] who are experiencing vaginal dryness, intercourse will be painful and getting to the point of orgasm may be difficult and not have the same desired results,” Wider said.
4. Remember to practice safe sex.
Even though you can’t get pregnant, Dr. Shepherd says, “in all instances, it is absolutely important to ensure and promote safe sex, which includes protection if with an unknown partner or a change in partner.” If not in a long-term monogamous relationship, your best bet is to use a condom (and ones that feature added lubrication can’t hurt!).
5. When sex isn’t appealing, lean into other forms of intimacy.
PSA: Penetrative sex isn’t the only way to connect with your partner. There are so many ways you can explore each other’s bodies, from erotic touching and trying sex toys to simply cuddling and snuggling. “We teach a lot of patients who maybe are cancer survivors, or males who might have issues with ED that there’s outercourse, which includes dry humping, fingering, dry sex, and grinding,” says Dr. Shepherd. You can also sub outercourse for intercourse with oral sex, mutual masturbation, and even sensory play. Basically, the non-penetrative possibilities are endless!
6. Find a frequency that feels right.
Everyone has different ideas about their desired frequency of sex, says Dr. Shepherd. Some people might only have sex twice a year with no complaints, while others have it three times a week. But whatever your sex schedule, you should be in agreement with your partner.
If you have different levels of desire, the best (and perhaps only) way to bridge this gap is to talk about each person’s wants and needs. “Women should engage their partners in discussions about menopause, the changes that occur with menopause, and, in general, should communicate about their sexual needs,” Dr. Faubion says. “This needs to be an open dialogue between partners.” That open dialogue can include a negotiation with your partner to figure out a frequency that meets those wants and needs.
Of course, if you try this and still aren’t satisfied with your sex life, you can also work with a sex therapist.
The bottom line: Your sex life isn’t over after you go through menopause. Instead, embrace the possibility of a new era in pleasure.
Meet the Experts: Dr. Jessica Shepherd, MD, is the chief medical officer at HERS and author of Generation M: Living Well in Perimenopause and Menopause. Dr. Stephanie Faubion, MD, is the medical director at The Menopause Society and director of Women’s Health at the Mayo Clinic.
Morgan Baker is the author of the memoir, Emptying the Nest: Getting Better at Goodbyes. She teaches at Emerson College and privately. She is the mother of two adult daughters and lives with her husband and two Portuguese water dogs outside Boston.
