The Truth About Having an Orgasm After Menopause

In classic Cialis ads, middle-aged women are depicted smooching on windswept beaches, gazing seductively from bathtubs and otherwise looking ready for steamy sex the moment their husband pops a pill.

It's an unrealistic depiction of sexual desire for some postmenopausal women who, with half of their lives still ahead of them, may experience decreased libido, difficulty becoming aroused and pain during intercourse. After going through menopause, women may also experience difficulty orgasming, said Claudia Six, Ph.D., a clinical sexologist in the San Francisco Bay area.

"It's one of those secret side effects of menopause they don't tell you," she said.

"During menopause, women have more distress over the changes in their sex lives than any other time in their lives," added Caroline Colin, M.D., an obstetrics and gynecology specialist in Santa Monica, California.

While life after menopause might not be exactly like a spicy erectile dysfunction ad, it doesn't have to be a desolate sexual wasteland, either. Good sex—and good orgasms—is possible after menopause, but you may have to adjust your approach and expectations.

Menopause is a natural part of a woman's life cycle brought on by dramatic hormonal changes. Often referred to as "the change," menopause marks the end of reproductive years and the menstrual cycle. As part of this multistage process, the ovaries cease production of hormones such as estrogen and progesterone.

During menopause, women may experience a variety of symptoms caused by hormone-related changes. The most common side effects include hot flashes and night sweats, a drop in energy, mood swings and weight gain.

Hormone-related changes can also interfere with sexual satisfaction. While individual experiences certainly vary, many women experience a dip in libido.

"For a lot of menopausal women, libido tanks," Six said. "They don't feel like sexual beings anymore."

In a report from SIECUS, the Sexuality Information and Education Council of the United States, the majority of postmenopausal women surveyed reported a drop in desire for sexual relations (23.1 percent) and more difficult arousal (19.1 percent).

For many women, penetrative sex can become painful after menopause.

"Some women say it feels like broken glass down there," Six explained. "It's worse for some than others."

The pain is usually related to vaginal atrophy, or the thinning of the vaginal walls that occurs due to loss of estrogen. Vaginal atrophy, in turn, can cause vaginal dryness and pain.

Another common experience for women is a diminished intensity of orgasm after menopause. Again, vaginal dryness may play a role, as does a decrease in blood supply to the clitoris. Blood flows to the clitoris and genitals more slowly, so they might not have the same sensitivity and may require more stimulation to reach orgasm. On top of all this, some women may experience painful uterine contractions after climaxing, which can be a major turnoff.

"Many factors go into a woman's desire for sex," Colin noted. "But if orgasms are less intense or seemingly out of reach—or even worse, if sex becomes painful due to hormonal changes—then their sex lives can suffer."

Despite these obstacles, you don't have to give up on orgasms or say goodbye to your sexual self after menopause. The main goal is to listen to your body and accept that what feels good might change, Six explained.

To combat dwindling libido, Six is an advocate of hormone replacement therapy (HRT), which involves taking medication that replaces the estrogen your body stops producing during menopause. HRT, also known as menopausal hormone therapy (MHT), is typically used to treat common menopausal symptoms such as hot flashes and vaginal discomfort. But it can also help make sex less painful and give your sex drive a boost.

"Hormone therapy can help menopausal women feel more sensual, more alive, more feminine," she said. "It increases libido and makes you feel like a sexual being."

However, Six noted that HRT isn't cheap. It's also not without risks, with some research associating hormone therapy with increased risk of stroke, blood clots, heart attack and breast cancer.

If you prefer not to take HRT, lifestyle adjustments can also help with low sex drive and other menopause-related symptoms. Regular exercise, yoga and following a healthy lifestyle can help manage the physical, emotional and mental symptoms of menopause.

To help with penetrative sex, some experts recommend trying lubricants to replace the vagina's natural moisture, relieving discomfort and helping to avoid vaginal tearing or bleeding. However, Six emphasized that this isn't a complete solution.

"[Lubricant] doesn't really address your libido, it just makes it possible for you to be penetrated," she said.

If penetrative sex becomes painful, don't force it. Six reminded us that there are plenty of alternatives.

"There's oral sex, there are toys, there's mutual masturbation, there's self-masturbation in the presence of others. I always recommend these things whether the woman is menopausal or not," she said.

If orgasm after menopause just isn't happening, Six said orgasms aren't necessarily the measure of good sex.

"An orgasm is a reflex, just like when the doctor taps your knee with a little hammer," she said.

While acknowledging this might not be the answer women want to hear, Six insisted you can have satisfying, pleasurable sex without ever achieving orgasm.

"Sometimes it can be fun to just build tension and have sex several times where you don't have an orgasm," she said. "Sometimes sex is so good that an orgasm is secondary."