Sex After Menopause: Postmenopausal Sexuality

Research shows that older adults consider enjoyment of sexuality one of the most important factors of sexual well-being.⁽¹⁾ During the menopause transition, the female body experiences physiological changes that can have a profound impact on women’s sexuality throughout their postmenopausal years. Understanding these changes can help women embrace different expressions of sexuality later in life.

Women enter postmenopause once menstruation has stopped for a year or more. Some women experience an increase in libido during this phase of life, while others find their desire for intimacy decreases. A lack of interest in sexual activity after menopause is often influenced by hormonal fluctuations that impact physical, mental, and sexual health. Estrogen, in particular, affects brain activity in areas associated with mood and motivation. The hormone also influences vaginal lubrication and blood flow.⁽²⁾ Because estrogen plays such a pivotal role in arousal, its decline during midlife and beyond can reduce sex drive, sexual satisfaction, and frequency of sexual activity.

This article will explore how women’s sex lives may change after menopause and the benefits of sex during postmenopause.

Female Arousal After Menopause 

Pelvic floor dysfunction can interfere with female arousal after menopause. The pelvic floor muscles support the surrounding organs and control muscle movements of the bladder, urethra, and lower rectum. As women age, these muscles may weaken due to hormonal fluctuations that occur during pregnancy, birth, or menopause. Postmenopausal estrogen deficiency can further impact their strength and function. Research suggests a connection between pelvic floor dysfunction and sexual dysfunction, which includes symptoms like low arousal.⁽³⁾

Along with declining estrogen levels, reductions in androgens during and after menopause can also impact female sexual arousal. Androgens are a group of sex steroid hormones that include testosterone, the hormone precursor dehydroepiandrosterone (DHEA), and its sulfated form, DHEA sulfate (DHEA-S). These hormones are believed to play a role in sexual motivation. Women with low testosterone may experience a decrease in sex drive, which may subsequently prolong arousal.⁽⁴⁾

Postmenopausal sexuality can also be influenced by sleep. Hot flashes and night sweats can make sleep difficult during menopause. In a study published in the American Journal of Obstetrics and Gynecology involving over 300 peri- and postmenopausal women with daily vasomotor symptoms, researchers found that sleep disturbances and night sweats were contributing factors to low libido.⁽⁵⁾Additionally, adults become more susceptible to health conditions as they age. Certain medical issues can impact sexuality, particularly among older adults in the LGBTQ+ community, who are at a higher risk for conditions such as cardiovascular disease and mental health challenges that may negatively affect sex and intimacy.⁽⁶⁾

Changes in Sex Life After Menopause

Some women may experience changes in their sex life after menopause. One study found that rates of sexual activity dropped from 74% among women in early postmenopause to 56% among women in late postmenopause.⁽⁷⁾ 

Some postmenopausal women may reduce sexual activity later in life, often due to changes in the vaginal lining during menopause. Genitourinary syndrome of menopause (GSM) involves the thinning and drying of the vaginal walls, which can lead to inflammation. As a result, individuals may avoid sexual activity due to pain, itching, irritation, or bleeding. Research indicates that approximately 50% to 70% of postmenopausal women are affected by symptoms of GSM.⁽⁸⁾

Other menopause-related changes, like weight gain or loss of muscle mass, can impact body image during postmenopause. Hormonal shifts during this stage of life can also increase stress and anxiety, further impacting sex life.

However, this doesn’t mean that women don’t value sex as they age. Some women report increased sexual satisfaction later in life. In a study published in The American Journal of Medicine that involved over 800 women — the majority of whom were postmenopausal — research findings showed that among those who were sexually active, the greatest frequency of orgasm satisfaction was reported by the oldest and youngest participants.⁽⁹⁾ Even in the absence of sexual desire, the majority of women expressed contentment with their sex life.

Increased sexual satisfaction after menopause may also be due to older adults often having fewer day-to-day responsibilities and no risk of pregnancy. 

Benefits of Sex After Menopause

The choice to engage or abstain from sexual activity during postmenopause is personal and unique to each individual. Women who choose to maintain an active sex life after menopause may experience the following physical and mental health benefits:

• Greater Partner Intimacy: With time and life experience, adults may find that sex later in life allows for deeper intimacy and provides opportunities for new explorations of sexuality.

• Increased Vaginal Blood Flow: Sexual activity after menopause can enhance genital blood flow and promote the health of vaginal tissue.⁽¹⁰⁾

• Mood Boost: Sexual activity has been shown to lower cortisol levels (the stress hormone) while increasing endorphins and oxytocin (the love hormone). As a result, postmenopausal women who are sexually active may experience reduced stress, improved mood, and a greater sense of love and connectedness.⁽¹¹⁾

• Lower Blood Pressure: Research has shown that older women who experience increased physical pleasure and emotional satisfaction during sex may be at a reduced risk for high blood pressure (hypertension). A study published in the Journal of Health and Social Behavior found that older women who reported their sexual relationship as highly pleasurable were less likely to develop uncontrolled or undiagnosed hypertension.⁽¹¹⁾

• Improved Cardiovascular Health: Sexual activity has been compared to exercise in that both boost blood vessel dilation, improve vascular wall function, and enhance oxygen transport to muscles. These heart health benefits may help reduce the risk of cardiovascular issues.⁽¹¹⁾

• Enhanced Cognitive Functioning: Regular sexual activity later in life may improve cognition. One study found that adults who engaged more frequently in sex, masturbation, or petting exhibited better working memory and executive functioning than those who engaged less often or did not participate in any sexual activity.⁽¹²⁾

• Better Sleep: Researchers have observed a relationship between decreased desire and sleep problems in women. Sexual activity may help improve the quality of sleep.⁽¹³⁾

• Increased Longevity: Postmenopausal sex may contribute to a longer life. Sexuality and sexual well-being are linked to emotional support and stress reduction, both of which can enhance physical and mental health, potentially increasing longevity. Research has also shown that postmenopausal women who report greater sexual satisfaction tend to feel they age more successfully, which may factor into a longer lifespan.^(1)(14)