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Healthy Woman

Sexual & Reproductive Health

How Sex Changes After Menopause

An older couple share a kiss as they dance together.

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With no need to worry about getting your period, becoming pregnant or being walked in on by your kids, your postmenopausal sex life should be stellar, right? It can be good, but don’t expect it to be the same type of sex you were having in your 20s, says Chris Kraft, Ph.D., director of clinical services at the Sex and Gender Clinic in the department of psychiatry at Johns Hopkins Medicine.

“While you may have greater freedom at home, this is also a stage of life with a lot of changes that can affect your intimacy,” he says. “You’re redefining your roles and your relationship as the kids go off to college and your careers wind down. And you’re also physically changing.”

Factors That Affect Desire

Your estrogen takes a nosedive during menopause (defined as when you haven’t had a menstrual cycle in 12 months) and the years leading up to it, called perimenopause. This change has a huge impact on your sexual function. It can lower desire and make it harder for you to become aroused. It can also make the vaginal canal less stretchy and you may experience dryness, which can cause intercourse to be painful. More than a third of women in perimenopause, or who are postmenopausal, report having sexual difficulties, from lack of interest in sex to trouble having an orgasm.

Additionally, with age you’re more likely to experience health problems. Chronic illness and injuries can deplete your energy, cause physical pain and lower your body image — all of which affect your sex drive.

Less Intercourse Is Natural

Despite what the media and prescription drug commercials would have you believe, intercourse in later years often isn’t as pleasurable for couples as it used to be. That’s because of bodily changes such as vaginal dryness and erectile dysfunction, says Kraft. Half of women in their 50s continue having intercourse, but by their 70s only 27 percent of women are doing it.

That doesn’t mean that you can’t be intimate with your partner — whether you’re having intercourse with the help of lubricants, vaginal moisturizers or prescription drugs, or choosing other ways of staying connected.

“About a third of long-term couples don’t have sex or have sex only occasionally. But they don’t necessarily consider that a problem. It’s just where their relationships have evolved,” explains Kraft. “They do other things that are intimate that they enjoy like cuddling, sharing a bed and laughing together. And they’re happy.”

Maintaining Intimacy

If giving up on your sex life sounds terrible, don’t worry: Many couples remain sexually active throughout their senior years. Just be aware that what feels good can change. Women often quit being sexual when getting aroused or having an orgasm becomes difficult, but what can help is more mental engagement and physical stimulation, says Kraft.

As you age, blood fills your genitals more slowly as you become aroused, which means you don’t have the same sensitivity and reaching orgasm takes longer. Typically, you need more direct and intense stimulation of your clitoris. “Doing things like rubbing and touching instead of intercourse may be what you like best at this stage of life,” says Kraft. “And that’s okay. You have to let go of what you think everybody else is doing and just think about what’s good for you and your partner.”

Communicating with your partner is key in setting realistic expectations about what you can do sexually and to achieve intimacy as you age. And, adds Kraft, “Living an overall healthy life — having good energy, getting enough sleep, being physically active and eating well — will go a long way toward helping you focus on and feel good about being intimate and sexual.”

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