Sexual Intimacy During Menopause

by, Susan A Peck, RNC, MSN-APN

Adrienne felt fortunate and happy in so many ways.  Since becoming “empty nesters” she and her husband Paul are really enjoying their new-found time together.  Whether they take vacations, head to the movies, or just spend time at home, their friendship and love have flourished. In the past, no matter what stressors life sent their way, Adrienne and Paul would always cherish their alone time as a way to reconnect and maintain their intimacy.

Compared to her friends, Adrienne also felt pretty lucky with her menopause experience.  She only felt hot flushes from time to time and wasn’t too bothered by insomnia.  All in all, life was good….until she began to feel uncomfortable…down there.  Was it a yeast infection?  Why did she feel itchy and irritated, especially after her morning walks?  And then, one weekend, when she and Paul became intimate, things just didn’t feel the same.  She loved Paul and wanted to be intimate with him, but it seemed like her body was taking a long time to catch up to her mind and heart.  This had never happened before – pleasure with Paul was never an issue. 

Adrienne just didn’t know what to do next…this was such a personal issue to talk about – does she talk to her friends?  It never felt right to talk about intimacy with her friends – that was something just for her and Paul.  Does she talk to her nurse practitioner?  She decided that was the right path to take, but still felt a bit awkward about having that conversation.  Fortunately, Paul was very understanding and patient, but she just wanted things to be back to normal.

Adrienne had that discussion with her nurse practitioner, who was very easy to talk with (thank goodness!), and provided her with useful information.  During menopause, not every woman experiences disruptive hot flushes, but all women’s vaginas change, sometimes as rapidly as within the first 6-12 months after the last menstrual period, and sometimes before – in the early 40’s.  Pre-menopause, the vagina is nourished by endogenous estrogen which maintains moisture and keeps the vaginal tissues thick, robust, and nicely lubricated.  During sexual response, the lubrication quickly increases and the vagina can easily and comfortably “accept” sexual activity.  But, after that natural production of estrogen begins to decline, the vagina becomes thinner, more fragile, and most women experience that it takes a lot longer to become lubricated.  Of course, this can affect intimacy, but it can also affect personal comfort, as it did with Adrienne during her exercise.  Adrienne felt reassured to know she did not have a yeast infection and that nothing was ‘wrong’ with her.  She felt most relieved to know that there were several options of how this issue can be improved so she and Paul can continue to enjoy their special intimacy.

As a nurse practitioner, I have similar conversations with women like Adrienne every day of the week.  As stated, all women’s vaginas change in peri-menopause and menopause, but it’s up to us as nurses and women’s health care providers to ask the sensitive questions and make those conversations easier.  We need to inquire regarding intimacy and sexual changes that occur because many women are not used to “talking about personal things like that” and may not initiate the discussion.  We also need to discuss all management options including over the counter non-hormonal sexual and personal lubricants as well as prescription based estrogen (vaginal and oral) and non – estrogen based medicines.  Many women have little knowledge about the safety of vaginal estrogens and will rely on us to inform regarding the safety of each method and how it fits best with her body.  It’s imperative that as women’s health care providers, we know how to partner with a woman during menopause so that her personal comfort and relationships will be maintained and nurtured.

Part of that partnership is having access to accurate information regarding the physiologic changes that occur in menopause as well as how to best manage them.  Of course, our AWHONN journals, JOGNN and Nursing for Women’s Health, frequently have articles authored by nurses with clinical experience in menopause. Another great resource to find useful, accurate information for both professionals as well as consumers is the North American Menopause Society – – an organization dedicated to promoting the health and quality of life during midlife and beyond through an understanding of menopause and health aging.  On this website you will find Fact Sheets, Slide Sets, Practice Pearls, Menopause Practice: A Clinician’s Guide as well as Position Statements such as Non-hormonal therapies and Vulvovaginal Atrophy.

Coming up at our annual Convention in Grapevine Texas in June 2016, we are honored to have Susan Kellogg Spadt, PhD, CRNP hosting our pre-conference, Managing Intimacy after Menopause.  Dr. Kellogg Spadt is a nationally recognized expert on female sexual health and has authored/co-authored 2 books, 15 book chapters, and more than 75 peer reviewed articles.  AWHONN is so fortunate to have her with us in Grapevine and we can look forward to learning a lot from her….as nurses for our patients as well for our personal experiences as women.

Learn more about her session and where to register at:


Susan A. Peck, RNC, MSN, APN is a practicing Women’s Health Nurse Practitioner. For 19 years, Ms. Peck’s career has focused on women’s health care, first as a labor and delivery staff nurse and for the last 15 years as an Advanced Practice Nurse. She currently works in the Department of Obstetrics & Gynecology within Summit Medical Group, a large multi-specialty practice group in Northern New Jersey.

Ms. Peck’s areas of expertise include contraception, osteoporosis, general gynecology and prenatal care. She has spoken at several national and state conferences including the AWHONN National Convention.