02/03/2017 11:15 EST | Updated 02/03/2017 11:20 EST

Sex After Menopause Is, Well, Complicated

Millions of women over age 55 are asking the same question: What's happening to my sex life? Some say that after menopause their sex drive is AWOL, that sex is painful and tangling up in the bed sheets is the last thing on their minds.

older couple bed

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Others say sex is different, but with a few accommodations it's still an enjoyable and significant part of their lives. Some say menopause isn't slowing them down one bit. They're having the best sex of their lives.

Adjusting to Changes in Your Sex Life

Sexuality, desire and sexual performance involve many interlocking and overlapping health, physical, social, interpersonal and psychological factors. As those factors shift and change throughout life, so does your sex drive and ability to have and enjoy sex. That doesn't mean your sex life has to have a shelf life though.

Your post-menopausal years may be the ones where you hit your sexual stride.

Janet Gibbens, MD, a gynecologist in Portland, OR, says: "Sex after menopause is complicated. Lots of positive and less positive factors affect a woman's sex drive and ability to have sex comfortably. The positives are the easy part. The kids are grown and out of the house, and couples find more time and opportunity to enjoy sex. Anxieties about sexual performance and body image ease up for a lot of women in their 50s, too. They're more comfortable in their own skin, they know what they like and they're less inhibited. Plus, they don't have to worry about getting pregnant anymore."

Other positives include no longer having to contend with cramps, menstrual flow and contraception, which can all put a damper on your sex life. If you're in a long-term relationship, you may be less stressed, more stable and in a more intimate stage of life. If you're single, you may be more open to exploring on your own or engaging with new partners.

In short, after a lifetime of experimentation, interruptions and sexual bumps in the road, your post-menopausal years may be the ones where you hit your sexual stride.

older couple bed

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Common Issues for Post-Menopausal Women

The North American Menopause Society cites vaginal dryness and pain, low libido and loss of flexibility as common issues for many post-menopausal women. "The most common issues I hear about in this age group," says Gibbens, "are vaginal dryness, poor lubrication and an inflexible, non-stretchy vaginal opening, which makes sex painful."

Vaginal dryness and lack of elasticity are caused by the natural decrease in estrogen that occurs with menopause. It reduces the vagina's ability to self-lubricate and makes vaginal tissues thinner and less flexible. Gibbens says that regular use of over-the-counter vaginal moisturizers, plus lubricant, during sexual activity solves this problem for most women. She clarifies though that "vaginal moisturizers are different than lubricants and must be used several times per week on a regular schedule."

"Sex often has to be a more deliberate, planned occasion than a spontaneous one." - Janet Gibbens, MD

The North American Menopause Society also reports that "in general, sex drive decreases gradually with age in both men and women, but women are two to three times more likely to be affected." Low sex drive isn't necessarily a problem if both members of a couple are on the same page or individuals don't mind going without. For many people though, going without just won't do.

"Lack of desire is a fairly common complaint, and it can be difficult to deal with," says Gibbens. "It's often related to interpersonal or lifestyle factors, not just health or physical ones. Couples sometimes drift away from sex once their hormonal drive to reproduce is gone. Body image can also play a role, especially with the weight gain that's so common with menopause. Partners may not share the same level of intimacy and spontaneity that once came naturally. Sex often has to be a more deliberate, planned occasion than a spontaneous one."

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A Few Ways To Boost Your Sex Life, Midlife

Gynecologists often recommend hormonal replacement therapy (HRT) and/or vaginal estrogen creams. HRT may include pills, patches or creams that replace estrogen, progestin and sometimes testosterone. Because HRT has been linked to significant health risks for some women, it's not an appropriate treatment for every woman.

Vaginal estrogen creams are considered safe for most women. They contain enough estrogen to help reduce vaginal tissue atrophy and restore natural lubrication, but not enough to affect other parts of the body or other menopausal symptoms.

You may begin to get your groove back.

Gibbens says: "Hormonal treatments are often worth a try. Sometimes they help and sometimes they don't. There is no Viagra for post-menopausal women yet, though there is a recently approved medication, called Addyi, for treatment of poor sexual desire. Unfortunately, it's approved for pre-menopausal women, not post-menopausal women, who, in my opinion, are the ones who need it most. It's also a daily medication, not an episodic one like Viagra, and you can't drink any alcohol while you're taking it."

Many older adults find that inflexible joints, aches and pains and other physical conditions also make certain sexual positions or activities difficult to manage. Once you've talked to your doctor about pain management and taken measures to improve your physical health and flexibility (hello, yoga), you may begin to get your groove back.

To learn more about sex after menopause, log on to the North American Menopause Society's website or talk to your doctor about solutions that are right for you.

Jeanne Faulkner is an RN with 25 years' experience working in women's health. Based in Portland, OR, she's the author of Common Sense Pregnancy and writes about health and wellness for a variety of publications and websites. As a CARE chairperson for advocacy, she's traveled worldwide to raise awareness of poverty eradication and global health issues.

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