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A post-menopausal woman feeling good in her body after receiving pelvic floor physical therapy for pain with sex and weak orgasm

Yes, You Can Have Great Orgasms and Pain-Free Sex After Menopause

If you've experienced a few major glitches in your sex life since you stopped menstruating, you're in the right place. “Sexual concerns during and after menopause are extremely common,” says Dr. Lyndsey Harper, an OB-GYN, CEO of sexual-health platform Rosy, and Origin advisor. “But just because they're common, doesn't mean they're normal or something to endure — you can get the help you deserve!”

What does 'help' look like? "Things like pelvic floor physical therapy; clear communication about desires, needs, and wants; appropriate vaginal hormone use; and the right lubes can assist in staying happily sexually active,” says Dr. Suzanne Gilberg-Lenz, author of Menopause Bootcamp.

As pelvic floor physical therapists who have helped hundreds of women and individuals with vaginal anatomy enjoy pain-free, satisfying sex after menopause, we're here to confidently assure you can enjoy getting intimate again.

Keep reading to find out how menopause can lead to symptoms like painful intercourse and weak orgasm and what you can do to address them.

How menopause impacts your sex life

As you no doubt know, most symptoms of menopause are related to the decline in estrogen that occurs when aging ovaries stop producing this essential hormone. You may have experienced some or all of the following:

  • Hot flashes
  • Disrupted sleep (e.g., insomnia, night sweats)
  • Mood changes
  • Brain fog
  • Weight changes

These symptoms may have understandably made you feel less comfortable in your own body and with sex, which can result in poor body image, reduced sexual satisfaction, and (over time) avoidance of sex. This can become a viscous cycle, as research shows that negative body image can also make menopausal symptoms of any kind more severe. This reinforces the deep connection between mind and body — and emphasizes the importance of nurturing a positive body image when treating menopause issues.

Pain with sex & weak orgasm after menopause

A decline in estrogen can impact your sexual functioning even more directly. For one, lack of estrogen is associated with reduced blood flow to pelvic floor tissues. According to the North American Menopause Society, this reduction in blood flow can make the clitoris less sensitive to stimulation, and orgasms less intense or harder to achieve.

Reduction in blood flow can make the clitoris less sensitive to stimulation, and orgasms less intense or harder to achieve.

Decreased estrogen can also lead to thinning of the vulvar and vaginal tissues as well as moisture reduction and a lack of lubrication that leads to inflexibility and sensitivity. The end result: Pain with any kind of vaginal penetration.

In people with vaginas who are 50 years old and above, these issues are the most common causes of painful sex, also referred to as dyspareunia. Dyspareunia can lead to a cycle of sexual dysfunction, where painful sex leads to fear and avoidance of sex — and makes sex more uncomfortable and painful later on through decreased lubrication and involuntary spasms of the vaginal muscles.

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Other pelvic floor issues that interfere with sex

Your pelvic floor is critical to healthy sexual function. Some of the menopause symptoms we’ve already mentioned, including pain with sexual penetration, are also signs of pelvic floor dysfunction (PFD). Other symptoms of PFD include bladder leakage, urinary frequency or urgency, and pelvic organ prolapse.

The two most significant contributing factors for pelvic floor dysfunction during and after menopause are:

  • Urogenital atrophy: Experts believe all postmenopausal people experience urogenital atrophy, which is the gradual decline of tissues that makeup and support the genitals and urinary system caused by lower levels of estrogen. People may or may not have noticeable symptoms of urogenital atrophy, like vaginal dryness, irritation, and itchiness.
  • Decreased resilience in pelvic floor tissue: At the same time, pelvic floor tissue becomes less resilient and less supportive because of low estrogen. This can cause or worsen symptoms like bladder leakage and urinary frequency or urgency.

How to have better sex after menopause

Like Dr. Gilberg-Lenz mentions above, there are many treatment options that can help you address pelvic floor dysfunction as well as other symptoms that put a damper on sex. Below are some of the most effective options to consider.

Hormone replacement therapy (HRT) for menopause

By increasing estrogen levels, hormone therapy can work wonders when it comes to alleviating menopause symptoms. While hormone therapy may slightly increase the risk of uterine and breast cancers, heart attack, stroke, blood clots, and gallbladder disease in those already at increased risk for disease, the benefits often outweigh the potential risks. If you have uncomfortable symptoms, talk to your gynecologist about whether hormone therapy could work for you.

In general, people with uteruses will take combined hormone therapy which consists of estrogen and progestin. Combining these two hormones significantly reduces the increased risk of uterine cancer that comes with taking estrogen alone. (Those who have had a hysterectomy will only take estrogen.)

Estrogen therapy can be systemic, as in for the whole body, or localized, as in targeting urogenital symptoms only. Systemic estrogen therapy may be administered along with progestin via pills or skin patches, as well as topical gels and sprays. Localized estrogen therapy can be administered in small doses through a vaginal ring, tablet, or cream.

Over-the-counter therapies for menopause

For people who have health conditions that make HRT risky or who prefer not to take hormones, there are non-pharmacologic treatments for menopause symptoms that interfere with sex.

The North American Menopause Society makes several recommendations for treating vaginal dryness:

  • Try over-the-counter vaginal moisturizers and lubricants.
  • Don’t use soap or powder on the vulva.
  • Don’t use fabric softener or anti-cling products with underwear.
  • Avoid using panty liners or pads.
  • Continue having sex — regular sexual activity can help by increasing blood flow to the pelvic region and maintaining the size of the vagina.

As for decreased sexual desire, the Society explains that many factors go into sexual desire — from the psychological to the interpersonal to the biological. Talking to your healthcare provider can help you get to the bottom of these issues, whether the cause is psychological, medical, or a combination of the two.

Pelvic floor physical therapy for menopause

Pelvic floor strengthening and rehabilitation have proven to be effective treatments for menopause symptoms that can impact sex and overall well-being.

A 2020 randomized controlled trial aimed to better understand how and why pelvic floor muscle training may be helpful for genitourinary syndrome in postmenopausal people. (Genitourinary syndrome is another term experts use to refer to the cluster of symptoms that are caused by decreased estrogen and impact pelvic floor tissue.) The study found that pelvic floor muscle training has significant positive effects on blood flow as well as pelvic floor muscle relaxation. It also showed that pelvic floor muscle training has a positive effect on pelvic floor muscle tone and strength — as well as skin elasticity in the pelvic floor tissues.

Another randomized controlled trial from 2021 demonstrated that study participants who received pelvic floor muscle training reported decreased sexual dysfunction after three months.

“Those with vaginal pain during sex may need to work on blood flow and flexibility of the pelvic floor tissues,” explains Dr. Ashley Rawlins, PT, DPT, physical therapist and the clinical learning and development lead at Origin, “while those with urinary incontinence may need to focus more on strengthening and coordination.”

Pelvic floor physical therapy for menopause symptoms may include the usage of vaginal dilators, core strengthening, kegels, yoga stretches, breathing exercises, and walking.

Other adjunct therapies that may help promote a better sex life after menopause include sex therapy and psychotherapy. Your OB-GYN, primary healthcare provider, or physical therapist can help connect you with the right people to build out your care team.

Menopause care at Origin

You can always reach out to your OB-GYN or primary healthcare provider if you’re experiencing uncomfortable sexual or other pelvic-area symptoms before or after menopause. If the two of you decide that pelvic floor physical therapy is the right choice for improving your quality of life, they can refer you to a compassionate provider like Origin. If you already know you’re interested, go ahead and book your first appointment. We take insurance and can provide you with a Superbill if we don’t take yours.

Origin’s team of pelvic floor physical therapists is here to support the whole you. They’re specially equipped with the clinical know-how to help you manage symptoms of menopause — and reduce painful or unsatisfying sex.

If the issue goes beyond the physical, which it often does, our physical therapists will work with you to find out what’s happening. This may include providing emotional support, ruling out possible conditions, and referring you to other specialists when additional treatment is needed.

Each plan of care is tailored to meet your needs and preferences. Importantly, we offer in-person as well as online treatment. And your physical therapist will incorporate all of the tools in their toolkit, from gentle movement to strengthening exercises to guidance for supportive devices like pessaries or dilators. Whatever will help you feel the best, right now, in your body.

In the meantime, for a refreshingly positive take on menopause, check out this post.

Sarah DuRivage-Jacobs
Sarah duRivage-Jacobs

Sarah duRivage-Jacobs is a reproductive health copywriter, editor, content strategist, and educator.

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