Sex and the Menopause: What Actually Helps
Changes to sex and intimacy are one of the least talked-about parts of the menopause. Many women assume they simply have to put up with them. You do not. Most of these changes are common, and there are ways to help.
What changes, and why
Falling oestrogen levels during perimenopause and menopause affect the tissues of the vulva, vagina and bladder. This is sometimes called genitourinary syndrome of menopause. Alongside this, many people notice changes in mood, sleep and energy that affect desire.
- Vaginal dryness, soreness or itching
- Pain or discomfort during penetration
- Less natural lubrication and slower arousal
- Lower desire, or desire that feels harder to access
- Urinary symptoms such as urgency or more frequent infections
- Changes in body image and confidence
Physical treatments to discuss with your GP
- Vaginal moisturisers and lubricants: moisturisers used regularly help with everyday dryness; lubricants make sex more comfortable
- Vaginal oestrogen: low-dose creams, pessaries or rings treat dryness and pain directly and are suitable for most women. If you have had breast cancer, discuss this with your cancer team first
- Hormone replacement therapy (HRT): can help with wider symptoms including sleep, mood and energy
- Testosterone: may be considered for low desire if HRT alone has not helped, under specialist guidance
The emotional and relationship side
Even when the physical symptoms improve, sex may not simply return to how it was. If sex has been painful, the body may have learned to expect pain, and anxiety can keep the discomfort going. Partners may have drifted into avoiding intimacy to protect each other. Menopause is also often a time of other big changes, from children leaving home to caring for parents.
How therapy helps
- Understanding how desire and arousal change with age, and adapting to that
- Breaking the cycle of pain, tension and avoidance
- Rebuilding intimacy gradually with a partner, without pressure
- Exploring what you want from sex and intimacy at this stage of life
As a GP as well as a psychosexual therapist, I can help you think about the medical options to discuss with your own doctor alongside the therapeutic work.
Talk to a doctor-led therapist
If the menopause has changed your sex life and you would like to talk about it, a doctor-led therapist can help with both the physical and emotional side. Read more about support for low desire, or book a confidential 30-minute consultation for £60.
Written by Dr Kahverry Rajeswaran MBBS, MRCGP, GMC-registered GP and COSRT-registered psychosexual therapist. Last reviewed: 22 October 2026. This article is general information and does not replace individual medical advice.