“Let’s Talk about Sex, Baby”

Sex After 50
By LuAnn Buechler

A great song title, but a much more difficult topic to address personally, would you agree? It’s no doubt on a lot of women’s minds, but it seems to be a taboo topic. News flash: Women are sexual beings, even as they age. They have needs and desires and have a right to a satisfying intimate life.

Sex is a natural part of our body’s function and provides us with much needed, healthful energy stimulation in the body. A good sexual relationship leads to a healthier life, increases a couple’s general happiness and satisfaction in their relationship and provides for better communication.

That’s not to say it doesn’t come with challenges. Sex after 50—or after menopause that occurs at any age—can become uncomfortable and may even progress to the point damaging relationships and even your personal health. Challenges with sex at midlife and beyond are prevalent in both sexes, so let’s talk about it.


According to Dr. Diana Gillman, a specialist in Obstetrics and Gynecology at Olmsted Medical Center, when someone says, “It hurts when I have intercourse,” post-menopausal vulvovaginal atrophy—a thinning of the genital tissues—is often at play. This commonly results in painful sex, or dyspareunia.

Dyspareunia occurs because vulvar and vaginal tissues are very estrogen-sensitive. Changes that occur around the time of menopause can lead to dryness that causes significant discomfort.

Low libido is also a common concern. As Gillman explains, so many factors go into this. “Our busy lives, relationship issues, the effect of common drugs for depression and anxiety (Prozac, Zoloft, etc.), all can cause both lower libido and impaired ability to achieve orgasm.”


Communication with your partner can go a long way in helping with sexual challenges. Express what feels good and what doesn’t. For example, if you’re experiencing discomfort from sex, you might express the need for additional foreplay to stimulate your body’s natural lubrication.

Getting outside help is often beneficial. “I often recommend, at least at first, counseling, to try and tease out environmental and couple factors that may be contributing to low libido and other sexual challenges,” says Gillman. “Or it may help to work on body image. It can be difficult to accept our changing shapes and sexual response as we age. A professional can be helpful.”

The medications you’re already using may benefit from a second look, as well. “Sometimes we look at changing to a different drug for depression or anxiety that has less of an effect on sexual well-being,” says Gillman.

Topical estrogen applied to the vaginal tissues is a key solution to dyspareunia and has very little systemic absorption, meaning it stays where you put it and doesn’t have the same risk of side effects that oral hormones do. “Typically it’s used every night at first, then eventually when used two to three times a week it works like a charm,” Gillman says.

According to Mayo Clinic, there are a number of treatments that can help with dyspareunia and other sexual challenges linked to menopause. A personal lubricant or vaginal moisturizer can be an effective starting point to make intimacy more comfortable. While low-dose estrogen therapy is frequently recommended, other drugs have also been approved in recent years to help with the condition. It may be worth a discussion with your health care provider about the benefits and risks of these drugs. Other options that can be explored include physical therapy for the pelvic floor muscles and sex therapy.


People need to also remember that when having sex—at any age—they need to use barrier protection such as a condom. If you’ve had sex with a new partner, getting tested for sexually transmitted infections (STIs) is also critical. According to Gillman, the largest-growing segment of people contracting HIV are those over age 50.

“It’s important to acknowledge that women over 50 have sex lives!” exclaims Gillman. “And often these lives are very fulfilling, free of the stress of unwanted pregnancy and the presence of young children in the home that zaps so much of our energy. However, the factors that interrupt a satisfying sex life deserve acknowledgement and require open communication to overcome.”

LuAnn Buechler, owner of PMC Events & Coaching, is a transformational coach.