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Healthy sex in midlife

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Many women are surprised by the impact menopause has on their sex life. Some women enjoy sex more after menopause, while others feel a drop in their sex drive. Be honest and open with your doctor about your concerns, so you can get the help you need to enjoy a healthy sex life.

Some women lose interest in sex because of:

  • vaginal dryness, which may be caused by the drop in estrogen, can make sex painful
  • hot flashes, irritability, or sleeplessness
  • emotional changes, stress, depression, or fatigue
  • a partner's changing sexual abilities or boredom with your sex life
  • less time with your partner or not having a partner
  • a serious illness or surgery or side effects of medications

Keep things lively

Menopause symptoms can cause some women to lose interest in sex, but it doesn't have to. A little experimentation can help:

Enjoy more foreplay. Longer foreplay can increase vaginal lubrication and boost your desire.

Spend time with your partner. Take a walk, go out for dinner and a movie, or just relax and talk. Experiencing emotional intimacy and closeness can help with sexual intimacy.

Try a lubricant. There are lots of nonhormonal vaginal lubricants or moisturizers available without a prescription. Apply lubricants, which are water-based, every time you have sex, and moisturizers just 2 or 3 times a week. Avoid petroleum jelly and creams and lotions that weren't made for vaginal moisturizing because they can introduce bacteria and infection into your vagina. 

Tone up with Kegel exercises. These simple exercises can improve your sexual function and improve bladder control at the same time. We recommend that all women do Kegel exercises.

Start an exercise program. Exercise can increase blood flow to your vagina.

Experiment having sex at different times. Enjoy sex in the morning or afternoon rather than at night when you and your partner are tired.

Talk to your doctor about using an estrogen cream. Estrogen creams, applied in and around the vagina, or an estrogen-filled vaginal ring or tablet, can help increase muscle tone and lubrication.

Consider adding testosterone to your HRT. With aging, your ovaries produce less testosterone, so your desire may also decrease. Sometimes, adding testosterone to your hormone therapy is helpful. Talk to your practitioner about whether testosterone is a good option for you.

Don't give up on sex

Regular sex, alone or with a partner, can strengthen the vaginal walls and reduce vaginal discomfort.

Be sure to use birth control and practice safe sex to avoid pregnancy and sexually transmitted diseases.

Reviewed by: Juanita Watts, MD, October 2014

Additional Kaiser Permanente Reviewers

© 2014 Kaiser Permanente