When cartoonist Sharon Rosenzweig was 45 and going through a divorce, she felt the pressure to meet someone new right away. “By the time I’m in my fifties,” she remembers thinking, “I’m going to be so old, I won’t even be interested in sex anymore.” She had this idea that menopause would eradicate her sex drive.

Turns out, she was wrong. She met the man who would become her second husband in the middle of menopause and was surprised to find her sex drive was still quite active. But she did have things to figure out, namely vaginal dryness, a common issue of menopausal and post-menopausal people.

Her doctor prescribed her estriol cream and it has made all the difference. For Sharon, sex after menopause is now even better. “I’m surprised how [my body] keeps getting more responsive. Orgasms are longer and more powerful than they used to be. I don’t know if that is me being more comfortable, or if it’s this cream, or it’s just having figured out a little bit more.” 

(By the way, estriol cream can be expensive. Sharon recommends looking into The Women’s International Pharmacy— an affordable pharmacy that offers mail-order services; however, another source warns us that pharmacies such as WIP offer compounded drugs, which are not FDA-approved and can be dangerous. We recommend talking to your health care specialist before making a decision about OTC products. )

Sharon tells her story in the new comic collection Menopause: A Comic Treatment. The embedded video is a promotion for the collection and tells Sharon’s story.

YouTube video

Sharon’s story is not uncommon. In their book What Fresh Hell Is This?: Perimenopause, Menopause, Other Indignities, and You, sex educator Heather Corinna writes, “Not only is menopause unlikely to doom anyone’s sex life, but it can even be a bridge to the best sex lives some people have yet experienced.”

Below, you’ll find tips on navigating sex, relationships, and a holistic sexual self during and after menopause, including:

  • Understanding Physical and Emotional Changes That Can Impact Sex
  • Tips on Finding and Talking to Your Health Care Provider About Sexual Health
  • Perspective Changes: How to Redefine Your Sexual Self

But before we dive in, a note on the gendered terms used in parts of this article. For this piece, I interviewed MaryJane Lewitt, Ph.D., RN, CNM, FACNM, is a nurse, midwife, and qualitative researcher who studies the sexuality of post-menopausal women. Since Lewitt’s research has focused primarily on cisgender women, for this article, when I quote Lewitt, that is who we’re referring to; however, if you don’t identify as a woman but are experiencing menopause, I hope you’ll feel included. 

Lewitt also mentioned that much of her advice is applicable to anyone regardless of their biological sex (genitals or dominant hormones) because much of the changes related to aging aren’t just about menopause, but rather embracing your whole self through all of life’s changes.

What Happens to Your Body During Menopause That Impacts Sex?

During menopause, your body’s completely rewriting its hormonal scripts. These hormones, including testosterone, progesterone, and estrogen, have a hand in everything, from managing sleep to emotions to body temperature. So if you’re perimenopausal and you’re experiencing some new physical or emotional change, it’s probably related.

You may notice changes to the size, thickness, and elasticity of your vulva and vaginal muscles, changes to the texture of your pubic hair, and changes to the level of natural vaginal lubrication and overall sensitivity. 

New or increased pain during intercourse can occur for a number of reasons, such as vaginal dryness, an increase in urinary tract infections, or a change in vaginal sensitivity. Besides the dreaded hot flashes, your breast tissue and nipples may become more or less sensitive.

Many individuals, like Sharon, expect a lack of desire for sex during or after menopause and are surprised when that’s not the case.

In What Fresh Hell, Corinna writes that one’s “levels or frequency of sexual desire,” experience of arousal, experience of orgasm, as well as “how we feel emotionally during and about sex and sexuality,” can all change during menopause — and it’s not just a once and done deal. Until your body’s off its hormonal roller coaster, be prepared for dramatic fluctuations in all of these things.

But there are things you can do to offset or adapt to these changes to continue to have a great sex life.

 Experiment Alone and With Partners

If traditional sexual intimacy (penetrative sex and masturbation) is important to you, but you’re experiencing changes in what you find pleasurable, it’s time to play. 

As you age, what feels good changes more quickly.  “You’ve got to shift and adapt on a regular basis in order to continuously create those moments of pleasure and intimacy,” Lewitt explained. 

The key is to approach sexual intimacy with a sense of curiosity and adventure. 

As an example, let’s talk about orgasms. Per Lewitt, post-menopause, it can take people with vulvas longer to achieve orgasm, and the nature of the orgasms can change. “They have to either pregame with a lot more foreplay or different lubricants or, for the first time, women have to try more specific forms of external stimulation from the variety of toys out there.”

Sexual play does not need to involve a partner. If you want to really understand your body’s changes and get a sense of your sexual self, consider making masturbation a regular practice. 

“Masturbation gives both short-term and long-term health benefits for women moving through the menopausal period,” Lewitt explained. “The act of masturbation itself increases circulation and lubrication and can maintain elasticity.”  

Talk To Your Partners About What’s Changing

To continue to have a vibrant sex life, you have to have open dialogue with your partner(s) about what’s changing and what you want. 

“Sustained sexual satisfaction … is usually about things like acceptance of and knowledge about our own bodies and sexualities; being present, self-aware, and authentic; honest, open communication; emotional connection and sexual and erotic intimacy; and willingness to explore and keep learning what pleasure is for us—all things we usually continue to get better at over time. In the event we aren’t already privileging or working toward all of that kind of stuff in our sexual lives, there’s truly no time like the present,” Corrina writes.

These conversations can also come in handy when it’s time to talk to your health care provider.

Finding an Adept Health Care Provider and Talking to Them About Sex

Unfortunately, there’s a good chance that your general physician or gynecologist will not be up-to-date on menopause research and therapies. According to What Fresh Hell, “While only about 20 percent of OB/ GYN residency programs include menopause training, and it’s often elective, this is the field where practitioners are most likely to have the most current menopause training or education.“

Pretty sad. Right?

So how do you know who knows their stuff? Corinna recommends asking questions like what kind of menopause education they received and how long ago it’s been.

Also make sure that any conversation about menopausal symptoms and treatments comes with a lengthy discussion of your existing medical conditions and other lifestyle factors. 

Find a NAMS Certified Menopause Practitioner (NCMP)

Use this form to someone who has been certified by the North American Menopause Society.

You can also seek out help from midwives, endocrinologists, Eastern medicine specialists like acupuncturists, sexologists, and more to manage menopause symptoms and gain new perspectives on your menopause journey.

 Schedule Time Specifically to Talk about Sex

“One thing I’m hearing over and over again is that conversations about sexuality with healthcare providers — even OBGYNs, nurse practitioners and midwives — are not happening at the frequency that most patients’ desire,” Lewitt explained.

These conversations can be uncomfortable for both parties involved, and often, neither the provider nor the patient wants to initiate. 

Another reason these conversations aren’t happening is that people assume that the problems they’re facing with their sex life can’t be helped. Lewitt explained this isn’t necessarily true: “A lot of things are starting to become available to women for addressing different elements of their sexuality.” 

For instance, during menopause, the body produces less natural lubrication and some over-the-counter lubricants can dry out the skin even more and can aggravate the skin. Physicians can prescribe or offer suggestions for vaginal lubricants and topical estrogens that will work better.

This is what Sharon experienced. She assumed her doctor would just suggest using generic OTC lubricant, but he was actually well-versed in this issue and had something better for Sharon to try (the estriol cream).

“You have to get past the embarrassment of saying what it is that you are having trouble with. I’ve known my doctor for 25 years, and it was really hard to bring up this topic of vaginal dryness and say those words to my doctor, even though he’s delivered babies,” she said.

Lewitt recommends scheduling a specific appointment to talk about your sexual health. “These take longer conversations with their healthcare providers to almost give women permission to explore different toys and really figure out what works best for them.”

To prepare for these appointments, Lewitt also recommends taking an inventory about what you want and what you’re experiencing. Here are examples of questions to ask yourself:

  • What are the things that you’ve tried to help improve your own personal satisfaction?
  • What are some of the things that have not worked?
  • When have you wanted to experience something different?
  • Was it related to a change in desire or something physical?
  • Were you having issues with urine leakage during intercourse which made you feel uncomfortable so you could not reach orgasm? Or was it a lack of that sensation?
  • Are you comfortable with masturbation?”

These questions can help prepare you for a thoughtful discussion with your HCP.

Redefining Your Sexual Self

Many moving beyond middle age find they’ve entered a stage in life with a ton of unexpected changes in their lifestyles and relationships. From divorce or other loss of long-term relationships, to kids moving out of the house, to new diagnoses of health issues, to major career changes and revisiting one’s life priorities. 

All of these can challenge your innate sense of self, including your sexual self.

You may find yourself dating again for the first time in decades or navigating sexual health with chronic illness. Or maybe you’re just ready to start prioritizing your own needs for the first time since becoming a parent.

You get to decide what it means to be a gorgeous, vibrant sexual being.

“Every [person] defines what [their] ideal sexual state is and what [their] own personal sexuality can be,” Lewitt explained. “It’s not the same for every single individual.”

Find Partners-in-Crime

It’s likely you weren’t raised in a culture that encouraged you to ask for what you need or made you feel comfortable talking about sex or sexuality. This becomes a battle of habit and conditioning.

If you have people in your life you feel comfortable being vulnerable with, open up slowly about changes to your body, your body image, sex life, and relationships. You might find that it’s a relief for them to open up as well. And if you’re dating and exploring, you might also find some partners-in-crime.

“Other women are your best allies,” Sharon explained. “They’re not your competitors, they’re your allies because they’re going to be out there dating and meeting people that they wind up not wanting to stick with, and they can pass them along. That’s what happened to me.” (Sharon was introduced to her second husband through a friend who’d dated him first.)

These allies might include new lovers, as well. Dating is no longer reserved for early adulthood. More folks are meeting people and even enjoying short-term or casual sexual relationships throughout their lives. 

You’re never too old to seek out new, rich sexual experiences.

Jera writes about sexuality, spirituality, and social justice. They are the author of Just the Tip, a queer-friendly, sex-positive, relationship advice column and the editor of Sacred and Subversive,...