Menopause and Sex in Marriage: What Changes and What Helps

When I asked our private Facebook group what they wanted to know about menopause, most of the questions came from husbands. Some version of the same question kept showing up: Where did my wife’s desire go?

Wives have their own fears. Many grew up with a mother whose only advice about menopause was “just you wait.” No wonder so many couples quietly assume this is where their sex life ends.

It doesn’t have to be. As my friend, Alisa DiLorenzo, pointed out when she joined me on the podcast, women can spend about a third of their lives after menopause. That is far too long to write off. With some understanding, a few practical changes and a lot of teamwork, this can be one of the most connected seasons of your marriage.

The short version: menopause changes hormones, comfort and desire, and it usually arrives alongside other big life changes. Lubricants, a good doctor, more time for arousal and a wider definition of sex solve most of the physical problems. The rest comes down to how you treat each other: talking honestly, not taking it personally, and facing it as a team.

What Actually Changes During Menopause

Menopause is reached after 12 months in a row without a period. In the US, the average age is 51. The years leading up to it, called perimenopause, often start in the early 40s and can last 7 to 10 years, so many couples are living with these changes long before the official milestone.

Here is what couples most often notice:

• Dryness and discomfort. As estrogen drops, vaginal tissue can become thinner, drier and less elastic. Doctors call this genitourinary syndrome of menopause. It can make sex uncomfortable or painful, and it can bring urinary changes too.
• Desire that works differently. Many women find they can no longer count on hormones to spark desire the way they once did. Desire often becomes more responsive: it shows up once touch and connection begin, rather than before.
• Sensations that change. Touch that used to feel wonderful may feel different, or not do much at all. Other things may start feeling better than before.
• Sleep, mood and energy. Hot flashes, night sweats, broken sleep, brain fog and mood swings all affect how much a woman has left to give at the end of the day.
• Everything else happening at once. Alisa described how menopause often lands at the same time as kids leaving home, career transitions and caring for aging parents. That is a lot of identity and stress for both spouses to carry at once.

And husbands, your body is changing too. Hormones shift for men in midlife as well, and erections may need more time and more direct touch than they used to. You are both adjusting, which is one more reason to approach this together.

For Wives: What Helps

Make comfort the first priority

No woman wants painful sex, and no husband wants to be the cause of it. Start with the simple things:

• Use a good lubricant every time. Water-based or silicone-based lubricants reduce friction during sex. If you are sensitive, avoid products with glycerin or warming ingredients.
• Try a vaginal moisturizer. Used every few days, moisturizers help with everyday dryness and last longer than lubricant.
• Give arousal more time. Your body may need longer to warm up than it used to. Slower foreplay is not a consolation prize. It is part of the solution.

If sex still hurts, do not push through it. Our article on painful sex has more ideas, and a pelvic floor physical therapist can help a great deal.

Find a doctor who knows menopause

Alisa’s advice was to look for a physician who actually specializes in menopause and hormone therapy, because not every doctor has that training. There are good options to talk through, including low-dose vaginal estrogen, which helps keep tissue healthy, and other forms of hormone therapy. A doctor can help you weigh the benefits and risks for your own health history.

Keep intimacy in your life

Sex therapist Natalie Wilton, who works with aging couples, told me that “use it or lose it” applies here. Regular arousal and touch help keep tissue healthy. That does not have to mean intercourse every time. It means not letting physical closeness disappear while you figure things out.

For Husbands: What Helps

• Listen before you fix. Alisa’s advice to husbands was blunt: when your wife tells you what she is going through, just listen. Don’t tell her to exercise, eat differently, meditate or get her hormones checked. At least not in the first conversation.
• Don’t take it personally. Many husbands tell Alisa it feels like they are living with a different woman. Her body and brain are going through a major change. Her lower desire is not a verdict on you or your marriage.
• Reassure her you are in this together. On the podcast, Dr. Emily Jamea shared the story of a wife who was heartbroken that she didn’t feel like herself anymore and told her husband she didn’t know what it meant for them. He put his arm around her, held her tight and said, “We love each other. We’ll figure it out.” Dr. Jamea said that in that moment, her desire came right back.
• Touch her without an agenda. If every touch feels like a request for sex, she will start avoiding touch altogether. Our post on non-sexual touch explains why, and what to do instead.
• Take care of your own health. Sleep, exercise, weight and stress all affect your sex life too. Episode 297 on boosting testosterone naturally is a good place to start.

Redefine Sex Together

One of the most freeing things a couple can do in this season is let go of the script from their 20s and 30s. Sex does not have to look the way it used to in order to be good. There are many different types of sex in marriage, and slow, playful, sensual ones often fit this season best.

In my conversation with Natalie Wilton, I shared a story from the book Magnificent Sex, a study of people who report extraordinary sex lives, including older couples in their 60s, 70s and 80s. One husband laughed that they used to have sex three times a week and now only had it once. But, he said, it started Thursday night and lasted until Sunday.

That is the opportunity in this season. With fewer kids at home and more time together, many couples discover a deeper, slower and more cherishing kind of intimacy. It is what I call stage 3 love making, and it often gets better with age. And on the days when intercourse isn’t on the table, there are still plenty of ways to be close.

When to See a Doctor

I’m a marriage coach, not a physician, and some symptoms need a medical opinion. Talk to a doctor if:

• sex is painful, or stays painful after you’ve tried lubricants and moisturizers
• you have any bleeding after menopause
• you have urinary symptoms, like needing to go much more often
• mood changes, anxiety or sleep problems are affecting daily life
• you have a history of breast cancer and are considering any hormone treatment

This Season Can Be Your Best Yet

God designed sex for the whole of marriage, not just the early years. Menopause changes the way intimacy works, but it doesn’t have to end it. Couples who talk openly, stay curious and treat each other with patience often find their sex life becomes more honest and more connected than it has ever been.

If you want to go deeper, listen to my conversations with Alisa DiLorenzo on menopause, Natalie Wilton on sex when aging and Shelly Wilkinson on hormones and libido, or read our article on sex and aging. And if you would like help reconnecting as a couple, our Virtual Lovemaking Retreat walks you through it together from home.

Menopause and Sex: Common Questions

References

• Mayo Clinic: Genitourinary syndrome of menopause, diagnosis and treatment
• Society for Women’s Health Research: Menopause 101