Men’s Guide to Sex Around Menopause

Menopause impacts a woman’s physical, cognitive, and emotional health, affecting their sexual desire, libido, and satisfaction. As a partner, these impacts also affect you, your relationship, and sex life. This guide includes the basics of menopause and sexual symptoms, addressing root causes, building a healthy foundation, strategies to implement outside and inside the bedroom, being realistic and persistent, and getting help where needed. Each section is presented as an action for you to consider in improving you and your partner’s relationship, sexual relationship, health, and overall wellbeing.

Due to the significant hormonal changes during menopause, most women will experience symptoms related to one or more of the following categories: Physical and Physiological; Genitourinary Syndrome of Menopause (GSM); Cognitive and Thinking; and Mood and Psychological. The various symptoms and changes women experience can challenge and strain sexual experiences.

GSM symptoms in particular, can directly lead to a low sex drive (low libido), orgasm and sexual arousal difficulty, and painful sexual intercourse (dyspareunia). They can also affect urinary and vaginal function, including infections like urinary tract infections (UTIs), urinary incontinence, vaginal dryness, and vaginal tears. These symptoms can all contribute to a decline in sexual comfort and satisfaction.

Indirectly, symptoms like mood swings, hot flashes, night sweats, sleep disturbances and fatigue, can all influence a woman’s sexual desire and libido. Other contributing factors include emotional health, body image shifts, stress, relationship dynamics, overall health, and men’s sexual function challenges.

While a woman may not be in the mood due to menopause symptoms and changes, sexual activity releases oxytocin and endorphins, hormones that help to decrease feelings of pain, reduce stress, boost mood, and promote feelings of wellbeing. This means that sexual activity can ironically help a woman feel better and enhance her overall health and wellbeing. This also extends to men and can help with a range of health conditions, including those related to sexual dysfunction.

To learn more about menopause from a male’s perspective, visit the Menopause 101 for Men page.

Root causes affecting sexual function, experience, and satisfaction can stem from women, men and combined as a couple.

For women, an important starting point is treating the root cause of her symptoms directly and indirectly, impacting the sexual experience. As the decline in hormones estrogen and progesterone during menopause lies at the root of many symptoms, Hormonal Replacement Therapy (HRT) particularly in the form of low-dose vaginal products, may be a suitable treatment to replace these hormones. This will, however, depend on a woman’s individual circumstances and guidance from a healthcare professional. While several treatment and management options exist, and can be explored on the Menopause Treatment and Menopause Management pages, the emphasis here is that if the underlying issues are not rectified, sexual related strategies and tactics that are implemented, will be short-lived.

For men, sexual experiences can be impacted by testosterone deficiency (known as Late-Onset Hypogonadism (LOH) or Testosterone Deficiency Syndrome (TDS)) which can develop later in a man’s life. Additionally, androgen deficiency, erectile dysfunction (ED), Peyronie’s disease (PD), prostate disease (inflammation (prostatitis), enlarged prostate (benign prostatic hyperplasia (BPH)), and prostate cancer), low libido, and premature, delayed or retrograde ejaculation, can also have an impact. Again, these require individualized treatment and management to address the underlying issues potentially impacting sexual experiences. Treatment may include Testosterone Replacement Therapy (TRT) where testosterone is deficient.

For women and men, root causes extend to physiological and psychological changes associated with aging (slower sexual response, increased time for arousal and orgasm, decreased vaginal lubrication, increased time to get an erection, negative perception of aging, etc.), physical and mental health conditions (like diabetes, cardiovascular disease, stroke, hypertension, cancer, respiratory diseases, anxiety, depression, etc.), certain medications (like antidepressants, heart failure medications, blood pressure medications, cancer treatments, etc.), and lifestyle choices (including being sedentary, smoking, drinking alcohol, etc.).

For couples, unresolved interpersonal conflict, and relationship challenges can continue to intensify, negatively affecting both their relationship and sexual experiences. This topic will be explored in the proceeding section Deal with Relationship Challenges.

A robust relationship is built on more than just sexual compatibility. Menopause symptoms and changes can challenge, strain, and test relationships. Add changes associated with aging, life stressors such as employment pressures and caregiving responsibilities, different priorities, interpersonal conflict, and unresolved relationship issues, sexual activity may be the last thing on a couple’s mind.

As a result of relationship challenges, both you and your wife might experience feelings of fear, guilt, isolation, and rejection, leading to a tendency to withdraw from each other. Withdrawal is what should be avoided, as relationship challenges become harder to address, and sexual intimacy becomes further from reach.

Open, honest, and early communication is key at all times in a relationship, particularly when faced with relationship challenges. Openly discussing the challenges and the effects they are having on your relationship is crucial, as is listening without judgement to each other’s perspective.

You both may need to commit to resolving the relationship challenges, renegotiate aspects of your relationship, find new ways to connect, and increase your understanding of each other and potential triggers. These can all help strengthen your bond as partners, and move toward a satisfying and fulfilling sexual relationship.

Where you and your wife are having difficulty resolving challenges on your own, external help may be considered. Refer to the Get Help Where Needed section below.

As explored on the Menopause Management page from a female perspective, there are several areas involved in managing menopausal symptoms. Many of these areas are beneficial in building a strong foundation for sexual health. These include mindset, diet, lifestyle changes, exercise, sleep, employment, social interaction, and relationships, which has been explored in the preceding section Deal with Relationship Challenges.

Mindset affects mood, confidence, mental state, physical health, and more. A negative mindset can be fast to adopt when faced with menopause, relationship, and sexual challenges. What is less known, however, is that sex drive (libido) is more likely to be affected by health and attitude surrounding sex and intimacy, than other factors such as age. Additionally, relaxing the body through mediation and deep-breathing exercises can reduce anxiety associated with sexual performance.

Diet and lifestyle changes both contribute to enhancing the sexual experience. Consuming a low-carbohydrate, including sugar, high-quality protein diet with nutrient-dense foods that contain polyphenols, antioxidants, and phytoestrogens can support sexual function. Making lifestyle changes like reducing caffeine, smoking, and alcohol use, which can limit blood flow to sexual organs, can help reduce interference with a woman’s ability to have an orgasm as well as vaginal lubrication and clitoral sensation, and a man’s ability to get or keep an erection. In addition, dietary supplements like Ginkgo biloba for women, and Tribulus extract for men, can support sexual function, among others.

Regular physical exercise and activity increases circulation and blood flow, which are key for sexual arousal. Exercise also releases endorphins which block the perception of pain, increase feelings of well-being, and boost energy levels. Additionally, exercise and activity can be completed both individually or as a couple.

Exercise can help improve sleep quality and reduce disrupted sleep, which can exacerbate stress and fatigue, both of which are significant factors that can impact sexual desire and performance. Adequate and restorative sleep is crucial for maintaining sexual function, as it plays a vital role in hormone regulation, including those that influence sexual health such as testosterone, estrogen, progesterone, and oxytocin, among others. Where vasomotor symptoms are impacting your wife’s sleep, it is important for her to treat and manage these.

Last, employment and active social engagement play pivotal roles in enhancing sexual health and strengthening relationships by fostering self-esteem, reducing stress (including financial), and promoting overall well-being. The sense of accomplishment and identity derived from employment and a sense of purpose (including hobbies, volunteer work, and social tasks and activities) can boost confidence, which is connected to sexual desire and satisfaction. Similarly, positive social interactions provide emotional support and reduce feelings of loneliness, which can negatively affect sexual libido.

Affection encompasses more than just physical intimacy in the bedroom. By prioritizing affection outside the bedroom at any time of the day and night, you can demonstrate your love, support, and understanding, and strengthen the emotional connection between you and your partner. On top of this, it helps to strengthen sexual intimacy by making intimacy a seamless process, whether engaging in structure sexual activity or not.

This can be achieved through gestures, time spent together, and shared activities. Gestures include making eye contact, holding hands, hugging, kissing spontaneously, and touching. Spending time together can include talking about your day, sitting next to each other on the sofa, laughing together, and reading or completing computer tasks in close proximity to each other. Shared activities include completing household chores, watching a movie, going out to a live event, enjoying a meal, pursuing a shared hobby, getting out into nature, being active like going for a walk, and exercising like going to the gym or cycling.

These and many other ways can bring you closer together as a couple, increase your enjoyment in each other’s company, relieve tension and hostility, provide reassurance and comfort, decrease stress, and anxiety related to sexual activity in the bedroom, and increase sexual satisfaction.

While sexual activity can be undertaken anywhere, anytime, the vast majority takes place in the bedroom. By reserving the bedroom as a place where either sexual activity or sleep takes place, it can become a sacred area where you can just focus on each other. This includes removing any visible distractions that may remind yourself or your wife of other activities or tasks to be completed.

Bedding should also be comfortable. If yourself or your wife have any bleeding, bladder, or bowel related symptoms, add a protective sheet or cover to relieve any anxiety related to spillages, and help in simple and fast post clean-up activities.

Not discounting spontaneity or surprise, creating an ambience for sexual experiences can help you both feel more relaxed and open to sexual intimacy. This may include reducing any possible interruptions like turning mobile phones off, playing music you both enjoy, dimming the lights, and lighting candles.

Essential oils with aphrodisiac properties include sandalwood and ylang ylang for females, and eurycoma longifolia and ginseng for males. Oils can be diffused, dropped into a bath, or added to a carrier oil such as coconut, almond, or jojoba, and massaged onto the skin. Alternatively, specifically designed massage or arousal oils can be used, which will be covered in the Use Sexual Products and Devices section below. Massage will also be covered in the proceeding section Think Beyond Sexual Intercourse.

Creating the right ambience for intimacy involves not just the physical setting, but also emotional and psychological elements. This includes being attuned to the changes your partner is experiencing during menopause. She may feel less attractive or desirable than before. By affirming your partner’s attractiveness, you can help boost her self-esteem, increase her sense of being desired, and enhance the sexual atmosphere.

Sexual experiences can be enjoyable and include orgasm, with or without sexual intercourse or penetration. Called foreplay, this involves a range of physical and emotional activities and interactions that precede sexual intercourse, and are aimed at enhancing sexual arousal and intimacy. Foreplay is particularly important if penetration is painful or uncomfortable for your wife due to a range of sexual, urinary, and vaginal menopausal symptoms.

Focusing on foreplay and thinking beyond sexual intercourse opens the door to a range of different strategies. This may require redefining what sexual intimacy means for your relationship.

Physical foreplay activities may include kissing, touching and caressing, massage, rubbing, humping, hand and oral stimulation/sex (including clitoral, either individually or at the same time called the 69 position), individual and mutual masturbation (autoeroticism or autosexuality) and stimulation using sexual aids (covered in the Use Sexual Products and Devices section below). Emotional foreplay activities may include verbal communication, and looking at, or watching sexual material you both find arousing. Effective foreplay recognizes and responds to the cues and preferences of both partners, creating a mutually satisfying sexual environment.

On touching and caressing, this includes touching and stroking each other gently and affectionately on the face, lips, neck, and erogenous zones including the breasts, vulva (often confused with the vagina which is the internal canal leading to the uterus, the vulva is the external part of the female genitalia, encompassing the labia, clitoris, and vaginal opening), buttocks, perineum, testicles, and penis, with the hands or a tactile tool like a feather. An erogenous zone is an area of the body that is sensitive to stimulation and can lead to sexual arousal when touched due to a higher concentration of nerve endings in the area.

Massage can be completed when both partners are naked, using essential oils (covered in the Create an Ambience for Sexual Experiences section), and in a slow and sensual manner. The partner being massaged can lie on their stomach with massage beginning in the upper areas of their body like their neck, ears and back before rolling to their back and massaging the remainder of their body including their chest, stomach, arms, legs, inner thighs, and erogenous zones. Ask your partner what they enjoy and focus more on these areas.

On verbal communication, this includes sharing sexual desires, fantasies, and preferences, engaging in role plays, expressing emotions, sharing what feels indifferent, pleasurable and painful, talking in a sexual and erotic way, and telling each other what you would like, and plan, to do sexually. Thinking about sexual activity fosters interest and creates excitement, building up sexual friction before sexual activity takes place.

Like sexual experiences being enjoyable without sexual intercourse, sexual activity can be just as, or more enjoyable trying new positions and paces.

Being open and adaptable to different sex positions can enhance both partners’ sexual experiences. Experimenting with positions that allow for more control over the depth and pace of penetration can be beneficial. Positions that prioritize your partner’s comfort, such as those allowing her to control the angle and speed, can make sex more enjoyable and less painful. This process is about finding what works best for both of you, ensuring mutual satisfaction and comfort, so communication is key.

Positions may include missionary, woman on top, lotus, spooning, doggy style and standing. Lubrication is helpful with all these positions to decrease discomfort and increase pleasure. Lubrication will be covered in the Use Sexual Products and Devices section below.

Missionary is a classic sex position where the man is on top of the woman, allowing for eye contact and intimate connection. This position may be uncomfortable when vaginal dryness is a factor, so a pillow can be placed underneath the woman’s lower back to raise her pelvis and make insertion smoother.

Woman on top or cowgirl is where the woman sits on top of a man who is lying down. In this position, the woman can control the speed and depth of penetration reducing pain and discomfort. This position can be reversed when a woman faces away from the man and is called reverse cowgirl.

The lotus position is similar to the woman on top or cowgirl position where a woman sits on top of a man facing him, however, the man is sitting up instead of lying down, and the woman’s legs are wrapped around his body. A variation of this position is one partner leaning back to provide deeper penetration and g-spot (an area two to three inches inside a woman’s vaginal canal that can lead to pleasure and orgasm) stimulation.

Spooning is a side-by-side position allowing for gentler penetration. This position allows the woman to control the depth of penetration and involves her bending her legs slightly. The position can be completed face-to-face, or with the woman facing away from the man.

Doggy style is a position where the man stands or kneels behind the woman, who is typically on all fours. This position allows for clitoral stimulation by the man or the woman. Additional support can be provided for the woman by placing pillows under her stomach or elbows.

A standing position may require more physical effort, however, can be spontaneous, dynamic and enjoyable. Standing can involve facing each other or the woman facing away from the man. For balance and support, the woman can stand and lean forward over a chair with her hands against a wall. Other aids may be used depending on comfort and height differences. A woman’s clitoris can be stimulated in this position.

Different paces or speeds are largely exploratory, and can involve an increasing or decreasing pace, as well as a combination between the two synchronizing with sexual orgasm and climax. An orgasm is the buildup of pleasure before climax, while climax is the peak of the orgasm. A slower pace encourages intimacy, sensitivity, and comfort, and a faster pace may be appropriate toward the end or peak of the sexual experience.

Using sexual products and devices goes beyond pleasure, as they can enhance overall health, wellness, and the sexual experience. The range of products and devices are extensive, designed for men, women, or both, and are largely based on function and personal preference.

Products include lingerie, role playing clothing and props including bondage, massage oils, arousal oils, lubricants including warming lubricants, topical and stimulatory creams, vaginal moisturizers, and tactile tools like feathers. Devices or sex toys include vibrators, vaginal dilators, penis extenders, penis rings, dildos, male masturbators, and strokers, suction or vacuum toys and devices, prostate massagers, pelvic wands, and Kegel balls.

Arousal oils are formulated to increase blood flow in the genital area which can increase stimulation and pleasure during masturbation, oral sex, and intercourse. Lubricants help to reduce friction and pain, and warming lubricants warm the skin on contact, which can be a pleasurable sensation. Vaginal moisturizers are used for vaginal dryness.

Topical creams, including prescription, help to dilate blood vessels, and increase blood flow and oxygen to the applied area. Other medications include selective estrogen receptor modulators (SERMs) to treat dyspareunia, and Viagra (sildenafil for men and vaginal sildenafil for women), for ED and sexual dysfunction.

Vibrators come in a range of shapes, sizes, and designs, perform a variety of functions, and can be manually or automatically operated. The vibrating action can be beneficial for ED, anorgasmia (the inability to orgasm), sexual arousal difficulty, and pelvic floor dysfunction, which will be expanded on below. Similarly, suction or vacuum devices that create suction around the penis, clitoris, or vulva, can do the same. Prostate massagers are used for males and target the prostate gland, also known as the male g-spot or p-spot.

On pelvic floor dysfunction, this affects the pelvic floor muscles, and typically impacts sexual, bladder and bowel function. Vaginal dilators, pelvic wands, and Kegel balls help relax tight vaginal muscles, improve natural lubrication, and re-strengthen weak pelvic floor muscles. Pelvic floor or Kegel exercises can help both men and women strengthen pelvic floor muscles that, when weak, may result in a range of sexual, bladder and bowel symptoms.

What these sexual products and devices have in common, is the purpose of helping to enhance arousal, making it easier for men and women to become aroused, reach sexual orgasm, and climax.

In navigating sex around menopause, patience, and realism are virtues that cannot be overstated. As a man, being patient and realistic about what your wife is experiencing, what may or may not change sexually, and other contributing factors, can help improve the sexual experience for both of you.

Being patient largely centers around time. This means allowing sufficient time for treatment and management strategies for underlying causes to take effect. This can vary and is dependent on other factors such as existing or new health conditions and medications. Patience also refers to allowing time for different sexual strategies that you and your partner try have an impact. New approaches rarely work well the first time. They often need tweaking and improving, and they can come with apprehension, which usually reduces over time.

Being realistic links with patience in the sense of having realistic expectations around how long something might take to have an effect. Additionally, it means being realistic about what may change within your relationship. Comparing yourselves to other couples is fruitless. Put simply, they are not you, and are in a different situation. Similarly, comparing yourself to younger couples is the same. This is because of the changes that come with aging.

On aging, as previously mentioned, hormonal changes (primarily a rapid decline in estrogen for women, and a gradual decline in testosterone for men) during aging can result in a slower sexual response, increased time for arousal and orgasm, decreased vaginal lubrication, and increased time to get an erection. This can be coupled with a negative perception of aging, impacting self-esteem, feelings of shame and guilt, and overall enjoyment. This means that being realistic about what sexual activity may look like, and may not look like, can enhance the overall experience. Additionally, being healthy and having a positive attitude about sex and intimacy can go a long way.

Remember that you and your wife may have days that are more challenging than others, even when you see peaks of improvement. You may also be ready for sexual activity at different times, requiring compromise and even solo strategies like masturbation as required.

Although your wife may be experiencing menopausal symptoms, menopause is not diagnosed until she has gone 12 consecutive months without a period, including spotting. This means, until this time, there is a chance of pregnancy, so contraception should be used for this to be avoided.

The choice of contraception is personal; however, using condoms can provide protection against infection in addition to contraception. Infection includes those related to sexually transmitted infections (STIs) as well as vaginal, urinary tract, bladder, and related infections. These are commonly experienced by women during menopause, and can negatively affect her health and sexual comfort.

Other strategies your wife can take to prevent menopause related vagina and vulval infection include avoiding products that may irritate the vaginal area, include scented products like soaps, toilet paper, or sanitary products, and douches, which are devices used to wash the vagina. Additionally, keeping the vaginal area dry, and wearing cotton underwear and loose clothing helps the vagina and vulval area breathe, reducing the risk of infection.

For urinary leakage, and urinary tract, bladder, kidney, and urethral infections, strategies include urinating before sexual activities to empty the bladder, trying different sexual positions such as spooning or lying side-by-side to reduce pressure on the bladder muscles, and following sexual intercourse both urinating and drinking purified water. This helps to flush out bacteria, decreasing susceptibility to infections. Additionally, smoking can act as an irritant to the bladder, increasing the risk of urinary incontinence.

Men may also experience urinary challenges related to aging, prostate disease, or other factors. They too will benefit from the urinary strategies. As covered in the Use Sexual Products and Devices section, pelvic floor or Kegel exercises can help both men and women strengthen pelvic floor muscles that can affect sexual, bladder and bowel function.

In certain situations, it may be difficult to improve sexual challenges on your own. Despite best efforts, and time waited, an alternative perspective and specific expertise may be required. For challenges affecting sexual function, medical consultation, talk therapy (also known as talking therapy or psychotherapy), physical therapy, and natural therapies may provide benefit.

Medical consultation is beneficial as a starting point, to treat any health-related issues, and seek guidance or perhaps referral to the most aligned help options. As covered in the Use Sexual Products and Devices section, a range of topical creams and medications may be prescribed to treat ED and sexual dysfunction like Viagra (sildenafil for men and vaginal sildenafil for women).

Talk therapy involves talking to a therapist alone or with your partner about challenges that are causing distress. The therapist and therapy style are personal preferences, with behavioral therapy (including hypnotherapy), cognitive-behavioral therapy (CBT) (including mindfulness-based cognitive therapy (MBCT)), and holistic or integrative therapy (including a blend of different approaches based on individual needs with counseling, couple therapy, and sex therapy often falling into this category), being most aligned. The aim is to address and improve underlying issues and overall quality of life. It may help in improving communication around sexual experiences, trying different strategies, and overcoming challenges.

Physical therapy can help with pain relief, healing, and restoring function and movement related to physical injuries or conditions affecting sexual function. Physical therapy like physiotherapy, sports therapy, and pelvic floor physical therapy involve exercises, manual therapy, and modalities like heat and cold therapy to treat various conditions. Pelvic floor physical therapy is used to treat symptoms related to the pelvic floor muscles, ligaments, and connective tissues that support the pelvic organs, including the bladder, rectum, uterus, and vagina.

Natural therapies such as acupuncture increase blood, oxygen, and energy flow to the genital area, which can stimulate natural lubrication and enhance libido and sexual pleasure. Other natural therapies include body movement therapies and mind-body exercises like yoga and Tai Chi, which combine physical postures, breathing exercises, and meditation to enhance physical and mental well-being. Sensory-based therapies like art, dance, music therapy, and visualization or guided imagery can be beneficial when feelings are hard to verbalize as the therapy helps engage the senses to promote healing.

Navigating the journey of menopause with your partner is a phase that likely introduces sexual challenges; however, it is also an opportunity to deepen your connection and explore new dimensions of intimacy. Contrary to the notion that menopause signals the end of a fulfilling sex life, many couples discover that this period results in greater sexual satisfaction and emotional connection.

Women often gain a renewed sense of self-confidence, develop different life perspectives, and embrace changes in life responsibilities—all of which can contribute to a richer, more diverse sexual experience. Similarly, men can also undergo similar changes in their life as they age.

Remaining positive during this period is important for yourself and your partner. It provides reassurance that the often-challenging times are worth it, and there is much to gain individually and as a couple. Not taking things too seriously will benefit both of you, so will remembering to laugh. Many menopausal symptoms are temporary and they do not define your wife or your relationship.

Persistence involves continuously seeking ways to improve together and being open to experimenting and trying new things. As mentioned in the Understand Menopause Impacts section, sexual activity despite its challenges releases oxytocin and endorphins, hormones that help to decrease feelings of pain, reduce stress, boost mood, and promote feelings of wellbeing.

Remaining both positive and persistent helps you and your partner navigate menopause and aging, not as the end, but as a new beginning—one filled with opportunities for growth, exploration, and deeper connection.

To learn more about the positive perspectives of menopause, visit the essentials.

Understanding the dynamics of menopause and the effects on your wife, relationship, and sexual health, provides potential for deeper connection, mutual growth, and a renewed and fulfilling sex life. This period requires empathy, patience, and creativity from both partners. It requires strong communication, and a process of trial and error, to achieve contentment, happiness, and satisfaction, inside and outside the bedroom. This time opens the door for transformation to occur, and as a partner, an opportunity to drive this change.