Why Your Sexual Health Still Matters During Menopause

Sexual health during menopause is something we need to start talking about more openly. Not because every woman needs to have an active sex life, but because our sexual health is an important part of our overall health. Yet, when menopause symptoms begin taking over our lives, this is often one of the areas we stop paying attention to.

Think about it. When you’re exhausted, struggling with weight gain, feeling uncomfortable in your body, or dealing with hot flashes and sleepless nights, intimacy can become the last thing on your mind.

I understand that feeling because I’ve been there.

But here’s something I want you to consider. Just because our bodies are changing doesn’t mean our sexual health becomes any less important. In fact, I believe menopause is a time when we need to start making it more of a priority.

And I’m not just talking about intimacy with a partner. I’m talking about understanding our bodies, supporting our physical and emotional well-being, practising self-love, and continuing to live our best lives.

Understanding the Difference Between Sexual Health and Intimacy

Before we go any further, I think it’s important to understand the difference between sexual health and intimacy. Although they’re connected, they’re not the same thing.

According to the World Health Organization (WHO), sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality. It’s about much more than the absence of disease or sexual dysfunction.

In other words, sexual health includes how our bodies function, how we feel about ourselves, our sexual needs, our comfort, our pleasure, and our ability to make informed decisions about our health.

Intimacy, on the other hand, is about closeness and connection. It can be physical, emotional, or mental, and it doesn’t necessarily involve sexual activity.

The Government of Canada’s Guide to Sexuality and Sexual Health explores these differences and explains how ageing can affect our bodies, sexuality, and intimate relationships.

Understanding this distinction matters because changes in our sexual health can affect intimacy, but they’re not the same thing.

And whether we’re married, single, in a relationship, or prefer to be alone, our sexual health still deserves attention.

Why Sexual Health During Menopause Changes

Our hormones play an important role in our sexual health. As we move through perimenopause and menopause, estrogen levels fluctuate and eventually decline. Changes in testosterone and other hormones can also influence sexual desire.

These hormonal changes can affect vaginal lubrication, tissue elasticity, arousal, and sexual comfort.

Some women notice their libido declining. Others begin experiencing vaginal dryness, irritation, or discomfort during sexual activity. Meanwhile, some women notice very little change in their sexual desire.

There’s no single way menopause affects every woman.

However, our hormones are only part of the picture.

We’re also dealing with symptoms that affect how we feel mentally, physically, and emotionally. Fatigue, depression, anxiety, sleep disturbances, and changes in our bodies can all influence our interest in intimacy.

When you’re spending your days trying to manage your symptoms and your nights trying to get enough sleep, intimacy can quickly fall down your priority list.

Before long, we can begin accepting these changes as the norm and something that simply comes with getting older.

But should we?

When We Stop Feeling Comfortable in Our Own Bodies

One of the most difficult parts of my menopause journey was feeling like a stranger in my own body.

I gained 40 pounds. I struggled with depression, memory loss, exhaustion, and so many other symptoms that affected how I felt about myself.

When your body changes in ways you don’t recognize, your confidence can change along with it.

You might stop feeling attractive. You might become embarrassed about your appearance. Perhaps you avoid intimacy because you’re uncomfortable with how your body looks or feels.

And when you’re struggling emotionally, it’s difficult to feel desirable.

Our mindset plays an enormous role in how we approach intimacy and our sexual well-being. If we’re constantly criticizing our bodies or focusing on everything we believe is wrong with us, how can we expect to feel confident and comfortable?

That’s something we need to start addressing.

We can’t always control the changes happening in our bodies, but we can work on changing how we respond to them.

Self-love means learning to support the body we have today, rather than constantly comparing it to the body we had years ago.

That includes recognizing that we’re still deserving of affection, pleasure, and connection.

Are We Using Age as an Excuse?

I’ll admit something.

There have been times when I’ve told my husband, “I’m 58 years old now. We can’t expect things to be the same as they were in our 20s and 30s.”

And while there’s truth in acknowledging that our bodies change as we age, I’ve also had to question whether I’m sometimes using my age as an excuse.

Am I accepting something because I’m genuinely comfortable with it? Or have I stopped considering what I might be able to do differently?

I believe we can become complacent about our health during menopause.

We get used to feeling exhausted. We accept certain symptoms. We tell ourselves that this is just how life is now.

And sometimes, without realizing it, we stop taking steps to improve things.

I’m not suggesting that every woman should have the same sexual desire she had when she was younger. Our needs, preferences, and relationships change throughout our lives.

But there’s a difference between being comfortable with those changes and feeling unhappy about something we’ve decided we can’t improve.

Getting older doesn’t mean we have to stop exploring ways to feel better.

Understanding Your Changing Vaginal Health

One area of sexual health during menopause that deserves more attention is what’s happening physiologically in our bodies.

As estrogen levels decline, changes can occur in the vaginal and urinary tissues. These changes are sometimes associated with a condition called genitourinary syndrome of menopause, or GSM.

GSM can affect the vagina, vulva, bladder, and urinary tract. Symptoms can include vaginal dryness, irritation, burning, painful intercourse, urinary urgency, and recurring urinary tract infections.

Unlike some menopause symptoms that improve over time, these changes can persist or worsen without appropriate treatment.

And here’s something important to understand.

Vaginal health isn’t only about having sex.

Vaginal dryness and irritation can affect our everyday comfort, regardless of whether we’re sexually active.

Fortunately, treatment options are available. These can include vaginal moisturizers, lubricants, and prescription treatments such as low-dose vaginal estrogen.

For some women, pelvic floor physiotherapy can also help address certain types of discomfort or pelvic floor dysfunction.

We don’t need to feel embarrassed discussing these concerns with our healthcare providers.

Understanding what’s happening in our bodies gives us an opportunity to take better care of ourselves.

The Age-Old Saying: If You Don’t Use It, You Lose It

We’ve all heard the expression, “If you don’t use it, you lose it.”

It’s an age-old saying that gets applied to everything from our muscles to our minds.

And while it isn’t a medical rule about sexual activity, I think there’s an important conversation to have around it.

As women, we can begin neglecting certain aspects of our health because we’ve convinced ourselves they’re no longer important.

Our sexual health shouldn’t be one of them.

Sexual stimulation, whether alone or with a partner, increases blood flow to genital tissues. For some women, regular, comfortable sexual activity can help maintain familiarity with their sexual responses and support sexual comfort.

However, not having sex or regular orgasms doesn’t automatically cause vaginal health problems. Hormonal changes can affect vaginal tissues regardless of sexual activity.

The important thing is to remain aware of our bodies and address changes that affect our comfort or well-being.

And remember, you don’t need a partner to explore your own sexual needs.

There’s nothing shameful about taking care of yourself privately. Your body belongs to you, and your choices about sexual pleasure are personal.

Nor should you feel obligated to engage in sexual activity to prove you’re taking care of your health.

It’s about understanding your body, recognizing your needs, and making informed choices.

Sexual Pleasure, Stress, and Emotional Well-Being

We talk a lot about managing stress during menopause, but how often do we consider sexual pleasure as part of that conversation?

Sexual arousal and orgasm involve chemicals associated with pleasure and relaxation, including endorphins and oxytocin.

For some women, sexual pleasure can provide temporary stress relief, improve mood, and create a feeling of relaxation.

And yes, I’m talking about the big O!

Whether that happens with a partner or through self-pleasure, it can be an enjoyable part of our overall self-care.

Of course, orgasms aren’t a requirement for good health, and they don’t replace other approaches to managing stress or mental health concerns.

But why should we automatically dismiss something that can contribute positively to how we feel?

I believe we need to broaden our understanding of self-care.

We make time for exercise, nutrition, meditation, and other practices that support our well-being. Sexual pleasure can also have a place in that conversation, if it’s something we enjoy and want in our lives.

And if our interest in sexual activity has changed, we can explore those feelings without judgment.

How Our Beliefs Influence Our Sexual Health

Something else worth considering is how our upbringing and societal beliefs influence the way we think about sexuality.

For some women, conversations about sexual health were never encouraged.

Perhaps sexuality was considered something private, embarrassing, or inappropriate to discuss. Maybe we were taught that sexual pleasure was something we shouldn’t openly acknowledge.

Those beliefs can follow us into adulthood and midlife.

As a result, we might hesitate to discuss vaginal discomfort with our doctors, ask questions about sexual function, or explore our own needs.

But there’s nothing embarrassing about wanting to understand your body.

And there’s nothing inappropriate about advocating for your sexual well-being.

Sexual health is part of healthcare. We should feel just as comfortable asking questions about vaginal dryness or painful intercourse as we do about headaches, joint pain, or sleep difficulties.

The more willing we are to have these conversations, the more opportunities we create to understand our options.

Why Communication Still Matters in Our Relationships

Although sexual health is about much more than intimacy, communication with our partners remains important.

One of the most valuable things I’ve learned throughout my menopause journey is that what your partner doesn’t know, they can’t help you with.

Even when we don’t fully understand what’s happening to us, we need to be willing to communicate.

I’ve had some very difficult conversations with my husband. Conversations about how I was feeling, what I was thinking, and why I was responding to certain things the way I was.

They weren’t always comfortable conversations.

But afterward, we understood each other better.

He had a clearer understanding of what I was going through, and I had an opportunity to understand how my feelings and responses were affecting him.

Because when sexual desire changes, our partners can sometimes interpret that as rejection.

They might wonder whether we’re still attracted to them or whether our feelings have changed.

Meanwhile, we might simply be exhausted, uncomfortable, or struggling with symptoms that have nothing to do with how much we love them.

That’s why our words matter.

There’s a difference between saying, “I can’t be bothered,” and explaining that you’re struggling physically but still want to feel close.

Communication doesn’t mean ignoring our needs to satisfy someone else’s. It means creating an opportunity for both people to feel heard, respected, and understood.

And sometimes, professional counselling or therapy can help us navigate those conversations.

Maybe It’s Time to Rethink Intimacy

Here’s another thought.

Why do we automatically associate intimacy with bedtime?

For many couples, nighttime has traditionally been when intimacy happens. But during menopause, that might be the worst possible time.

If you’ve spent the day feeling exhausted and you’re worried about waking up with hot flashes or night sweats, chances are you’re thinking about sleep.

I know I have!

So perhaps we need to rethink our approach.

Maybe intimacy doesn’t always need to happen at night.

Maybe there’s room for a little afternoon delight!

Or perhaps intimacy means spending time together, holding hands, cuddling, kissing, or enjoying affection without expecting anything more.

The emotional connection matters.

And sometimes, changing our routines can help us find ways to maintain that connection while respecting how we’re feeling physically.

We don’t have to keep doing things the same way simply because that’s how we’ve always done them.

Advocating for Your Sexual Health During Menopause

If you’re noticing physical, mental, or emotional changes affecting your sexual health, I encourage you to start by speaking with your healthcare provider.

Ask questions. Explain your symptoms. Discuss how you’re feeling and what concerns you.

And if you don’t feel your concerns are being addressed, seek another qualified opinion.

There are different treatment options available, and what works for one woman won’t necessarily work for another.

I know this personally.

When I was going through perimenopause, I didn’t recognize that many of the symptoms I was dealing with were connected to hormonal changes.

I wasn’t putting the pieces together.

And because I didn’t understand what was happening, I didn’t pursue the medical assessments or support that might have helped me sooner.

That’s something I wish I’d done differently.

Today, I encourage women to advocate for themselves and explore their options.

Depending on your symptoms, your healthcare provider may recommend blood work to investigate other possible conditions. However, routine hormone testing isn’t always necessary to identify perimenopause, particularly after age 45.

What matters is receiving an appropriate assessment and developing a plan that addresses your individual needs.

And if one treatment doesn’t agree with you, that doesn’t necessarily mean you’ve exhausted your options.

Keep asking questions, do your research, and work with qualified healthcare professionals to make informed decisions.

Our goal should always be to feel our best and continue taking an active role in our health.

Desire Is About More Than What Happens in the Bedroom

There’s one final point I want to make.

When we talk about desire during menopause, we usually think about sexual desire.

But I believe desire goes much deeper than that.

It’s also about having the desire to care for ourselves, improve our well-being, nurture our relationships, and continue living the lives we want to live.

It’s about recognizing that our needs still matter.

Whether you’re married, single, in a relationship, or perfectly happy on your own, your sexual health remains part of your overall health.

You don’t need anyone else’s permission to prioritize it.

And you certainly don’t need to feel guilty or embarrassed about exploring what feels right for your body.

For me, this is part of the Menopause Mindshift.

We stop allowing our symptoms to dictate every aspect of our lives and begin looking at what we can do to support ourselves. It means we can make informed choices, seek support, and take an active role in our health.

Menopause doesn’t mean our sexual health stops mattering. It means we may need to change how we care for it.

And isn’t that what self-love is about?

Acknowledging that we matter enough to take care of ourselves, physically, mentally, emotionally, and sexually.

Because the goal isn’t to return to who we were in our 20s or 30s.

The goal is to feel our best, support the bodies we have today, and continue writing our own menopause stories.

Medical Disclaimer: This article is intended for educational and informational purposes only and includes personal perspectives. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional about your individual health concerns and treatment options.