How to Keep Your Sex Life Satisfying After Menopause

A new study of menopause-related symptoms like vaginal dryness and pain during sex has experts talking about whether these are fixable problems.

For many women, perimenopause and menopause come with a host of physical and emotional curveballs, including changes to their sex drive and to the experience of sex itself.

During and after the menopause transition, as many as 4 out of 5 women experience what’s called the genitourinary syndrome of menopause — a collection of symptoms including vaginal dryness, burning, urinary issues, and vaginal pain during sex that’s described as cut glass or barbed wire.

Findings from a new study of Japanese women suggest that women who regularly engage in sexual activity are less likely to experience vulvar pain than women who don’t have sex. Researchers concluded that “some sexual functions and symptoms change with age but may be maintained in women who engage in more regular sexual activity.”

Some experts, however, think that it would be a big mistake to conclude from the data that more sex will solve the medical issue of painful sex. Indeed, the direction of the relationship between not having sex and painful sex likely goes the other way, says Lauren Streicher, MD, the founding medical director of the Northwestern Center for Sexual Medicine and Menopause in Chicago.

“What this observational study basically found is that women who don’t have pain during sex are the ones having sex. And women who are having pain during sex are less likely to be sexually active — also not surprising,” says Dr. Streicher, who wasn’t part of the investigation.

While Desire Declined, Orgasm and Sexual Satisfaction Stayed the Same

The study looked at more than 900 Japanese women ages 40 to 79 who had been sexually active within the past year.

Researchers split them into two groups:

Women who’d engaged in sexual activity in the past three months (the “regular activity” group)
Women who hadn’t been sexually active in the past three months but had in the past year (the “lower activity” group).

Key findings included:

Women who were sexually active in the past three months reported fewer symptoms of vaginal dryness, pain, and irritation during their daily lives.
Desire, arousal, and lubrication ability declined with age but orgasm and satisfaction stayed about the same, especially among women who maintained regular sexual activity.
Women in the regular activity group were generally younger and more likely to be premenopausal, which could partially explain the findings, according to the authors. Still, the link between regular intimacy and fewer symptoms remained, even after adjusting for factors like age and hormone therapy.

Is There Any Truth to ‘Use It or Lose It’?

For women with genitourinary syndrome of menopause who experience pain during intercourse, having intercourse more often will not help sex become less painful, says Streicher.

“Quite the opposite,” she says. “If it’s painful, intercourse makes it worse. Your body goes into ‘defense’ mode — pelvic floor muscles tighten and you have more dryness."

But there is some truth to the “use it or lose it” adage for people who have pain-free penetrative sex, says Streicher.

“If they are having penetration on a regular basis, whether it’s a penis or a toy or a vibrator or whatever they’re using, that does stimulate blood flow, it does help with lubrication, and it does keep the tissue elastic. So there is some truth to ‘use it or lose it,’ with the caveat that this is for people who don’t have pain with intercourse,” she says.

Having Pain During Sex? Talk to a Menopause Expert to Get Treatment

“A big takeaway here is that it is never okay to have pain with sex. If you have pain with penetration, you should stop having intercourse or penetrative sex. I don’t say, ‘Don’t have sex,’ because you can have sex a lot of ways other than penetration,” says Streicher.

You should talk to a healthcare provider — preferably a menopause expert — to get treatment, she says.

Monica Christmas, MD, an associate medical director of the Menopause Society and an associate professor obstetrics and gynecology at UChicago Medicine, says the findings highlight the importance of diagnosing and treating genitourinary syndrome of menopause.

“Unlike other menopause-related symptoms like vasomotor [hot flashes and night sweats] or mood-related symptoms that can improve over time without treatment, genitourinary symptoms do not,” says Dr. Christmas, who wasn’t an author of the study.

Vaginal Estrogen Therapy Is the Most Effective Therapy

For mild discomfort during intercourse, over-the-counter moisturizers and lubricants may provide some relief, but when symptoms persist or are more moderate to severe, prescription therapy is warranted, Christmas says.

“Local low-dose vaginal estrogen therapy is safe and highly effective at alleviating bothersome vulvovaginal symptoms contributing to pain and avoidance of intercourse,” she says. “Unlike systemic hormone therapy, there are almost no contraindications to local low-dose vaginal estrogen therapy.” A contraindication is a condition that constitutes a reason not to take a certain treatment because of potential harm.

Vaginal estrogen therapy comes in numerous formulations, including a vaginal pill, insert, and cream administered twice weekly, or a vaginal ring that is inserted every three months. “It can be started at any time and continued indefinitely,” Christmas says.

While vaginal estrogen therapy is effective for many women, it won’t solve the issue for everyone. “That’s why it’s important to see an expert in person for a diagnosis,” she says.

Bottom line: No one should have to suffer when there are safe and effective treatment options. “And although optimal sexual health is integral to overall well-being, it is also imperative to recognize the effect these symptoms can have on women who aren’t sexually active. Treatment should be offered to anyone with symptoms, whether they are engaging in sexual activity or not,” says Christmas. “Normalizing the use of local low-dose estrogen therapy should be a thing.”

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