What Nobody Told You About Intimacy, Vaginal Dryness, and Desire During Menopause
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Imagine being intimate with someone you love, someone that you're still very much attracted to, but instead of enjoying the moment, you're uncomfortable, maybe even in pain. And now you're starting to dread something that you used to look forward to. Now, you haven't lost your attraction, you haven't stopped loving your partner, but something has changed, and you're not quite sure why.
And maybe you've started making excuses to avoid intimacy because explaining what's happening feels even more uncomfortable than experiencing it. Now, look, I know I'm a man, and I cannot personally experience what you're going through, but after more than 20 years of working with women over 40, I can tell you that this is a conversation that I've had more times than you might imagine.
But what concerns me the most isn't just the discomfort that women are experiencing, it's how many women quietly accept it, believing that it's simply what happens as you get older. Well, [00:01:00] ladies, here's something you may not know. Vaginal dryness, painful intercourse, and changes in sexual desire are common during menopause.
But that doesn't mean you have to simply accept them. And here's something else that might surprise you. These changes aren't always just about sex. They can affect your confidence, your relationships, your everyday comfort, and how you feel about yourself. So today, we're talking about why sex and intimacy can feel different during menopause, what's really happening to your body, and most importantly, what you can do about it.
See, as a menopause education strategist, I help women understand menopause, how it can affect your body, your health, and your daily life, and more importantly, what you can do about it
I'm Tafiq Akhir, Mr. Menopause here, your go-to source for reliable, unbiased, evidence-informed menopause and healthy aging support. Welcome to the Menopause [00:02:00] Made Simple show. Now, since there are so many moving parts connected to this conversation, I'm gonna break things down into five different parts throughout this episode.
We're gonna start by talking about why sex can begin to feel different during menopause, including changes in desire, arousal, and pleasure. Then we'll talk about vaginal dryness, lubricants and moisturizers, and why understanding the difference between the two matters. In segment three, we're gonna cover what happens when your sex drive seems to have gone missing.
Next, you'll learn how to talk with your partner about intimacy and your changing needs. And finally, how to bring this up with your doctor so you can get real answers and explore your options. So let's get into segment one, which is all about when sex starts to feel different. Now, here's something that I wanna clear up right away.
Just because you're going through menopause doesn't mean your sex [00:03:00] life is over I've heard too many women sharing that they believe that once they reach a certain age, that they're just supposed to lose interest in sex, accept that things don't work the way that they used to, and simply move on.
Now, if you have no interest in sex and it's not related to menopause, that's one thing, but if you believe that these changes are something that just happens after a certain age that you just have to deal with, well, I can confidently say you do not.
Now, does menopause affect sexual health? Absolutely, and it can change how your body responds to sexual activity as well. It can also affect desire, arousal, lubrication, and even how comfortable sex feels. But those are different things, and understanding the difference matters. For example, as it relates to desire, some women say they don't think about sex as often as they used to.
Maybe they used to initiate intimacy regularly, and now the [00:04:00] thought just barely crosses their mind.
Others say they still enjoy sex once it gets started, but that spontaneous urge just isn't showing up the way that it used to. Now, something more women and their partners need to understand is the difference between spontaneous desire and responsive desire because spontaneous desire is when you're just going through your day, minding your own business, and suddenly you're thinking, "You know what sounds pretty good right about now?"
But responsive desire is different, right? That's when sexual interest develops after something pleasurable has already begun. Maybe it's kissing or touching, affection, or simply feeling emotionally connected to your partner. In other words, you don't necessarily start out wanting sex, but desire can develop as things progress.
And guess what? Both are normal ways of experiencing sexual desire. Now, this doesn't mean a woman should [00:05:00] engage in sexual activity when she doesn't want to. Desire, comfort, and consent always matters. But it does mean that a change in how desire shows up doesn't automatically mean that something is wrong.
And then we move on to arousal because wanting sex and your body physically responding to sex are not the same thing either. A woman can feel mentally interested in sex but notice that her body isn't responding the way it used to. . Or maybe you're experiencing physical arousal without necessarily feeling a strong desire to have sex.
And this is where menopause-related hormonal changes can become especially relevant because as estrogen levels decline, the tissues of the vagina and vulva can become thinner, drier, and less elastic. Changes in lubrication and tissue sensitivity can also make certain types of sexual activity uncomfortable or even painful.
And obviously, [00:06:00] if what used to feel good now causes burning, irritation, or pain, well, your interest in doing it again, well, can most likely change, right? Because over time, the discomfort can start affecting anticipation, desire, confidence, and even communication with your partner. So what might look like a loss of libido could actually involve several different factors.
And this is why it's so important that every sexual health concern during menopause does not get lumped into one big category of low sex drive. Because if the actual problem is vaginal dryness or painful intercourse, telling a woman she just needs to find ways to increase her libido doesn't address what's actually happening.
And another important distinction is that not every change in sexual desire is caused by hormones. Sleep problems, stress, certain medications, relationship problems, mental health, other [00:07:00] medications, and personal circumstances can all influence sexual interest and satisfaction. And some women just aren't interested in sex, and they're perfectly happy that way.
Not wanting sex isn't necessarily a medical issue, but it does become a concern when the change is unwanted, causes distress, affects your quality of life, or involves symptoms like pain that deserve real attention. Because the goal is not to get you to want more sex. The goal is to help women understand their sexual health and make choices that reflect what you actually want for yourself.
Next is a topic that doesn't always get the attention it deserves, which is vaginal dryness. Because this is one of those issues that women sometimes tolerate for months or even years without realizing that there are practical ways to address what they're experiencing. And there's a difference between something that helps with dryness [00:08:00] during sex and something designed to help with consistent vaginal moisture
So first, let's talk about lubrication because vaginal dryness is one of those things that can make a perfectly enjoyable intimate moment turn into something that you'd rather forget, right? And unfortunately, some of you have been led to believe that dryness is just part of getting older and something you're supposed to put up with.
Well, the good news is, like I said earlier, you don't have to. Just because something is common doesn't mean you have to accept being uncomfortable, and it's all about knowing what your options are and when to use them. Vaginal lubricants and vaginal moisturizers are not the same thing, and understanding the difference can make a real improvement in your comfort.
A lubricant is designed to reduce friction during sexual activity. Think of it as something you use when you need a little extra glide, right? Now comes the hard part because [00:09:00] there are so many options available nowadays. You've got water-based, silicone, and oil-based products, and they don't all work the same way.
Water-based lubricants are generally easy to clean up and compatible with most condoms and sex toys, although some dry out more quickly. Silicone-based lubricants tend to last longer, which can be helpful when friction is a concern, But some of those aren't compatible with silicone sex toys.
And with oil-based products, you need to be careful because they can weaken latex condoms So as you can see, what you choose does matter. And if you're sensitive to certain ingredients like fragrances, warming additives, or other irritating ingredients, be sure to avoid those products and opt for lubricants with ingredients you're more comfortable with.
Now, on the other side are vaginal moisturizers, which serve a very different purpose. Unlike lubricants, [00:10:00] which you generally use during sexual activity, vaginal moisturizers are designed to help with ongoing dryness. They're typically used regularly according to the product's instructions, whether you're having sex or not.
You can think of it this way. A lubricant helps to reduce friction in the moment. A vaginal moisturizer helps with ongoing dryness. And depending on your symptoms, you might even benefit from both. But here's something else that you should know. Sometimes dryness isn't just about needing a little extra lubrication.
As estrogen levels decline during menopause, vaginal and surrounding tissues can change. They can become thinner, drier, and less elastic. For some women, that can lead to burning, irritation, discomfort, or painful intercourse. And there's actually a medical term for this. And it's called genitourinary syndrome of menopause or GSM.
[00:11:00] GSM describes a group of genital, urinary, and sexual symptoms associated with hormonal changes during menopause. Something else important to know is that unlike hot flashes, which often improve over time, GSM symptoms can continue or even get worse without treatment.
So if you're experiencing ongoing dryness, irritation, or discomfort, don't assume it's something you have to just live with because there are options available.. For example, low-dose vaginal estrogen, well, it can help address menopause-related changes in vaginal tissue.
And before anyone panics because I said the word estrogen, you should know that low-dose vaginal estrogen isn't the same as systemic hormone therapy. It's designed to work primarily in the local tissues, which lower systemic exposure. Now, there are also other options, including vaginal DHEA, which might also be appropriate depending on your symptoms and medical [00:12:00] history.
And then there's pelvic floor physical therapy, which can be helpful when pelvic floor muscle problems are contributing to pain. Also worth knowing, not all painful sex is caused by vaginal dryness or menopause during this stage of life.
Infections, skin conditions, pelvic floor problems, and other medical concerns can also cause discomfort. That's why persistent, new, or worsening pain deserves a proper evaluation. And ladies, please hear me on this one.
You do not have to push through painful sex just to please somebody else. Your comfort matters, your pleasure matters, and your sexual health deserves the same attention as every other aspect of your health. So now we've talked about the physical side of sexual comfort, but what happens when the challenge isn't dryness or pain?
What happens [00:13:00] when you're physically comfortable, your relationship is fine, but you still find yourself thinking, "Hmm, I don't wanna have sex anymore"? Well, that leads to us talking about libido, because if there's one thing I've learned from talking with women about menopause, it's that changes in sexual desire can bring up a whole lot of questions and sometimes a whole lot of frustration too.
My clients have said, "Tafiq, I love my husband. I'm attracted to him. We have a great relationship, but I just don't feel like having sex anymore." And others have even shared that, "I don't even recognize that part of myself. I used to love sex. Now I couldn't care less." " And if you're single, you might be saying, "Well, I'm not seeing anyone right now, and I've stopped thinking about that part of myself altogether. But is that normal?"
Well, it can be. But either way, a change in sexual desire doesn't automatically mean that you've lost your sexuality. And whether you're in a [00:14:00] relationship or not, it doesn't mean that part of you is gone for good either. But if that change is bothering you, then it's definitely worth exploring what's contributing to it.
Now, we talked earlier about the difference between spontaneous and responsive desire, so let's look at what else can influence your sex drive. Because despite what some of the advertisements might have you believe, there isn't one magical hormone responsible for making you want sex.
They lead you to believe that there's just one hormone that'll flip the switch and suddenly you're ready for action. Well, unfortunately, human sexuality doesn't work quite that way. Estrogen and testosterone can influence sexual function and desire, but so can sleep, stress, medications, emotional well-being, physical comfort, and relationship dynamics.
And sometimes several of those factors are happening at the same time. For example, imagine [00:15:00] you're waking up three or four times at night. You're exhausted during the day, you're managing work and family responsibilities, and by the time you finally get into bed, all you wanna do is sleep. And now some online guru or a friend comes along and says, "Maybe you need to get your testosterone checked," well, maybe there's a hormonal factor worth discussing, maybe not. But wouldn't it make more sense to look at the fact that you're completely exhausted? Because if your body is practically begging you for rest, sex might not be at the top of your priority list, and that's not necessarily a libido disorder either.
Or let's say you've recently started taking a medication and suddenly your interest in sex isn't what it used to be. Could the medication be contributing? Well, absolutely, because certain medications, including some antidepressants, can affect sexual desire and response. And please don't interpret that as me saying that you should stop taking [00:16:00] them.
It means that you should have an open and honest conversation with your healthcare provider about what you're experiencing. Now, here's another question worth thinking about. Is your change in sexual desire actually bothering you, or are you feeling pressure because someone else thinks that you should want sex more often?
Because those are two different things as well.
Now, if you're perfectly comfortable with your level of sexual desire, then that doesn't mean there's a problem that needs to be fixed. And if your partner wants sex more often, that's something worth discussing together. But again, it does not mean that something is wrong with you. And even if you're flying solo, that pressure can still come up, whether it's friends, dating apps, or the idea that you should be getting back out there.
Your timeline is yours to choose. But if you've noticed a change that's affecting your satisfaction, your confidence, or your quality of life, there are options [00:17:00] available worth exploring, and that brings me to something that's getting a lot of attention lately, and that, of course, is testosterone. It seems as soon as somebody mentions low libido during menopause nowadays, testosterone enters the conversation immediately.
And look, yes, testosterone plays a role in women's sexual health. But as with everything, low sexual desire doesn't automatically mean you have low testosterone. In fact, a blood test alone cannot determine whether a woman has a sexual desire disorder at all. Now, for some post-menopausal women experiencing persistent low sexual desire that's actually causing distress,
Carefully monitored testosterone therapy can be an appropriate option after completing a comprehensive evaluation. But testosterone isn't a universal solution, and it's certainly not the answer to every sexual concern during menopause. [00:18:00] There are other treatment options too, depending on what's contributing to the problem.
Sometimes addressing sleep, managing stress, reviewing medications, or treating an underlying health condition can make a big difference, as I've been sharing throughout this episode. For other women, sex therapy or counseling can help with changes in sexual response, distress, and relationship concerns.
And sometimes a combination approach makes the most sense.
The important thing is figuring out what's actually contributing to the change rather than assuming that the most talked about treatment is the right solution for you. Now, if you have noticed a change in your sexual desire, here are three questions worth asking yourself.
Number one, what exactly has changed? Number two, is that change actually bothering you? And number three, what else has happened with my health, relationships, or daily life around the [00:19:00] time that I first started noticing the changes? Because maybe you're not thinking about sex as often, maybe you're interested but having trouble becoming aroused, or maybe you still enjoy sex, but you rarely feel motivated to initiate it.
Those experiences aren't necessarily the same, and identifying the difference can help you have a more productive conversation about what you're experiencing with both your partner and your healthcare provider, and also gives you a better understanding of how to find the right solution that fits you.
And remember, there's no universal number of times a woman is supposed to want sex. Your sexual wellbeing isn't measured by how often you have sex. It's about your comfort, your satisfaction, your personal preferences, and your quality of life. And let's not forget that pleasure doesn't require a partner.
Solo pleasure is normal. It's a healthy part of sexual wellbeing at any age, and it can help you [00:20:00] learn what feels good and comfortable for your body now. And speaking of satisfaction, there's another part of this conversation that deserves attention because even when you understand what's happening physically, talking about it with your partner can be an entirely different challenge.
Regardless if you have a partner or not, the first conversation about your changing needs is the one that you need to have with yourself.
And if you're dating or think you might in the future, these same conversations will matter with someone new. And let's be real, talking about vaginal dryness, painful intercourse, or changes in sexual desire isn't easy.
And look, I'm sure there's a few of you who were uneasy hearing it coming from me, but it can be especially difficult when you're having the conversation with someone that you've been intimate with for years. Yet oddly enough, sometimes the longer you've been together, the harder that conversation can be.
But it [00:21:00] does need to happen because many times your partner notices that you're not initiating sex as often anymore. Maybe you've started avoiding certain types of intimacy because you're uncomfortable, or maybe you're worried that saying something will hurt your partner's feelings.
But before you know it, you're both making assumptions about what's happening, but neither of you is actually talking about it. Another thing worth considering, your partner can't respond to something they don't understand. If sex has become uncomfortable but your partner doesn't know that, they might interpret , your hesitation, as rejection.
And if your desire has changed but you haven't talked about it, they might assume that you've lost interest in them. Meanwhile, you might be thinking, "If I have to explain this one more time, I'm going to lose my mind."
But this is where communication becomes so important. And I'm not talking about sitting your partner down for some big dramatic relationship [00:22:00] summit. You know what I mean, right? The kind where the talk starts with, "Honey, we need to talk." And the other person immediately starts wondering, "What have I done wrong?"
I'm simply talking about having an honest conversation about what's changed for you, how you're feeling, and what might help. And that conversation doesn't have to happen in the bedroom either.
In fact, sometimes it's easier to talk about sexual concerns when you're not in the middle of a sexual encounter. And when you do talk, you could say something like, "I've noticed some changes in how my body responds to sex, and I'm trying to understand what's happening."
Or even, " I still enjoy being close to you, but some things aren't as comfortable as they used to be. Can we talk about how we can make it feel better?" And if your desire has changed, you could say, "I've noticed I'm not interested in sex as often, and I'd like for both of us to understand what's contributing to it so [00:23:00] that neither of us has to make assumptions."
Or maybe you're dating and you're getting close to someone. Well, you could say, "My body has changed during menopause, and I'd like to take things slow and talk about what feels good for me and you." The important thing about these conversations is that they are not accusations.
You're explaining what's happening without assigning blame or making promises about how often sex should happen. And for any partners tuning in, this part is important for you too because if someone tells you that the sex has become uncomfortable or that their desire has changed, listen to them.
Don't immediately make it about whether they're still attracted to you. Ask questions. Be curious. Find out what they're experiencing and what kind of support they'd appreciate because sometimes the most helpful response isn't trying to fix everything. It's creating enough [00:24:00] comfort for an honest conversation to happen.
Now, there's another part of intimacy that deserves more attention as well because sex doesn't have to mean intercourse. Intimacy, as we all know, can include kissing, touching, cuddling, massage, mutual pleasure, and other forms of physical and emotional connection. And for some couples, exploring different ways of being intimate can take the pressure off having sex a particular way.
Maybe certain positions are uncomfortable now. Maybe more time is needed for arousal. Maybe the kind of touch that used to feel wonderful doesn't feel quite the same anymore. Well, that's information worth sharing because your partner is not a mind reader, and neither are you. What feels pleasurable can change throughout life, by the way, not just during menopause.
So again, conversations are important, and that's true whether you're exploring it with a partner or on your [00:25:00] own. And those changes don't have to mean the end of a satisfying sex life, as I said at the beginning. They can actually be an opportunity to communicate more openly about your comfort, your pleasure, your preferences, and your expectations.
Also important, intimacy should never become an obligation. Nobody owes someone sex because they're married, in a relationship, or because they used to have sex more frequently, and nobody should feel pressure to tolerate discomfort or pain to maintain a relationship.
And if you're dating, nobody should rush you either. You get to set the pace. A satisfying intimate relationship is one where everyone involved feels respected, comfortable, and free to communicate their needs and boundaries. Now, what if you've tried talking about these changes and you're still struggling?
Well, that's where additional support can be helpful. A qualified sex therapist or couples [00:26:00] counselor can help address communication difficulties, difference in desire, and concerns affecting intimacy. And you don't need a partner to see a sex therapist, by the way. Many work with individuals as well.
And if there are physical symptoms involved, a healthcare professional with experience in menopause and sexual health can help investigate possible causes and appropriate treatment options. Sometimes both types of support are useful because sexual wellbeing involves more than hormones, and addressing it sometimes means looking beyond the bedroom. And it's also important to know that you don't have to have all the answers before starting the conversation. You can br- you can be figuring things out and still communicate what you're experiencing. Some couples find that figuring things out together brings them closer and provides a new type of intimacy.
And if you're single, getting to know your body as it is now is its own [00:27:00] kind of intimacy, and the same goes for your healthcare provider. You don't need all the answers before that conversation begins.
And that brings us to another conversation that far too many women are not having because when was the last time your doctor asked you about your sex life? And I'm not talking about whether you're sexually active or what you're using for birth control. I'm talking about whether sex is comfortable, whether your desire has changed, or whether you're experiencing something that's affecting your sexual satisfaction because for many women, those conversations are not happening.
And sometimes even when a woman brings up concerns, she's told something like, "Well, that's just part of getting older." Like you're just supposed to accept that sex becomes uncomfortable after a certain age, and this is coming from your doctor. Well, I can boldly say that you absolutely do not have to struggle.
Sexual health is part of your overall health, and concerns [00:28:00] about sexual function deserve to be taken seriously. You don't have to wait for your doctor to bring up the subject. And you certainly don't need to feel embarrassed about asking questions. Trust me, healthcare professionals have heard about vaginal dryness, painful intercourse, and changes in sexual desire before.
And if your healthcare provider makes you feel embarrassed or dismisses your concerns, well, that's a problem, right? Imagine sitting in your doctor's office and they ask, "So how have you been feeling?" And you say, "Fine." Meanwhile, you've been avoiding sex for six months because it's uncomfortable, and you're experiencing vaginal dryness, and your libido is completely gone. Well, ladies, that's not fine. And I'm not saying that, that to criticize doctors or anyone, right?
Sometimes it's difficult to know how to bring these things up, especially when you've only got a few minutes with your doctor. But you can start with something as straightforward as, "I've noticed some changes [00:29:00] in my sexual health since entering perimenopause, and I'd like to understand what's causing them."
Or you can say, "Sex has become uncomfortable, and I'd like to know what my options are." That's it, real simple. You don't need some elaborate explanation or going into more details unless you're asked. And here's where being specific can really help . Instead of saying, "My sex life isn't what it used to be," explain what's actually happening.
Is it dryness? Is it burning? Is it pain, difficulty becoming aroused, or a change in desire that's bothering you? As well as when it started because those details matter for making a better diagnosis. And don't be afraid to ask whether menopause could be contributing or whether something else needs to be investigated.
Remember, not every sexual health or health concern in general during midlife is caused by menopause. And if your doctor recommends a treatment, find out why it's appropriate for you. [00:30:00] What are the benefits? What are the risks? How long will you take it for, and what happens if it doesn't help? Because you deserve to understand your options before making decisions about your care.
Now, there's something else I need to mention because if you're experiencing bleeding after menopause, please do not ignore it. If you've gone 12 consecutive months without a menstrual period and then experience vaginal bleeding, even a small amount, that needs medical evaluation.
And unexplained bleeding during or after sex deserves attention as well. Don't automatically assume it's just vaginal dryness or an effect of hormonal changes. Next, what happens if your doctor doesn't have the answers? Well, that doesn't mean there aren't any answers. Sometimes it means you need someone with additional training or experience in menopause or sexual health.
And there's absolutely nothing wrong with asking for a referral or seeking a second opinion [00:31:00] Look, you shouldn't have to choose between accepting uncomfortable symptoms and figuring everything out on your own. There are healthcare providers who specialize in these concerns, and there are treatment options worth exploring.
So if you can talk to your doctor about your blood pressure, cholesterol, digestive problems, or joint pain, you can definitely talk to them about your sexual health too. It's part of your overall well-being. Look, menopause can change aspects of your sexual health, but those changes don't have to define your sexuality, your relationships, or your quality of life.
And whether you're dealing with dryness, changes in desire, discomfort, or simply trying to understand what's happening, it's important to know and understand your options. And that's exactly why this conversation matters so much
Now I've certainly covered some ground in this episode today, and probably a few things [00:32:00] that don't usually come up in daily conversation. But that's exactly why these conversations are so important, because vaginal dryness, changes in sexual desire, and painful intercourse shouldn't be subjects that anyone feels embarrassed to discuss, and they certainly shouldn't be things that women are expected to just tolerate.
Now, does every woman experience these changes during menopause? No. And does every woman want the same kind of sex life? Absolutely not. The point isn't how often you're having sex, it's whether you're comfortable, satisfied, and getting the support you need when something isn't right. And if there's one thing worth taking away from today's conversation, it's this: menopause doesn't mean your sex life has an expiration date.
Things can change. Your preferences can change. Your needs can change. And sometimes those changes require a different approach, a little more communication, [00:33:00] or some additional support. But none of that means that your sexuality has to disappear. And please don't let embarrassment keep you from getting the answers you need either.
And whether that means talking with your partner, asking your healthcare provider questions, or exploring options for relief, you deserve to make those decisions with accurate information and confidence. Now, I'm curious, why do you think it's still so uncomfortable talking openly about menopause and sexual health?
Is it embarrassment, generational attitudes, or have we just gotten so used to treating women's sexual health as something nobody's supposed to discuss?
Well, let me know what you think in the comments, because I'd really like to hear your thoughts. And if you know someone who could benefit from this conversation, be sure to share this episode with them. Now, we've talked about vaginal dryness, painful sex, and changes in sexual desire,
But there's another important part of [00:34:00] sexual health that we haven't explored in much detail, and that's your pelvic floor. And ladies, if you think pelvic floor health is just about Kegels or preventing bladder leaks, there's a whole lot more that you should know. I spoke with Kim Vopni, also known as the Vagina Coach, to talk about vaginal health during menopause, the role of your pelvic floor, and what you can do to help improve your comfort and sexual well-being.
And trust me, there's some valuable information in that conversation. So click the link in the description to check out my interview with the Vagina Coach
