Menopause and Sex: A Physical Therapist’s Perspective

As a women’s health physical therapist, I see many patients with sexual problems. Sometimes it’s a physical problem that PT or medical intervention can improve; sometimes, it’s a psychological issue, stress, or fear. As physical therapists we teach and counsel on issues regarding sex; we are not sexual therapists, nor do we prescribe medications, but we can help educate our patients, point them to appropriate resources or referrals, and give them tools to improve their sex lives.


Does menopause affect sex?

The stages of menopause are some of those life events that may affect sex as a result of changing hormone levels. The functions of estrogen as related to sex are the maintenance of skin elasticity and sub-skin tissue thickness, and the effects on blood vessel neurotransmitters that help the vaginal lubrication process. Estrogen revs up our sensory organs so the world is a more sensual place. Lack of estrogen means vaginal and vulvar skin thinness and sensitivity and decreased vaginal lubrication.

But wait! All is not lost. There are many things you can do to have a satisfying sex life during and after menopause.


What do I need to know about having sex as I age?

Let’s get the healthy behavior basics out of the way; First and foremost, sexually transmitted diseases (STDs) occur no matter how old you are. Discussion of sexual health history with your partner, screening for STDs, and use of male or female condoms to prevent transmission of STDs are necessary at all ages. Health habits of no smoking, moderate alcohol use, adequate sleep, and good nutrition are necessary for good health and good sex. Exercise needs to happen, as blood flow is key for sexual arousal. A sedentary lifestyle prevents blood flow, and as a result, blood vessels become less pliable and don’t function as efficiently. It’s best to exercise every day for at least 30 minutes—the blood will flow, the endorphins (happy hormones) will be excreted, and the muscles will be more flexible and strong, resulting in GREAT SEX!


Sex after menopause

The most common complaint regarding sex after menopause is vaginal dryness and resulting discomfort during sex. Vaginal dryness can also occur after pregnancy and with some medications. During menopause—in addition to a lack of estrogen—the tissues of the vulva and vagina are less lubricated and may thin over time. Friction activities, common with sexual activity, may create irritation or pain.  

Estrogen hormone therapy can increase vaginal lubrication, resulting in less pain during sexual activity. Local vaginal estrogen is recommended as the treatment of choice for vulvovaginal atrophy (VVA), the thinning of the vaginal and vulva tissues. Creams, tablets and rings are available and have low absorption rates to the rest of the body.


Sex lubricant do’s and don’ts

For those that do not want to use local estrogen, a variety of lubricants are available. Lubricants can moisturize sensitive skin and increase circulation and skin strength when paired with regular massage. For vulva or vaginal dryness, massaging a moisturizing lubricant into the skin of your genitals twice a day will increase elasticity and encourage blood flow, so arousal is easier. Regular massage helps maintain the elasticity of your genital skin and the thickness of the tissue under your vulva, and helps prevent skin tearing.

Lubricant preferences vary from person to person; a lubricant that is pleasurable for one person may be irritating to another. Trial and error is one way to find out—and might be fun—but I would also suggest reading through www.sexualityresources.com. They have information on different types of lubricants and their pros and cons. In general, to prevent genital irritation, avoid lubricants with menthol, lidocaine, capsaicin (the oil of hot chili peppers! Ouch!) or Chlorhexidine (a preservative found in K-Y Jelly). Oil lubricants may be preferred by men, but the vagina is sensitive and oils may cause irritation or infection. Water and silicone lubes are more vagina-acceptable. Using a general vaginal lubricant every 3 days (such as Replens) as well as a lubricant during sexual activity, will assist in moisturizing the inner tissues of the vagina and the outer tissues of the vulva.


Pelvic floor dysfunction: Therapy and exercises to build muscle strength

Conditioning your pelvic floor muscles to maintain their strength is important for lasting sexual health. A healthy pelvic floor is strong and flexible and connects you with the experience of sexual arousal. The loss of strength in the pelvic floor is common as we age, and many women lose touch with what is happening in their groin area. Regular orgasms (no partner required!) are a good way to give the sexual system exercise. Your system will remember what sexual arousal is all about, blood flow will be increased to your genitals and your nervous system will be functioning. Just like much of the body, the adage, “Use it or lose it” applies to your sexuality.


Menopause and low libido

Menopause symptoms can affect libido, the mind and desire part of sex. Our levels of libido can also depend on stress, health, outside distractions, previous sexual experiences, and what we have been taught about sex. Is your lack of sex drive due to other influences? Maybe you’re too busy, or stressed to take time to nurture your desire for sex? Are you depressed? Overwhelmed with the demands of life? Just don’t want to make the effort? Whatever your libido is, it is individual and normal. Some people have no interest in sex, others have a higher sex drive; it is only when it causes you distress that it becomes a problem. 

If you feel that your hormonal levels have decreased your libido, discuss this with your primary care provider. The effect of other medical problems and medications may be affecting your desire for sex. Anti-depressives, cardiac medications, and corticosteroids are some of the most common medications that may affect sexual libido.


How do I increase my sexual arousal?

First, be comfortable with your body. Do you feel healthy? Attractive? If you don’t feel good about yourself, you won’t feel desirable. Connect with your physical body; be aware of your body’s response to movement, emotions, and food. Exercise, yoga, a relaxing bath, a massage, or stretching can assist you in connecting with your physical self. Second, explore your emotional self. What makes you feel good? Reflect on good past sexual encounters and fantasies. Notice what happens to your body when you reflect, and tune into your self-awareness. Having confidence is a huge libido booster! And finally, always remember that sex is not just sexual intercourse. There are lots of ways to express and receive pleasure. Finding what works best for you will leave you feeling fulfilled and satisfied.

Sexuality Resources is a great resource for sexual information, and is written by a physician and a sexual therapist. Have fun, ooh la la!


If you need pelvic floor rehabilitation and/or information regarding sexual activity within the limitation of a disability or movement problem, the Des Moines University Physical Therapy Clinic can help. Visit our website or call 515-271-1717 to schedule your appointment.

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Laura Covill, D.P.T., OCS, COMT

Laura Covill DPT, OCS is a professor and physical therapist in the Department of Physical Therapy at DMU. She has been post-menopausal for over 15 years and accepts the physical changes of lack of estrogen but isn’t exactly happy about them. Dr. Covill’s professional expertise is in musculoskeletal physical therapy, chronic pain, women’s health and the integration of yoga and physical therapy. She is a believer in using lifestyle medicine in conjunction with traditional medical management to achieve her best self.

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