Menopause: How to address challenges of intimacy during menopause

Can hormonal changes cause intimacy issues?

Menopause can have consequences on relationships and sexual health. In addition to psychological issues that can make intimate relationships and desire complicated, there are physical issues that can make those relationships painful. The main menopause symptom related to sexual issues is vaginal dryness.1

How do these changes explain a decreased interest in intimacy?

Testosterone decline

Testosterone is a male hormone that is produced in women’s bodies in lower quantities than in men and contributes to libido. Menopause itself is not responsible for the decrease of testosterone in the woman’s body, which is instead caused by aging.3 Nevertheless, during the menopause stage, a woman’s low levels of testosterone may contribute to a decrease in libido.

You can discuss with your doctor the benefits of starting a hormonal treatment to address the decrease of testosterone in your body. This treatment can be started during the menopausal period.

Vaginal dryness and libido

Vaginal dryness, which can be a menopausal symptom, is caused by low levels of estrogen. Drier skin, loss of elasticity, and thinning of the vaginal walls all occur due to decreased secretion of the hormone. A dry vagina leads to painful intercourse,4 also called dyspareunia,1 which may decrease a woman’s libido. As a result of the pain, even the idea of intimacy can make some women nervous.

Other menopause symptoms

Menopause symptoms may be associated with overall fatigue, hot flushes, joint pain, and sleepless nights. These factors can contribute to a woman’s irritability, fatigue, or even depression, which further decrease the desire for intimacy.5

A vicious cycle can occur between painful intimacy, fear of intimacy, and becoming nervous and irritated because of uncomfortable intercourse. These states can be stressful to women, thus continuing the cycle.

Don’t be afraid to speak up! You are not alone in this journey

Still, many women do not disclose their sexual problems to their doctors.6 This should not be your case: discuss the problems you face with your doctor to be able to provide solutions that will work best for you.

What solutions exist to help with intimacy issues?

Fortunately, there are many solutions to help you maintain a healthy intimate life. Your partner can also be particularly supportive in this process.4

Here are some solutions:

  • Medical. These solutions should be strictly used under the supervision of your doctor. Do not self-medicate.
    • Menopause Hormone Therapy (MHT) replaces some of the estrogen and testosterone that your body is producing in smaller quantities than before. This treatment in turn alleviates some menopause symptoms8 (see article on MHT), which can improve libido.
    • Lubricants for vaginal dryness may reduce pain during intercourse4, 8.
  • Non-medical
    • Physical activities may reduce stress and anxiety through the release of endorphins, which can enhance sexual desire.9 (see article 9 on physical exercises recommended during menopause). Adapt the intensity and duration of exercises to your physical state.
    • Kegel exercises (pelvic floor exercises)7, 10 involve contracting your vagina and bladder. However, to be effective, they need to be performed the right way. Once you know what the movement feels like, do Kegel exercises three times a day:
      • Make sure your bladder is empty, then sit or lie down.
      • Tighten your pelvic floor muscles. Hold tight and count three to five seconds.
      • Relax the muscles and again count three to five seconds.
      • Repeat the exercise ten times, three times a day (morning, afternoon, and night).
    • Discuss issues with your partner, and, if necessary, do not hesitate to consult a couples’ therapist.

If you are experiencing intimacy issues, talk to your doctor: there are many ways to restore a healthy sexual relationship. Often it is necessary to first resolve the underlying sexual concerns, which are frequently psychological.1 When you manage to reduce the fear and frustration surrounding intimacy, the physical pain may decrease on its own.

Feeling low and suffering from a poor body image can make the situation more difficult.2 Boost your confidence and set both a diet and exercise challenge for the next seven days! Ask your doctor for more targeted advice. A nutrition plan can help your body become more toned and improve your body image, and physical activity can lift your spirits and increase sexual interest.

There is always hope and room for improvement. Relax, put yourself first, keep your partner in the loop, and don’t forget to breathe. These recommendations and the list of activities provided are not exhaustive and depend on your health profile. Please check with your doctor to define what solutions are suitable for you depending on your health.


  1. Hailes, J. Sex and Relationships. . Published 2020. Accessed October 29, 2020.
  2. The North American Menopause Society. Poor Self-image and Changes in Your Partner, Sexual Side Effects of Menopause. . Published 2020. Accessed October 29, 2020.
  3. The North American Menopause Society. Changes in Hormone Levels. Accessed October 29, 2020.
  4. National Institute of Aging. Sex and Menopause: Treatment for Symptoms.  Published May 2017. Accessed October 29, 2020.
  5. Healthline. Does Menopause Affect Your Libido? Published May 2017. Accessed October 29, 2020.
  6. Thornton K, Chervenak J, Neal-Perry G. Menopause and Sexuality. Endocrinol Metab Clin North Am. 2015; 44(3): 649–661.
  7. U.S. National Library of Medicine. Kegel Exercises –Self-care. Published January 2019. Accessed October 29, 2020.
  8. The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020 Sep;27(9):976-992.
  9. Mayoclinic. Female Sexual Dysfunctions. Accessed October 29, 2020.
  10. Kegelbell. 6 Best Non-Surgical Vaginal Rejuvenation Treatments.,%2C%20and%20vaginal%20laxity%2Flooseness. Published October 2020. Accessed October 29, 2020.