How to enjoy sex after menopause, according to an expert

Senior couple flirting and looking in each other's eyes with desire while relaxing in bed sex menopause
It is possible to have pleasureable sex after menopause. An expert explains how. (Getty Images)

Menopause is one of the biggest transitions a woman will go through. Not only will her periods cease, but it can also lead to other side effects, such as painful sex.

During a recent interview, actor Halle Berry got candid about the realities of having sex after menopause.

"Okay, TMI but get ready: I’m trying to have sex and [it’s as if] I’ve got razor blades in my vagina," the 57-year-old said, as per SELF.

"He [her partner, Van Hunt] comes at me with [what feels like] scissors at night, and I’m like, ‘Get away!’ But he’s the love of my life, and I realise there’s something wrong."

After consulting a doctor, Berry was told that this was a symptom of menopause, which she said was also causing brain fog and fatigue among other side effects.

What causes painful sex during menopause?

Painful sex is a common symptom of menopause as oestrogen levels begin to fall rapidly to around 90% of their premenopausal numbers.

"The cells located at the vaginal skin surface (or epithelium) are dependent on oestrogen to grow and develop," explains Dr Deborah Lee, of Dr Fox Online Pharmacy.

"When oestrogen levels are low, there are far fewer layers of the vaginal epithelium, which becomes thin, and the vaginal epithelial cells are small and shrunken. This is called atrophic vaginitis or is sometimes referred to as genitourinary syndrome of menopause."

JEDDAH, SAUDI ARABIA - DECEMBER 07: Van Hunt and Halle Berry attend the red carpet on the closing night of the Red Sea International Film Festival 2023 on December 07, 2023 in Jeddah, Saudi Arabia. (Photo by Daniele Venturelli/Getty Images for The Red Sea International Film Festival)
Halle Berry has said sex felt like 'razor blades' after menopause. (Getty Images)

These changes also lead to reduced lubrication, which can cause discomfort during penetrative sex.

"The thrusting of sexual intercourse can cause local trauma to the vaginal walls, resulting in chafing and sometimes bleeding," Dr Lee adds.

How common is painful sex after menopause?

Up to 45% of women find sex painful after menopause, studies show.

"The medical term for painful sex is dyspareunia. The discomfort ranges from feeling just a minor soreness to being extremely painful," Dr Lee says.

"Although atrophic vaginitis due to oestrogen deficiency is the most common cause of dyspareunia in this age group, other causes include loss of natural vaginal lubrication leading to vaginal dryness and pain on penile penetration, and vulvodynia - a specific type of vulvovaginal pain syndrome."

How to make sex enjoyable again after menopause

Using topical oestrogens is one way to help aid the enjoyment of sex after menopause, Dr Lee suggests.

"Topical oestrogens are available as either a vaginal cream or a suppository that are inserted into the vagina," she explains. "These are natural oestrogen preparations, of which only tiny amounts are absorbed from the vagina into the bloodstream.

"The vast majority of the oestrogen is absorbed by the local vaginal epithelial cells, causing the cells at the cell surface to thicken, mature and retain more glycogen, and produce more lactic acid. The use of topical oestrogen improves blood flow to the vagina, the elasticity of the vaginal wall, and natural lubrication."

However, Dr Lee notes that topical oestrogen is not the same as HRT and does not ‘cure’ other menopausal symptoms such as hot flushes.

"Topical oestrogen not only helps relieve vaginal dryness and dyspareunia, but it can also improve urinary symptoms such as frequency, urgency, nocturia and recurrent urinary tract infections, and can help libido," she explains.

"Women with a history of hormone-sensitive breast cancer should not use topical oestrogens as a rule. Any decision about this should be made with their oncologist."

For women who cannot choose or access topical oestrogens, Dr Lee recommends vaginal moisturisers and lubricants as a good alternative to help combat any dryness and discomfort.

Menopause: Read more

Watch: Naomi Watts has no idea how she got pregnant after being told she was menopausal in her 30s