I’ve said it before and I’ll say it again: Sex after menopause can be challenging. That’s behind many of the conversations I have in my medical practice, and a major motivation for the conversations on this website. You may have thought your sex life would actually improve as you aged. After all, the kids are moved out (or more independent), you’re likely in a better financial position, and no more periods means no worries about pregnancy.

And you may be encountering the reality that now you’re in the throes of perimenopause or menopause, your sex life isn’t quite what you imagined. You’re not alone.

I spend a lot of time discussing obstacles to sex during menopause faced by women like you. As you read through the list below, see if you identify with some or all of them. You may find that you have a lot of company on the road you thought you were traveling alone.

  • Loss of interest in sex. It’s important to know there’s nothing unusual if you have little (or no) interest in sex. Your body is going through significant changes during menopause, and one of those changes is a loss of estrogen. As a result, sexual function often decreases drastically, affecting libido and making arousal difficult.
  • Stress and fatigue. I lump these together because they often go hand in hand. All the physical and emotional changes of menopause can make you feel especially tired, and night sweats can make it impossible to get a good night’s sleep. What happens next? Your stress level rises because you’re tired. It’s a vicious cycle—one that can leave you less interested in sex.
  • Body image issues. Weight gain during menopause is common. If this is something you’re experiencing, you may not be feeling as sexy as you once did. Your partner may be telling you that you’re beautiful, but that’s not what you see when you look in the mirror. Feeling less sexy can also make you feel depressed or anxious and unable to enjoy sex.
  • Boredom in the bedroom. It’s hard enough to get aroused with all the menopause changes stacked against you. Throw in the same old routine in the bedroom, and your chances of having a night of passion are probably not great.

If you can relate to any or all of these, be assured there are others who have shared your experience, and have sought out ways to surmount each obstacle. Don’t be afraid to talk to your partner and be honest about how you’re feeling. Use this website or print pages from it to prompt discussion. If you feel like your symptoms are more than you can address on your own, make an appointment with your health care provider to investigate solutions.

The best time to work on the challenges of sex during menopause is now. You have years of great sex ahead of you; don’t waste time trying to figure it out alone.

Before it became okay to call menopause by its name, women called it “the change”—with good reason. The waist thickens, the hair thins, and sleep goes haywire. You may be wondering if there is anything that doesn’t change after menopause. There might be (your favorite food?)—but add your vagina to the long list of things that do.

Declining estrogen changes the vaginal lining, making it thinner and less elastic. The official term used to be vulvovaginal atrophy (VVA), and you may see articles using that term (or hear it from your health care provider). Now, more accurately, it’s called the vulvovaginal syndrome of menopause (GSM). Symptoms include

  • Vaginal dryness, irritation, or burning
  • Burning and/or urgency with urination
  • Urinary tract infections
  • Urinary incontinence
  • Discomfort and/or light bleeding after intercourse

Yes You Can: Dr. Barb's Recipe for Lifelong Intimacy

A new study by European Vulvovaginal Epidemiological Survey (EVES) points to just how prevalent this condition is. In the study of over 2,000 women between the ages of 45 and 75, a gynecological exam was done on each woman who reported one or more symptoms. In 90 percent of those women, GSM was confirmed.

Women often overlook GSM, either because they aren’t aware that the condition even exists, or because they think of each of their symptoms as individual problems, rather than collective evidence of something else.

But as the EVES study also showed, women with GSM also experienced a lower quality of life than those who didn’t have GSM. That’s unfortunate, because, although GSM is chronic, it’s also treatable with, for example, localized (vaginal) estrogen or non-estrogens that restore health to genital tissues.

Your doctor can help, but only if you let your doctor know about your symptoms. So take a deep breath and explain what’s been going on. Once you begin treatment and see that there are ways you can manage the change, rather than just letting it happen to you, you’ll feel a whole lot better.

You say that you have that sensation even though you’ve had Mona Lisa treatments [a procedure for restoring vaginal tissue] and use Uberlube, and that sensation continues for a couple of days after intercourse.

It’s possible you could have one of three conditions: atrophic vaginitis, vulvodynia, or a urinary tract infection (UTI) caused by intercourse.

The Mona Lisa Touch therapy doesn’t completely take care of atrophy for some women, and you might be one of them. If so, there are safe and effective prescription therapies available, and it may be helpful to add one of those.

Vulvodynia happens when the entrance of the vagina becomes inflamed, causing burning pain during and after intercourse.

Finally, in some women intercourse itself actually causes a UTI, a bladder infection that causes the symptoms you describe.

Those are the most likely possibilities, but please talk to your provider about what’s going on. She or he can determine the cause and recommend the best course of treatment for you–and there is treatment for each option.

We talk a lot about how to stay connected to your partner and build intimacy (and last week’s post was about taking advantage of your new empty nest). But what if, in spite of your best efforts and intentions, the relationship is still unsatisfying? Here are a few places you can look for help.

Books. How do you find the good ones? Ask people you trust for recommendations. Books that my patients have found helpful include: The All or Nothing Marriage: How the Best Marriages Work (Eli Finkel), The Five Love Languages (Gary Chapman), Ten Lessons to Transform your Marriage, and The Seven Principles for Making Marriage Work (John Gottman).

Podcasts. Esther Perel has a great podcast called “Where Should we Begin.” Each episode features a couple in an actual counseling session with Perel, who helps them articulate their feelings and get to the bottom of what’s really going on.

Weiss quoteSeminars and retreats. Using Google, you can find everything from reasonably priced retreats hosted by religious organizations to pricey seminars hosted in scenic locations by marriage experts (often authors of books on marriage). Be sure to do your research and discuss what you’ve learned and what you expect with your partner before signing up. Some are classroom style with small group breakout sessions, while others may include public roleplaying, couples counseling, or game playing designed to foster connection.

Counseling. A good marriage counselor can help identify the underlying issues in your relationship and then facilitate the conversation as you work through them together. Look for counselors who specialize in marriage and family counseling and find out what kind of approach they use. Cognitive behavioral therapy, which focuses on changing negative thoughts and behaviors, is quite different from a Freudian approach, which focuses on unconscious meanings and motivations. Imago relationship therapy (IRT) is another approach; it explores how emotional wounds in childhood affect adult relationships so partners can better understand each other.

Marquez quoteHow will you know if a counselor is good? Our friend Ann McKnight, a clinical social worker who is experienced with couples and families, has some thoughts. After the first session, you’ll likely have an idea of whether or not the person understands the issues and can offer a direction that makes sense to your and your partner.  Don’t be afraid to ask about the counselor’s training and experience working with couples, as well as what kinds of outcomes they see. And, she says, “Do your own homework, as well, in considering ahead of time what outcomes you are hoping for from the process. Willingness to take ownership for your own role in the challenges of your marriage is important.”

All marriages go through rough patches. Often, they can recover with some extra help. Ann says that, of the couples she sees “an extremely high percentage of marriages can recover, particularly if people start to work on the marriage before they’ve reached the point of total burnout and hopelessness.”* It’s important to point out that she sees a self-selecting group in that they have sought out therapy—but you would fall into that category, too.

Whatever you do, don’t wait. Just like with your physical health, the sooner you address whatever the issue is, the greater the chance that it can be fixed.


*This holds true as long as there’s no domestic violence and/or untreated substance abuse.

The Empty Nest Reset

It’s move-in weekend at the college in the town where I work, and seeing all those packed minivans crawl along the side streets, trying to find their way to the right dorm, makes me think of the parents who drove out of the driveway with their youngest child and a full van—and will return with an empty van to an empty nest.

Some will break out the champagne; others will retreat with a box of tissues. And some will do both within 20 minutes. It’s a wild time.

Emma Thompson quote

This built-in transition also happens to be the perfect time to reset your relationship with your significant other. As with so many other things we talk about, the important thing is to be intentional. As Dr. John Gottman says, couples often ignore each other’s emotional needs “out of mindlessness, not malice,” so being mindful is critical.

In the first few days, give each other some space. Everyone has their own way of processing this major milestone, and you may find that your partner’s way is a lot different than yours. It’s okay. As long as the behavior isn’t harmful, live and let live. If your partner goes silent in those first few days, check in occasionally, but don’t hover.

If you suddenly realize you’ve drifted apart over the last few years (or decades), row back together. Raising children is a demanding job, and many couples are surprised to find that while they were busy tending to their children’s needs over the years, they lost track of each other. It’s not too late to find your way back to each other. There are many ways you can do it—all of them start with acknowledging that you’ve drifted and desiring to come back together.

Without children to monitor and guide, it can be tempting for partners to monitor and guide each other. Resist the temptation. Instead, look for the good in your partner, including the things that you might be taking for granted, and express appreciation. Every time you do, you are making a deposit in what Gottman calls “the emotional bank account,” and you can draw on that bank account during hard times. Ideally, that account is healthy before you get to the empty nest, but it’s never too late to start.

Rediscover the things you used to enjoy doing together before the kids’ needs and activities commandeered your time. You could start by having a dinner conversation reminiscing about your dating days. How did you like to spend time together then? Then try to remember what, over the years, you said no to because there wasn’t time. Going on a mission trip? Hosting a salon to discuss literature or art? Which of those things are you still interested in? Then make a plan together for doing them.

Emma Thompson quoteFind a new interest that’s yours and yours alone. I know. I just said to find things to do together. But the truth is that you need both. Pursing your own passion is not just rewarding for you—it can also be intoxicating to your partner, who will see you with fresh eyes. In her research, Esther Perel found that one of the times a person is most attracted to their partner is when watching the other do their thing from a distance. “When I look at my partner, radiant and confident, [is] probably the biggest turn-on across the board,” says Perel. She’s a big advocate for nurturing both intimacy and mystery (AKA security and passion) in relationships, and doing something new is a way to amp up the mystery.

With time and effort, your relationship can be more satisfying and simply more fun than ever. Enjoy it! And appreciate it while it lasts, because those children might come home again. Thirty-two percent of children 18 – 34 live with their parents, according to Pew Research Center. But that is a topic for another time.

To raise the topic of renewed intimacy with your partner, or to support mindfulness for yourself, check out our Empty Nest Kit

Yoga, stretching, weight lifting, aerobics—they’re all forms of exercise, and they’re all good for you. But, do they all give you the same boost in the bedroom?

It’s true that any form of exercise is good for you and may help you lose weight, build muscle, and improve body image, among other benefits. These are all compelling reasons to get moving or keep moving if you already have an established exercise routine. But, there is one form of exercise—strength and high intensity workouts—that may help spice things up in the bedroom.

Research (from health.com) shows that physically active women have a greater sexual desire, increased arousal and higher satisfaction than women who do not exercise. In addition, another study (also from health.com) among physically inactive men who began a strenuous workout routine reported “more frequent sexual activity, improved sexual function, and greater satisfaction. Those whose fitness levels increased most saw the biggest improvements in their sex lives.”

In addition, any exercise, especially strength training, can increase testosterone levels in both men and women. You may already know that, but did you know higher testosterone levels may increase your sex drive—and your partner’s as well?

That could be a good reason to start doing some high intensity workouts with your partner. A win-win for both of you between the sheets!

High intensity and strength training workouts can also have other benefits that many women don’t think about: improved stamina and durability, and stronger orgasms. You and your partner will likely enjoy your sexual encounters more if you’re not gasping for breath or sweating profusely part-way through your sex date.

More research has shown that strength training had “the strongest relationship to overall satisfaction with quality of orgasm.” And many studies show a correlation between aerobic exercise and quality of orgasm.

If you’ve been thinking about increasing your activity level or looking for ways to heat things up with your partner, consider adding strength training and/or high intensity workouts to your routine. I think you will be pleased with the results—in more ways than one!

When Aretha Franklin sang “Respect,” “It was a demand for equality and freedom and a harbinger of feminism, carried by a voice that would accept nothing less,” writes the New York Times. We agree.

Born in Memphis to a preacher and raised singing gospel in New Bethel Baptist Church in Detroit, Franklin had a “both/and” life, experiencing hardship alongside success. Her parents separated when she was six, and her mother died just a few years later.

Things didn’t get any easier. Franklin had two children by the age of 15, married at 19 a man who managed and physically abused her, and struggled with alcohol and marijuana for a time as an adult. In the 1980s, she lost her father, her brother, and a sister.

Sometimes, what you're looking for is already there. Aretha Franklin

But alongside the pain (some say as a result of it), she experienced lasting success and fame. Songs like “Respect,” “Think,” “Chain of Fools,” “Ain’t Nothing Like the Real Thing,” and “Freeway of Love” are included in many of our personal soundtracks of life.

She received far too many awards to list, but they include induction into the Rock and Roll Hall of Fame (1987), a Grammy Lifetime Achievement Award (1994) and the Presidential Medal of Freedom (2005). Beyond her professional achievement, she was deeply committed to and engaged with her community. And Aretha set an example in owning her own body and appearance, embodying self-worth and self-love.

Like the rest of us, Franklin was human—not perfect. She jealously guarded her “queen of soul” title and could be difficult to deal with. And she was a strong women who sang powerfully and, in so doing, inspired others to respect themselves and demand that others do the same.

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