The Impact of Perimenopause on Sexual Health
Perimenopause is the precursor to menopause, which occurs when you have gone an entire year without a period. During this time, your hormones fluctuate, and declines in estrogen and progesterone levels can make your cycle all kinds of irregular, mess with your sleep, and bring other symptoms
related to your sexual health that you may not have experienced before. These changes can affect your confidence, sex life, and relationships.
Declining Libido
If you are experiencing declining libido, you don’t feel as interested in intimacy or sex as you used to. Your libido can shift naturally over time, thanks to things like hormone changes, stress, poor sleep quality, aging, health issues, medications, or even relationship issues. If your declining libido is distressing you, it might be a sign of desire disorder— and it’s worth talking to your doctor about it. Don’t let low libido shake your confidence-it’s something that can be addressed.
Vaginal Dryness
Estrogen helps keep your vaginal walls lubricated, elastic, and thick. But as those estrogen levels drop, the walls of your vagina can start to thin out, become drier, and get more easily irritated. This can lead to burning, discomfort, or even pain during sex. Dryness can occur beyond the vagina and affect the vulva. Many women may first notice vulva irritation when putting on underwear.
Painful Intercourse (Dyspareunia)
There are different forms of painful intercourse, and they can feel like this: pain only when you’re penetrated, pain with each penetration (including when using a tampon), deep pain during thrusting, a burning or aching pain, or throbbing pain that sticks around for hours after sex. The causes behind painful intercourse can vary depending on where you’re feeling discomfort. Pain during penetration could be due to things like vaginal dryness, irritation, injury, inflammation, infection, or even muscle spasms in the vaginal wall. Deep pain often happens with deeper penetration and could
point to conditions like endometriosis, pelvic inflammatory disease, fibroids, IBS, ovarian cysts, or even pelvic floor issues. Emotional factors, like stress, anxiety, depression, body image issues, or a fear of intimacy, can also make things painful.
Difficulty with Arousal
While a drop in desire can make you less interested in sex, issues with arousal mess with your body’s physical response. You might notice it’s harder to get or stay aroused during sex, and orgasms might feel out of reach. Common signs include insufficient lubrication, or absence of swelling and that tingling feeling down there. So why is this happening? Hormonal imbalances, especially during menopause, can play a big role, but things like
depression, certain medications, relationship struggles, or other health issues can contribute too.
How to Stay Intimate in Menopause
Upgrade your lube routine:
You may want to add a water based vaginal moisturizer to your arsenal to relieve vaginal dryness. Vaginal moisturizers do more than provide lubrication; they offer longer-lasting hydration. Utilize a personal lubricant to enhance comfort during sex. With so many personal lubricants available, select one that effectively provides moisture, reduces friction, and improves comfort during sexual activity.
Focus on foreplay:
Foreplay is often seen as just the warm-up for sex, but it is so much more than that. It provides an emotional and physical connection with your partner that can significantly enhance your sexual experience. No matter what your foreplay preferences are—whether it involves kissing, caressing, biting, spanking, dirty texting, or oral sex, it’s all priming your body naturally for sex. Step up your foreplay by taking your time, avoiding the rush to sex, and staying present with your partner.
Schedule a date for intimacy:
Many sex therapists recommend this tip because it encourages couples to prioritize closeness by shifting away from spontaneous sexual encounters to responsive sexual moments. Responsive sexual desire actually begins in your brain, not in your genitals, and can enhance your arousal response with touching, kissing, and other forms of intimacy.
Use a vibrator:
Whether flying solo or with your partner, using a vibrator will stimulate blood flow and trigger natural lubrication. Studies have shown that with regular use, vibrators can significantly improve desire and arousal response, orgasm, and sexual satisfaction.
Have sex more often:
Once sex is comfortable for you again, try to make it a regular thing. Frequent sexual activity helps keep vaginal tissues lubricated and elastic, making sex more enjoyable and easier over time. No partner? Your vibrator’s got you covered.
Learn about hormone therapy:
Talk to your doctor about hormone therapy to address declining estrogen. There are plenty of options, including local therapies, that can help with
lubrication and ease vaginal dryness and painful intercourse. Maureen Whelihan, M.D. from Elite GYN Care of the Palm Beaches explains, “Hormone fluctuations during perimenopause often play a role in sexual concerns, but addressing sleep and mood disturbances—both common during this stage—can also significantly improve intimacy. In addition to managing hormone changes, we often focus on these factors to help patients regain a fulfilling sex life.” The best way to maintain a satisfying sex life during perimenopause, when your usual mojo isn’t cooperating, is to consult your healthcare provider. Yes, discussing sex with your doctor might feel awkward, but as Dr. Whelihan reassures, “Doctors are human too and may feel a bit uncomfortable discussing this topic. I recommend simply asking if you can talk about your sexual health concerns. If they don’t have the answers, they can connect you with someone who does."
Not sure where to start? Find a provider who fits your needs.
Source:
Low Libido (Low Sex Drive): Cleveland Clinic: January 2023
Experiencing Vaginal Dryness? Here’s What You Need to Know: The American College of Obstetricians and Gynecologists, February 2024
Painful Intercourse (Dyspareunia): Mayo Clinic, February 2024
Sexual Health: The Menopause Society, N.D.
The Role of Vibrators in Women’s Pelvic Health: National Library of Medicine, April 2024
Hormone Therapy for Menopause: The American College of Obstetricians and Gynecologists, February 2024
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