When the ovaries stop producing estrogen due to menopause, menstrual periods stop. While not having periods or worrying about an unplanned pregnancy can benefit your sex life, aspects of menopause can affect your ability to become aroused and enjoy comfortable and fulfilling sexual activity.

How does menopause affect sexuality?

This depends on the person. Some people enjoy sex more; others find that their desire or response is less intense than before. Many people remain sexually active throughout their senior years. Just be aware that what feels good can change.

Half of women in their 50s report continued sexual activity, but this percentage declines to 27% in women in their 70s.

More than a third of women in perimenopause or menopause report having sexual difficulties, from lack of interest in sex to trouble having an orgasm.

The main culprit is declining levels of estrogen, which can reduce a person’s desire to have sex and make sexual arousal more difficult.

There are other factors that can make sexual activity less appealing. As aging progresses, chronic illness and injuries can deplete your energy, cause physical pain and change your body image — all of which affect the sex drive.

Vaginal dryness during sex

Painful sex after menopause can be a challenge. Too-little estrogen can reduce natural lubrication in the vagina and cause the vaginal canal to become less stretchy. Surgery or radiation can result in narrowing of the vaginal canal, scar tissue or sensitivity. Together, these factors can cause sexual activities involving penetration to be painful.

Sex drive and response in menopause

Discomfort is one aspect of menopause that can affect sexual activity and a diminished sexual response is another.

As you age, blood fills your genitals more slowly as you become sexually aroused, which means you may not have the same sensitivity you did before menopause. While medications exist that can create penile erections, so far there are none that restore desire during or after menopause.

Dealing with menopausal changes

If you want to continue a fulfilling sex life but feel held back by menopausal changes, there are steps you can take to lessen the impact of lower estrogen, diminished desire and less sensitivity. Here are some options:

• Ask about hormones. Hormone replacement therapy can ease menopausal symptoms, but can also increase the chances of serious health problems in some people, so your doctor will help you weigh the risks versus the potential benefit.
• Review your meds. If you are taking medications such as antidepressants that affect your libido, ask your doctor if making changes to your meds can help.
• Consider products: A range of commercial lubricants and vaginal moisturizers can make intercourse and other sexual activities more comfortable.
• Try something new: Reaching orgasm can take longer and require more direct and intense stimulation of the clitoris. Rubbing, touching or using toys such as a clitoral stimulation device may boost sensitivity and response.
• Check your mental health. If you are living with excessive stress, anxiety or depression, get help for these conditions, all of which can dampen sexual desire and response.
• Be true to yourself. Experts advise letting go of what you think everybody else is doing and exploring what’s enjoyable for you and your partner.

Less sex can be OK

Not everyone finds sex as gratifying after menopause, and that’s OK. It is important to accept your body and your feelings and not feel pressured to continue ― or give up on ― sexual activity.

Communicating with partners is key in setting realistic expectations about your changing sexuality as you age. A spirit of compromise can help reconcile differences in sexual drive among people who want to keep their sexual connection alive.

Sexual activities are not the only ways of expressing physical love and staying connected. Other intimate activities such as cuddling, sharing a bed, remembering happy times and laughing together can underscore the pleasure of being close.

Living your best life in menopause

Sexuality during and after menopause can start with a healthy lifestyle. Feeling good, getting enough sleep, being physically active and eating well can go a long way toward keeping the spark of intimacy and sexuality alive.

Along with supportive partners and clear communication, sexuality and intimacy thrive with an accepting attitude toward change. Making room for new emotions and attitudes will help menopausal people maintain a strong self-image and redefine their roles in sexual relationships, family and society.