Dear Doctor: What Can I Expect When it Comes to Sex After Menopause?

Dear Doctor,

I keep hearing people say that sex after menopause can still be great, but honestly, I’m struggling to believe it. Ever since I hit menopause, my sex drive has really dropped, and getting aroused feels almost impossible. 

I deal with dryness, discomfort, and just don’t get that same spark I used to. Does this mean my libido won’t return after menopause, or is there something I can do to feel interested again? 

I miss being close to my partner, but sometimes I am uncomfortable or sex just hurts too much. Are there real ways to improve menopause and sex, like natural tips or treatments that actually work? Can women still enjoy sex after menopause, and is orgasm after menopause even possible? 

I want to feel good in my body again and not dread intimacy. What should I try or talk to my doctor about?

Best,

Losing My Libido

Dear Losing My Libido,

I’m glad more women are open to talking about postmenopausal intimacy. I want you to know this up front: sex after menopause can be comfortable and satisfying, with the right tools and care. Vaginal dryness and tissue thinning (called the genitourinary syndrome of menopause or GSM) are often symptoms of menopause and postmenopause, because you have less estrogen. GSM can cause painful sexual intercourse (AKA dyspareunia), lower arousal, and dampen libido, but these changes are treatable.

Start with simple fixes to see if they help:

• Vaginal Moisturizers: You can try an OTC vaginal moisturizer several times a week to hydrate tissues. Moisturizers support everyday comfort, helping reduce irritation and dryness. 
• Add a Lubricant for intimacy: On top of a moisturizer, you can add lubricant right before sex to reduce friction during intercourse–it’s safe to use both simultaneously. 
• Condoms: If you use condoms, choose water- or silicone-based products. 

These basics alone dramatically improve comfort for many women.

If dryness or pain persists, prescription low-dose vaginal estrogen (cream, tablet, or ring) often restores elasticity, lubrication, and comfort with minimal systemic absorption. There are also nonhormonal options, like a selective estrogen receptor modulator (SERM), which are drugs that act like estrogen in some tissues while blocking its effects in others.

Work with your provider for an individualized plan, especially if you have a history of estrogen-sensitive conditions. We can discuss the benefits and risks of your unique situation and each treatment option.

There may be other reasons why your libido hasn’t returned postmenopause, like lack of sleep, stress, relationship dynamics, and medications. Ensure you’re getting at least seven hours of sleep every night and practicing stress management techniques.

Additionally, give your body a longer runway for arousal and desire: extend foreplay, add external clitoral stimulation, try a vibrator, and explore positions that let you control depth and pace. Pelvic floor physical therapy can reduce pain and boost confidence.

Safety still matters at sex over 50. Because thinner tissues can tear more easily, barrier protection reduces the risk of STIs/STDs (and don’t forget regular testing!).

Patients often ask, “Do women enjoy sex after menopause?” and “Can women orgasm after menopause?” The answer is yes. Pleasure is possible at every age, especially once you find the underlying causes of discomfort or loss of libido.

Here’s a quick game plan for post menopause sex:

1. Regularly use moisturizer–add lubricant during intimacy
2. Schedule intimacy when you’re rested and have time to get in the mood.
3. Try a low-dose vaginal estrogen if OTC measures aren’t enough.
4. Add whatever external help you need, like a vibrator or pelvic PT sessions.
5. Talk with your partner about pacing and pressure—women and sex after menopause thrive on communication.

Will libido return after menopause? It can and does for many women, once comfort, sleep, mood, and relationship factors are addressed. You deserve pain-free intimacy and real pleasure. Let’s tailor a plan that fits your health history and goals so that you can enjoy the full benefits of sex after menopause—in your body, on your terms.

If you’ve tried OTC or at-home remedies and are still having issues, request an appointment with your Genesis provider. We have menopause doctors and specialists across major Arizona cities, including Phoenix, Tucson, Mesa, Scottsdale, and Chandler.

Wishing you good health,

Dr. Anna Nelson-Moseke

OB/GYN, Genesis Women’s Health

Anna Nelson-Moseke, MD, FACOG, is a board-certified OB/GYN and the Medical Director of Genesis OB-GYN. She practices at Pueblo in Tucson, AZ.