For many older women, talking about sex can be downright awkward. But if you want to enjoy a happy, healthy sex life (which has been shown to reduce stress and improve heart health), candid discussions with your partner and doctor are often essential.
“Women over 50 make up a large part of our population, and we need to make space for menopause to be talked about more openly,” says Natasha Jenkins Cooper, MD, a gynecologist at Rush. “It’s a normal part of aging, and there’s support that can help women transition through this stage of life more comfortably.”
Here, Jenkins Cooper offers advice to help older women have a fulfilling sex life after menopause.
What is menopause?
As you near menopause, your ovaries produce less estrogen and other hormones. Doctors call this transitional time perimenopause, and it often starts four to five years before your final period.
“The transitional phase can be really challenging for women,” Jenkins Cooper says. “One minute you feel pretty normal and then the next minute you don’t. It can make you question ‘What’s going on here?’”
A woman reaches menopause when she has gone through 12 consecutive months without any periods. After that, she’s considered postmenopausal. The average age of menopause is 51, but Jenkins Cooper says it can depend on the person.
“You may start having symptoms when you’re 44 and someone else may be 50 years old,” she says. “So going to speak to an OB-GYN or your primary care provider as early as you can is important.”
The causes of sexual problems in older women
The loss of estrogen and decreased collagen from menopause can make your vaginal walls thinner, drier, less elastic and sometimes inflamed, so you may experience vaginal burning and itching. That said, sex may be uncomfortable or even painful.
When vaginal tissue is thinner and more fragile, sex can cause tiny tears in the vagina, which make women more susceptible to sexually transmitted infections.
“If you experience any postmenopausal bleeding, that should be checked right away,” Jenkins Cooper says. “Even if it seems related to sex or a possible tear, we need to rule out more serious causes, including cancer, and make sure nothing is missed.”
Dwindling estrogen can also decrease the healthy bacteria in your vagina, raising the risk of urinary tract infections.
After menopause — when your ovaries stop secreting estrogen altogether — vaginal problems like these become even more likely.
What to do if sex is painful or uncomfortable
Some women simply stop having sex altogether. But avoiding sexual activity actually can make matters worse; with sex, the adage “use it or lose it” is especially true. It’s also important to note that more frequent sex promotes vaginal elasticity and lubrication, both of which decrease as women age.
“If sex is painful or uncomfortable, it simply means that some changes might be necessary,” Jenkins Cooper says. “Just because these issues are likely to occur doesn’t mean that you have to tolerate them.”
There are effective remedies:
- Vaginal lubricants. Over-the-counter silicone-based products (such as Astroglide and K-Y Jelly) can temporarily ease vaginal dryness and discomfort if you use one before or during sex.
- Vaginal moisturizers. You use these over-the-counter products (such as Moist Again and Replens) every few days to help with dryness, as well as symptoms like burning.
- Prescription low-dose vaginal estrogen. You apply this directly to your vagina, usually as a cream. It can help restore vaginal tissue to its premenopausal state and reverse thinning and dryness, and it may also help prevent urinary tract infections.
- Vaginal suppositories. Over-the-counter hyaluronic acid suppositories can help increase moisture in the vaginal tissue. They’re a non-hormonal option that may ease dryness and can be used on their own or alongside vaginal estrogen for added support.
These options are very low-risk forms of estrogen therapy, since it is mainly absorbed by your vagina and not your bloodstream — unlike hormone therapy delivered through a pill or patch, which may raise the risk of stroke, breast cancer and blood clots. If you have heart disease, however, talk to your doctor before using topical or vaginal estrogen to make sure it’s safe for you.
- Hormone therapy. If you’re also having symptoms like hot flashes or night sweats, hormone therapy may be an option. “Starting hormone therapy earlier in the menopausal transition helps your body maintain the estrogen it’s used to, which can ease symptoms and support vaginal health and comfort over time,” Jenkins Cooper says.
- Testosterone — yes, that’s the male hormone — patches can improve sexual response. “Your testosterone starts to gradually go down in our late 20s and 30s. So for perimenopausal women, you may feel like your libido is low,” Jenkins Cooper says. “And when we go through menopause, that level continues to go down, but it can be treated with testosterone.”
New positions may also be helpful in reducing discomfort brought on by age-related problems, such as osteoarthritis.
Feeling comfortable and confident at any age
While your body has changed over the years, you have so much more to offer in terms of having a healthy and fulfilling relationship.
“Body positivity is key for aging women,” Jenkins Cooper says. “Embrace your body and appreciate all that it’s been through as you entire this new chapter.”
Taking care of your body can help build on that confidence. Exercising at least three times a week for 30 minutes and eating right can help combat health problems that can interfere with a good sex life, such as obesity, high blood pressure and diabetes.
Jenkins Cooper adds that honest conversations about comfort, desire and mood can go a long way, too.
“Talking with your partner and your gynecologist sooner rather than later can help you feel supported and find relief. So if something doesn’t feel right or is painful, speak up,” she says. “Pushing through discomfort can make symptoms worse, but a conversation can lead to changes or treatments that help.”
Redefining 'Safe Sex'
Unfortunately, pregnancy isn't the only issue sexually active women have to worry about.
If you’re not in a long-term monogamous relationship, regardless of your age, you must insist that your partners always use condoms.
Unlike Generations X and Y, older women — and men — didn't come of age worrying about HIV/AIDS and other sexually transmitted diseases, so incorporating safe sex practices into an intimate relationship isn’t as automatic. Condom use, for many older women, fell off the radar once they reached menopause and the threat of unwanted pregnancies disappeared.
But thanks to Internet dating and erectile dysfunction medications, more and more older adults are having sex. As a result, instances of STDs in this age group are on the rise according to the AARP.
Regardless of age, it’s important that all sexually active women be proactive about protecting themselves and their partners against STDs. This means talking about your sexual health with your partner, getting screened for STDs — which can lie silent and dormant for years — and using condoms, even if you're the one who has to go to the drug store to purchase them.
If you feel too embarrassed to buy condoms at the store, you can easily — and discreetly — order them online.
