Sexual Health after Menopause: a practical guide
Sexual health during and after menopause is a topic that doesn't get talked about nearly enough, but it should absolutely be something every woman can navigate with ease and the right support, so she can keep enjoying sex if she wants to.
In this blog, we explain the changes that occur in a woman's body that may impact sexual health, the professionals available to seek support from, and the practical, non-hormonal tools that we hope can help.
What Is Genitourinary Syndrome of Menopause (GSM)?
The changes that occur to the intimate areas during menopause are termed GSM.
GSM is a chronic, progressive condition caused by falling oestrogen levels, commonly experienced by women during this time. These changes impact the vagina, vulva, bladder and urethra, as all these tissues rely heavily on oestrogen to stay healthy (plump, lubricated and free from inflammatory microbes). Declining collagen and elastic also drive these symptoms.
Many of the symptoms of GSM directly and indirectly impact a woman's sexual health, including:
- Vaginal dryness, burning, itching or discomfort
- Urinary frequency, urgency, burning or recurrent UTIs
- Shortening or tightening of the vagina, loss of elasticity
- Pain or bleeding during or after intercourse
- Reduced lubrication, arousal, desire or difficulty reaching orgasm
Not everyone experiences all of these, and symptoms can vary at different points in the menopause journey, but these are very common and need to be addressed if they are impacting a woman's life.
If any of this sounds familiar, you're far from alone, and there are many options out there to help.
Support Pathways for Sexual Health Post Menopause
If you're experiencing any of these symptoms, please consider the following:
See a GP, or better still, a menopause specialist. These experts can listen to your specific symptoms and consider medical options or referrals as required. Hormone replacement therapy, particularly vaginal oestrogen, can be hugely beneficial for many women, promoting lubrication, plumper tissue, and a better microbial environment. The British Menopause Society can help you find a trained specialist.
A women's health physiotherapist. A specially trained women's health physiotherapist will examine you and check for any physical factors potentially impacting sex, including prolapse, a tight pelvic floor, tense muscles, pain or skin disorders, and help you work around any of these barriers. We recommend finding a specialist via POGP.
Consult a psychosexual therapist. These experts help women and men work through physical and/or mental challenges, fears and barriers to achieve their sexual goals. We recommend using COSRT's directory to find a qualified therapist.
Self-Care Basics
A few basics can make a real difference:
- Choose a pH-balanced lubricant. We recommend lubrication at any age, especially post menopause, to facilitate good glide and minimise micro-tears and tissue damage. Anything you use on or in the vagina should be formulated for gynaecological health (avoid glycerin, glycols, petrochemical derivatives and oestrogen mimics). The YES water-based lubricant is an excellent choice for better glide, whether used with a partner, alone, or with a dilator or vibrator.
- Don't douche. The vagina is self-cleaning, so please don't use harsh, scented products near the delicate tissues. A pH-balanced wash can be useful externally, on the vulva, but internally nothing is needed.
- Never push through pain. Sex, dilator or vibration therapy should never hurt. If something is painful, stop, try a different approach, and see a specialist.
- Wear breathable fabrics. Cotton or bamboo underwear, avoiding tight clothing, and changing promptly out of gym wear all help keep the balance of bacteria in check.
- Choose cotton, organic pads where possible, and consider a gentle barrier cream such as Olive & Bee Intimate Cream or YES oil-based lubricant, for vulval soreness or micro-tears.
- Support blood flow. Circulation helps maintain tissue health, so sex, masturbation, pelvic floor exercises, vibrators and dilators are all beneficial, as long as they're enjoyable and pain-free.
- Use a pH-balanced, clean vaginal moisturiser. A good product rehydrates tissue, easing everyday dryness as well as supporting sexual health. We recommend YES Vaginal Moisturiser, applied daily or a few times a week as needed.
-
Consider dilator or vibrator therapy.
- Dilators maintain tissue space, helping prevent the shrinking and tightening that can occur with reduced oestrogen, and can retrain the pelvic floor to understand that penetration doesn't have to hurt. Dilator therapy can be started alone, provided there are no physical barriers (we have more detailed steps here), or under the guidance of a women's health physiotherapist.
- Vibrator therapy has real therapeutic value beyond pleasure too, it supports blood flow and can aid pelvic floor relaxation. We sell both external vibrators (Katio Sky) and an internal vibrator (Kaito Sea).
- Eat an anti-inflammatory diet. Include protein and healthy fats to support tissue repair, plus probiotic and prebiotic foods for good microbial health - think kombucha, kefir, live yogurt, sauerkraut, kimchi, bananas, oats, artichokes, garlic and onions.
- Consider D-mannose if you're prone to UTIs after sex. Intercourse can introduce microbes into the bladder more readily, and postmenopausal women are already at higher risk of bladder infections. D-mannose is a simple sugar that helps flush E. coli out of the bladder before it triggers an infection, and it can be a real game-changer for some women. We include D-mannose as part of Ultimate UT, our bladder probiotic, to help support women with bladder health.
The Emotional Side of Change
Lifestyle, tools and creams are only part of the picture. Changes in desire, comfort and body confidence around menopause can bring up fear and self-consciousness, sometimes even a reluctance to show simple affection out of worry it will "lead somewhere."
A few things that may help:
- Communicate openly with your partner about what feels good and what doesn't right now.
- Set clear boundaries together: agreeing, for instance, that affection for a period won't lead to anything further can rebuild trust and closeness without pressure.
- Consider psychosexual therapy. It isn't something many people know is available, but it can be a genuinely valuable form of support (cosrt.org.uk).
There's a persistent myth that women should want frequent, spontaneous sex throughout their lives. In reality, desire naturally shifts, and post-menopause it may take longer to build arousal, even though pleasure is still very much possible. That's completely normal, not a sign that something is wrong.
Sexual health is a broad, deeply personal topic, and no single article or single set of products works for everyone.
Please reach out if you would like any product guidance, or signposting to specialists.
You might also find these related blogs helpful:
