Sex After Menopause Can be Great

While talking about vaginal pain during intercourse last week, physical therapist Erica Azzaretto from 5 POINT Physical Therapy PLLC., Manhattan, mentioned one of the potential causes as a loss of hormones due to the onset of menopause or a hysterectomy. As a woman ages and her hormones change, her sex drive can taper off. Loss of libido is a common reason women seek my help as a sex coach. They think it’s just natural or there is something wrong with them, especially women who haven’t gone through “the change” yet.

Melissa*, 67, is one of my clients who recently reentered the dating scene and was conflicted by her desire for sex and her lack of sex drive. She worried that her new beau would be up for sex (pun not intended) more than she would. And Melissa had good reason to be concerned.

Think of the types of cosmetic surgery some women opt for as they age — tighter skin, plumper lips, fuller cheeks — because as estrogen decreases, thinning occurs. The same thing happens to vaginal walls, which can cause tearing along the vaginal opening, it can start before a woman realizes perimenopause is upon her.

“[Hormone loss] makes the tissue weaker so you can experience incontinence, too,” Azzaretto added.

So what can a woman like Melissa do? Certainly not put up with bad sex! A woman is never “too old” to feel desired and sexy.

First thing I told Melissa is to get rid of the idea that sex just goes away as a person ages. Just because the reproductive system is closing up shop, it doesn’t mean that the pleasure and closeness gained by sex have to end.


You are never too young or old for lube.

Whether you are 62 or 22, one thing is for certain: you should not feel ashamed buying lube. It doesn’t mean you’re “dried up” or old or that there is something wrong with you. There are a lot of choices when it comes to lubrication, but women with lower estrogen levels can ask their doctors about topical estrogen to re-plump the vaginal walls.

Melissa doesn’t have a history of cancer, so topical estrogen was a possibility she and her doctor considered.

Or, you could do acid. Not the kind you dropped in college —  I’m talking the kind of acid that makes your skin radiant. Check your bottle of facial lotion. That same hyaluronic acid that removes dead skin and gives your face a youthful glow comes in vaginal suppositories you can get from your doctor, Azzaretto said. Hyaluronic acid can be used before and after sex, but don’t be tempted to use your face lotion in your vagina. Be sure to talk to your gynecologist.

Dial it up.

One you plump it up, you might also want to pump it up with vaginal dilators.

“It’s a medical-looking dildo,” Azzaretto said while describing the different brands of dilators. “It comes in smaller sizes to larger sizes. You start small and increase the size as the patient is able to move the dildo in and out without any pain.”


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The patient can increase the size until it matches her partner’s penis or strap-on or an average-size penis, Azzaretto explained. Dilators and dildos are typically made of silicone with varying softness and can be purchased on Amazon, but Azzaretto suggested talking to your OB/GYN first.

“It’s helpful to have someone show you how to use them,” she said.

Vaginal rejuvenation

Nope, not Vagazzling. I don’t mean rhinestones and sequins adorning your mons. Vaginal rejuvenation is an umbrella term that covers a variety of medical and cosmetic procedures, such as labiaplasty, clitoral hood reduction, labia majoraplasty, monsplasty and vaginoplasty, according to the American Society of Plastic Surgeons.

Vaginoplasty, a procedure that tightens the vagina, is a bit controversial because it is seen as an extra, unnecessary surgery. But having your excess mucosa removed and the muscle walls reunited isn’t just for looks. Many women experience looser vaginal muscles post-childbirth. Again, weak vaginal muscles can cause incontinence, an inability to keep tampons in place and sexual dysfunction. A non-invasive or surgical vaginoplasty is an option to discuss with your OB/GYN.

And for the grand finale…

Masturbate with a vibrator! Use a vibrator during masturbation to get the vaginal muscles working, the body’s natural lubrication going and to stoke that sexual pilot light.

Rather than feeling like she’s old and deteriorating, Melissa now understands that the changes that happen outside her body also take place inside. After talking to her doctor about topical solutions, lubrication, masturbation and her physical therapist showing her how to use dilators, Melissa is enjoying a sex life on par with the sex she had the first time around.

*Name changed to protect anonymity.