If you’ve been wondering, “Why is sex after menopause more painful?” or “Why am I not getting as wet as I used to?” – the first thing I want you to know is that you’re not broken.
This is because your body is going through significant hormonal shifts. Unlike hot flashes, which tend to eventually fade over time, the impact of hormonal changes on your vagina and vulva is chronic and progressive.
But does that mean your days of comfortable, satisfying sex are behind you? Not at all.
Let’s break down what’s really going on in your body and what you can do to enjoy sex after menopause.
Why Does Sex Feel Different After Menopause?
When estrogen levels drop, your vaginal tissue naturally becomes thinner, less elastic, and dryer. The healthy, flexible collagen that once kept your vaginal walls supple starts to break down.
In its place? Weaker, stiffer tissue that just doesn’t stretch the way it used to. Even the vaginal canal can become smaller and less flexible, making sex feel uncomfortable or painful.
Moreover, estrogen loss also reduces the number of blood vessels in the vaginal area, which play a big role in natural lubrication. Moisture created with arousal comes in part from fluid seeping through vaginal walls from blood vessels. With fewer vessels, your body might struggle to produce the wetness you once had—no matter how turned on you are.
Can Women Enjoy Sex After Menopause?
Absolutely!
While these changes may sound overwhelming, there are plenty of solutions to help you enjoy pleasurable, comfortable sex again. If you’re starting to notice less natural vaginal moisture or discomfort, addressing it early can make a big difference.
As I often tell patients, “Don’t wait until you’re a D student down there to ask for help. If you’re at a B level now, let’s keep you there, or better, help you become an A student.”
4 Treatments for Improving Sex After Menopause
When it comes to sex after menopause, the key is to work smarter, not harder. By keeping your vaginal tissue healthy and supporting your body’s natural functions, you can improve comfort and pleasure. Here are four effective options:
1. Vaginal Estrogen
Vaginal estrogen has been one of the most effective ways to restore vaginal health. Available in creams, tablets, and rings, it’s designed to nourish and rebuild vaginal tissue, improve elasticity, and restore vaginal wetness. Many women might worry about safety, but the good news is that vaginal estrogen use has not been linked to an increased risk of cancer or heart disease.
2. Oral Medication
Ospemifene is an oral medication that’s not a hormone but works similarly in certain tissues. It activates estrogen receptors in the vagina and bladder while leaving other parts of the body unaffected, except the bones. For women with osteoporosis or osteopenia, this can offer valuable support. It’s a once-a-day pill you can take with food, making it easy to incorporate into your routine.
3. CO2 Laser Therapy
Recognizing the need for a non-estrogen option to address vaginal atrophy in breast cancer survivors, I pioneered the use of CO2 laser in the US both intravaginally and on the vulva. Since 2015, I’ve taught clinicians this technology on five continents and advocated for women’s health, reproductive, and sexual rights.
In a nutshell, this treatment is about creating tiny micro-injuries in the vaginal tissue. As your body repairs itself, it builds fresh collagen, restores blood flow, and strengthens the tissue, improving both wetness and flexibility.
4. Pelvic Floor Physical Therapy
For women dealing with pelvic pain, tight muscles, or vaginal discomfort, pelvic floor physical therapy can be life-changing. Therapists use targeted techniques to release tension, enhance blood flow, and restore strength. While it can require time and investment, the results can be transformative, especially for women who’ve struggled to enjoy sex due to discomfort or pain.
Finding the right solution can feel tricky but you don’t have to do it alone. Book a free 15-minute call, and I’ll help you get started.
