Menopause, sexual health

Most women experience a decrease in sexual function around the time of menopause. In fact, up to 85% of women over forty experience a decrease in lubrication, up to 59% experience painful sex and up to 77% experience vaginal itching and irritation (1). If sex is painful, dry and irritating, it is unlikely something you will want, even with the best romantic partner.

Why does menopause change sexual function?


During the time of menopause, estrogen levels drop significantly. The lowered estrogen effects not only the vulva and the vagina, but also the urethra, bladder and pelvic floor muscles. Before menopause, estrogen maintains a thick layer of healthy skin. This thick layer of healthy skin is full of cells that produce moisture. The skin is also full of collagen to maintain elasticity. And the skin has folds and ridges, called rugae, to allow stretching and mobility. During the low-estrogen state of menopause, the skin gets very thin, which makes it susceptible to abrasions and cuts. The moisture producing cells decrease dramatically. And the elasticity and rugae decrease, so the skin cannot move with the same ease. Estrogen plays an important role in keeping the pelvic floor muscles healthy, so as the levels of estrogen decrease, the risk for organ prolapse increases. And due to lowered estrogen, the urinary tract is more susceptible to irritation, increased urinary frequency and urinary tract infections.


There are solutions!


The most effective treatment for changes to the genital region due to menopause is topical hormone therapies. Topical hormones, such as DHEA, testosterone and estradiol, have the ability to actually stop and reverse the cellular changes that give rise to the symptoms. Topical hormones are generally well-tolerated and have few side effects because they mostly stay local, in the genital region. In addition to topical hormone therapy, there are a few other things that are known to help reduce your symptoms:


  • Keep sexually active! Sexual activity increase blood flow to the genitals. This blood flow helps the tissue stay as healthy as possible, given the low estrogen.
  • Stop smoking. Tobacco use is associated with lowering estrogen, which will worsen your symptoms.
  • Treat your depression. Women that have depression are more likely to experience distress from their menopausal changes.
  • Use sexual lubricants. Use pH-friendly sexual lubricants when you have sex. Good Clean Love designs products that are intended to be helpful to the vaginal pH.
  • Use vaginal moisturizers. Consider regular use of vaginal moisturizers, which are used a few times per week (Examples include Vagisil and Replens).
  • Talk to your doctor about topical hormones. Consider visiting your doctor to assess if you are a good candidate for topical hormone replacement therapy.


Dr. Lauren Gresham is here for all your sexual health needs. Please feel free to reach out for support and treatment. You deserve to be having amazing sex and Dr. Gresham can help!



  1. From the UpToDate article titled, “Clinical manifestations and diagnosis of genitourinary syndrome of menopause (vulvovaginal atrophy), retrieved on December 13th, 2019.