Menopause and sex: body changes, challenges, and tips for intimacy and comfort

Menopause isn’t just about the end of your period. Perimenopause and menopause can bring many physical and emotional changes, including some you might not expect in your sex life. Maybe you’re experiencing vaginal dryness or your desire has dipped. While these changes may be challenging, sex during and after perimenopause and menopause can still be pleasurable, meaningful, and deeply satisfying.

“You can maintain and even enhance your sense of intimacy, connection, and enjoyment — solo or partnered — during and after menopause,” says Amy Bock, PT, DPT, a physical therapist at Hinge Health. “A fulfilling sex life starts with understanding how menopause affects your body, addressing disruptive symptoms, and finding approaches that work for you.”

Here’s a closer look at how perimenopause and menopause affect your sex life, and how to support your sexual well-being, including tips and exercises from Hinge Health physical therapists.

Menopause starts when you haven’t had a period for 12 months. The phase leading up to it, called perimenopause, usually begins in your 40s or 50s and can last several years. 

How does menopause affect sex?

Sex during perimenopause and menopause can change for a lot of reasons, from shifting hormones, bladder issues, mood shifts, and other body changes to lifestyle issues like stress and sleep patterns.

• Hormone changes. Estrogen levels decrease during perimenopause and menopause, which can lead to thinner, drier, and less elastic vaginal tissues. These changes often reduce the natural lubrication that makes sex more comfortable and contribute to vaginal dryness and discomfort during sex. Testosterone also declines with age and menopause. Lower testosterone is linked with decreased sexual desire (libido) after menopause.

• Bladder issues. Less estrogen can make bladder tissues thinner and more sensitive. This can contribute to urinary symptoms like urgency, frequency, or leaking urine.

• Stress. Menopause can be a stressful time, affecting your overall wellbeing and interest in having sex. Stress and anxiety can also cause pelvic floor muscle tension, which makes intercourse less comfortable.

• Mood changes. Mood swings, brain fog, anxiety, and depression can all influence sexual desire.

• Body image. Menopause can bring changes to weight and body composition, which can affect self-esteem and libido.

• Sleep disturbances. Hot flashes, night sweats, and other symptoms can interfere with sleep, which may leave you with less energy or interest in sex.

“People may not realize just how much hormones can influence sex and libido during menopause, and that’s just one piece of the puzzle,” says Dr. Bock. 

Sleep is another major factor. Night sweats, frequent waking, or regularly getting less than seven hours a night can lower libido and affect your sex life. “Taking a holistic approach — whether it’s pelvic floor physical therapy, talking to your menopause provider about treatments, trying menopause hormone therapy, or making small lifestyle changes — can make a real difference in your sexual well-being.”

7 menopause symptoms that affect your sex life

Perimenopause and menopause can bring symptoms like vaginal dryness, low libido, hot flashes, weight gain, and joint pain — all of which may impact your comfort, interest, and confidence during sex:

• Vaginal dryness. As estrogen decreases, vaginal tissues naturally become drier and less elastic. This can result in discomfort, burning, itching, or pain during sex and daily activities, and a higher risk of urinary tract infections (UTIs). 

• Low libido. A dip in estrogen and testosterone can contribute to a lower sex drive during menopause. For many people, “spontaneous desire” — that feeling of suddenly being in the mood — may become less frequent. Instead, “responsive desire” becomes more common during and after menopause. Responsive desire is when interest in sex develops after intimacy begins, such as through touch, cuddling, kissing, or foreplay.

• Hot flashes and night sweats. Frequent hot flashes and night sweats aren't just physically uncomfortable — they can disrupt sleep, sap  energy, and affect interest in intimacy.

• Weight gain. Changes in metabolism and hormonal balance may lead to menopause weight gain or redistribution. This can influence self-image and, in turn, affect how confident and comfortable you feel sexually.

• Joint pain. Menopause can bring new or increased joint pain. Stiffness and discomfort in the hips, knees, or back may make some movements or sexual positions less comfortable.

• Sleep disturbances and fatigue. Hormone shifts during menopause can disrupt sleep, leading to night sweats, frequent waking, and trouble staying asleep. These sleep issues often leave you feeling tired, which can lower your energy and interest in sex. Ongoing fatigue may make intimacy feel less appealing or spontaneous.

• Mood changes. Mood swings, anxiety, and low mood are common with menopause and can influence your desire for intimacy. Emotional ups and downs may make it harder to feel connected or interested in sex. Supporting your mental health — through self-care or seeing a mental health provider — can help boost both mood and sexual well-being.

It’s important to be aware of changes in your body and how symptoms around menopause can affect your sex life. “But instead of just focusing on the negatives, remember there are so many ways you can care for yourself and support your sexuality throughout this transition,” says Dr. Bock. 

These changes are common, but there’s a lot you can do to maintain, enhance, and even rediscover pleasure and connection, she adds.

Genitourinary syndrome of menopause and sex

Many physical symptoms that impact sex during perimenopause and menopause are part of genitourinary syndrome of menopause (GSM). As estrogen levels drop, the tissues of the vagina and urinary tract become thinner, drier, and more sensitive. 

GSM can show up in several ways — vaginal dryness, needing to urinate urgently and frequently, leaking urine, more frequent urinary tract infections (UTIs), waking up at night to pee, itching or burning, and increased sensitivity to clothing or pressure. It can also cause pelvic pain, pain or bleeding during sex, and decreased arousal and desire. 

The most effective treatment for GSM is long-term, low-dose vaginal estrogen. This is available as creams, tablets, suppositories, or a flexible ring that slowly releases estrogen. This medication can restore healthy vaginal tissue, improve lubrication and blood flow, reduce UTIs and nighttime bathroom trips, and make sex more comfortable. 

Other options include non-hormonal vaginal moisturizers and lubricants for temporary relief, and pelvic floor exercises to help with bladder and pelvic symptoms. Talk to your provider about which approach might work best for your pelvic and sexual health.

“We’ve made progress in opening up conversations about menopause, but there’s still a lot of room for more,” says Dr. Bock. Up to 84% of people in menopause experience genitourinary syndrome of menopause (GSM), so it’s important to get comfortable talking about these symptoms, she explains. “The more we talk about it, the more we can explore all the ways to address and treat GSM and improve your quality of life.”

Tips for improving sex in menopause

You can support sexual well-being and improve libido during perimenopause and menopause by focusing on pelvic floor health, regular exercise, healthy eating, stress management, quality foreplay, open communication, and making time for intimacy. Here’s more information about these options:

• Strengthen your pelvic floor. Pelvic floor exercises build muscle strength, promote relaxation, and enhance sensitivity — helping with bladder control, pelvic pain, and sexual enjoyment. “Research shows that strong pelvic floor muscles are linked with more frequent sexual activity and satisfaction,” says Dr. Bock. Hinge Health physical therapists recommend exercises beyond just Kegels, such as pelvic tilts, bridge, squats, and more (see exercises below).

• Regular exercise. Movement is key to feeling better mentally and physically — especially during perimenopause and menopause. Aerobic exercise, strength training, and stretching can help increase blood flow, regulate mood, boost energy, support a healthy weight, and promote bone and pelvic floor health — all of which contribute to sexual health and comfort. Even household activities or walks count.

• Eat a balanced and healthy diet. Nourishing your body with whole foods — fruits, vegetables, whole grains, lean proteins, and healthy fats — supports hormone health and energy levels, which can boost sexual well-being. “Aim for a varied diet that lets you get most of your nutrients from food rather than just supplements,” says Dr. Bock. 

• Manage stress. Stress and anxiety about intimacy or menopause symptoms can decrease libido and increase discomfort. Mindfulness, meditation, and breathing exercises can help you tune into your body and stay present. Even a few minutes a day can make a difference.

• Prioritize sleep. Getting consistent, restful sleep can be challenging during menopause with night sweats, frequent waking, and insomnia all interfering with your rest. But better sleep is linked to improved energy and sexual desire. Focusing on sleep hygiene — like setting a regular bedtime, keeping your room cool and dark, limiting screens before bed, and winding down with a relaxing routine — can help support your libido and overall well-being.

• Schedule time for intimacy. Whether you have a partner or not, intentionally making space for intimacy, connection, and exploration helps keep desire and pleasure a part of your life.

• Get creative. Experiment with new positions or try incorporating sex toys to discover what feels best for you. Exploring different ways of being intimate can increase comfort and add excitement.

• Focus on foreplay. Desire often grows as you feel more relaxed and engaged. Longer or varied foreplay helps your body become more receptive to pleasure and shifts the focus to connection and enjoyment.

• Communicate openly. Talking with your partner about your needs and experiences helps foster connection and makes it easier to get the support you need. If sexual health feels awkward to discuss, consider couples or sex therapy for guidance.

Painful intercourse during menopause

Painful intercourse (dyspareunia) is more common during perimenopause and menopause due to changes like vaginal dryness, reduced tissue elasticity, or pelvic floor muscle tension. Lower estrogen levels may cause the vaginal walls to become thinner and more sensitive, leading to burning, itching, or a pulling sensation with penetration. When sex becomes uncomfortable, it can influence physical intimacy and your connection with a partner. These challenges might also lead to changes in sexual desire or create anxiety around intimacy, making it even more important to find solutions, like these below.

Treatments for painful intercourse during menopause

Managing painful intercourse during perimenopause and menopause may involve targeted pelvic floor exercises, relaxation techniques, topical estrogen, additional prescription treatments, lubricants, moisturizers, and open communication with your partner. Talk to your provider if you’re interested in prescription treatments for vaginal dryness to ease painful intercourse.

• Try physical therapy and targeted exercises. Targeted exercises — especially those that strengthen and relax your pelvic floor — can improve blood flow, reduce pain, and support comfortable, pleasurable sex. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit. See below for exercise examples.

• Try topical estrogen. Treatments like vaginal creams, rings, or tablets are applied directly to the vaginal area and can restore tissue health, improve lubrication, and boost comfort during sex. Vaginal estrogen also relieves urinary symptoms, supports healthy vaginal bacteria, and reduces UTIs and nighttime bathroom trips. Because only a small amount is absorbed into your bloodstream, side effects are uncommon, and studies show it does not increase the risk of cardiovascular disease or cancer. Many providers prescribe vaginal estrogen even for those taking systemic hormone therapy or who have had hormone-sensitive cancers. “Vaginal estrogen can make a world of difference. I’ve seen many people notice less burning, more moisture, and much less pain with intercourse after starting it,” says Dr. Bock.

• Consider other prescription options. DHEA (dehydroepiandrosterone) is a hormone involved in estrogen production. DHEA, or other prescription therapies, may be recommended by your provider if topical estrogen is not an option for you. These can help restore tissue health and reduce pain and dryness. Research on oral DHEA supplements is limited, but vaginal DHEA has been shown to be safe and effective for treating vaginal symptoms in menopause. There’s also an oral hormonal medication (ospemifene) for painful sex and vaginal dryness. 

• Use vaginal lubricants. Water-based or silicone lubricants provide additional moisture, reduce friction, and can ease discomfort during sex. 

• Try vaginal moisturizers. Over-the-counter vaginal moisturizers can help keep tissues hydrated between sexual activities. They don’t provide the same tissue-healing benefits as vaginal estrogen, but can help ease discomfort. 

• Talk with your partner. Open conversation about discomfort, desire, and preferences helps you and your partner work together toward pleasure and satisfaction. Sharing what feels good and what doesn’t can deepen trust and intimacy.

Pelvic floor physical therapy for painful intercourse

If pelvic floor muscle problems are contributing to pain during sex, a pelvic floor physical therapist (PT) can help tailor an exercise plan that includes specific moves and modifications that are appropriate for you. A PT may recommend pelvic floor stretches and diaphragmatic breathing to help relax muscles and calm your nervous system. You can see a physical therapist in person or use a program like Hinge Health to access a PT who specializes in pelvic health via telehealth/video visit.

Pelvic floor physical therapy for pelvic pain and other symptoms is a comprehensive treatment that includes education, behavioral and lifestyle strategies, movement and exercise, and manual therapy.

To increase comfort during sex, your pelvic floor PT may recommend exercises including these below.

Practicing these pelvic exercises regularly can offer a range of benefits to support your sexual wellbeing during perimenopause and menopause. Child’s pose eases tension and encourages relaxation, helping you feel more comfortable before intimacy. Pelvic tilts build awareness and flexibility in your core and pelvic floor, making sex more comfortable. The bridge exercise boosts hip flexibility and pelvic strength, while squats open your hips and improve both blood flow and lower body mobility — all important for supporting comfort and pleasure. Standing groin stretches increase flexibility and circulation, making various sexual positions feel easier and more comfortable. Kegels strengthen the pelvic floor, enhancing arousal, sensation, and support. Clamshells improve hip and pelvic stability, supporting positioning and comfort. 

Together, these exercises contribute to flexibility, strength, and confidence, helping you feel more at ease, comfortable, and capable in your sexual activity.

“Warming up for sex, just like you would for exercise, helps bring blood flow to the pelvic area and can make intimacy more comfortable and enjoyable,” says Dr. Bock. “You can use these exercises in two ways: Doing them right before intimacy helps get your body ready in the moment, while practicing them regularly as part of your movement routine supports pelvic strength, flexibility, and overall sexual comfort over time,” says Dr. Bock

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

When to see a doctor

Sexual changes during perimenopause and menopause often improve with the right approaches and support. Talk to a healthcare provider if sex is painful, your symptoms are severe or getting worse, or you're having trouble enjoying intimacy despite trying different solutions. It’s also a good idea to get care if you have:

• Bleeding after sex

• Persistent pelvic pain

• Symptoms of a possible UTI (pain with urination, frequent or urgent need to pee, fever, chills)

• New or changing vaginal discharge

• Concerning symptoms that don’t improve with home care

PT tip: Small changes can make sex more comfortable

Gentle pelvic exercises, small adjustments in daily habits, and using lubricant are simple ways to support sexual comfort during perimenopause and menopause. “Small changes in your routine can make a real difference,” says Dr. Bock. “And when it comes to more enjoyable sex, lubricant can be a game-changer — even if it’s not the only solution. If you’re still having pain or pelvic floor challenges, pelvic floor physical therapy can also help.”

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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