*Content reviewed by HotPause Health medical advisor, Tanya Goodrich, PT, DPT.

How to Have Great Sex in Menopause

Let’s be honest: sex can get complicated during perimenopause and menopause. You might feel like your desire has disappeared, your body doesn’t respond the way it used to, or that intimacy just feels more like a chore than a source of joy. More than a third of women in perimenopause or menopause report having sexual difficulties, from lack of interest in sex to trouble having an orgasm. You’re not broken. You’re not alone. And yes, you can still have deeply satisfying sex during this phase of life.

How Menopause May Affect Your Sex Life

Sexual health is about more than just desire—it involves arousal, lubrication, comfort, and the ability to orgasm. All of these can be impacted by hormonal shifts that happen during the menopause transition. Estrogen and testosterone levels can drop, which can affect everything from mood to blood flow to vaginal tissue health.

Symptoms that can interfere with sex include:

• Vaginal dryness and thinning 
• Lower libido or less spontaneous desire
• Pain during penetration (dyspareunia)
• Difficulty reaching orgasm
• Mood swings, anxiety, and sleep disruption

These symptoms are real, but they are not the end of your sex life. With the right information and support, you can address what’s getting in the way.

Why Libido Might Drop in Menopause—and What to Do About It

There’s no one-size-fits-all solution to a lowered sex drive, but the first step is understanding the cause.

• Hormonal shifts: Estrogen and testosterone both contribute to sexual desire. Systemic hormone therapy may help, but it’s not for everyone. Talk to your provider about whether menopause hormone therapy (MHT) or low-dose vaginal estrogen is right for you.
• Mental health and stress: Depression, anxiety, and everyday life stressors can crush libido. If you’re taking SSRIs for mood symptoms, know that they can also dampen sexual desire. Alternatives like bupropion (Wellbutrin) may help.
• Relationship dynamics: If you’re not feeling emotionally connected to your partner, or if you’re dealing with tension or resentment, sex may feel off. Sometimes improving communication can be the most powerful aphrodisiac.

Painful Sex in Menopause? You Have Options.

Pain during sex is incredibly common after menopause, and you should never ignore it or try to power through. Here are a few tips you can consider to find relief:

• To reduce anticipatory pain during sex, focus on physical and mental relaxation, increased foreplay, and exploring different positions and techniques.
• Vaginal Estrogen: Can help restore elasticity and hydration in vaginal tissues, making sex more comfortable.
• Lubricants and moisturizers: Water-based or silicone-based lubes can reduce friction. Vaginal moisturizers (used a few times a week, not just during sex) help maintain baseline comfort.
• Pelvic floor physical therapy: A skilled PT can help release tight pelvic floor muscles and teach you how to relax or strengthen the muscles that support sexual function.
• Rule out other causes: Infections, skin conditions, or past trauma can also make sex painful. A thorough pelvic exam can help identify what’s going on.

Tools That Can Help:

• Vibrators and clitoral devices: These can increase blood flow and enhance sensation, which is helpful when natural arousal takes longer to kick in.
• Arousal oils: Over-the-counter products may boost sensation and comfort.
• Testosterone therapy: Off-label low-dose testosterone can help some women with sexual desire, though it’s not FDA-approved for this use. Talk to your provider about whether it’s appropriate for you.

Tips for Better Connection

• Redefine intimacy: Intercourse isn’t the only way to feel close. Sensual touch, mutual exploration, and shared vulnerability can be just as satisfying.
• Talk about it: Honest communication with your partner about what feels good (and what doesn’t) can deepen trust and reduce performance pressure.
• Try something new: Explore new positions, toys, or settings. Novelty can activate desire in powerful ways.
• Mindfulness and stress relief: Yoga, deep breathing, and body-based mindfulness practices can reconnect you with pleasure.

The Bottom Line

Your sex life isn’t over just because you’re in perimenopause or menopause. In fact, with the right tools and mindset, it might just be getting started. There is no shame in wanting more joy, more intimacy, and more pleasure. You deserve all of it.

If you’re struggling, start by talking to a provider who understands menopause. At HotPause Health, we’re here to help you find the information, support, and community you need to feel good in your body again—in bed and beyond.