The loss of estrogen and testosterone during menopause causes changes in your body and sex drive. Declining estrogen levels can lead to vaginal dryness, hot flashes, night sweats, and mood swings. It can affect female arousal, drive, and physical pleasure.

Sexual intercourse can be painful due to a loss of estrogen in the vaginal tissues. There is a decreased blood supply to the vagina, which can reduce vaginal lubrication. Thinning of the vaginal walls can lead to atrophy, which causes the vagina to become less elastic and dry. This leads to pain during intercourse.

It’s a common problem, but not all women experience vaginal dryness. Regular intercourse and vaginal activity can keep the vaginal muscles toned, stimulate blood flow, and help preserve elasticity.

Yes. About 10 percent of women in the United States experience low sexual desire. It’s been reported in studies at a rate of 12 percent among midlife women, and 7 percent in women ages 65 or older.

Potentially. Loss of hormones can affect other body organs.

Depending on the underlying condition, estrogen loss can affect the genitourinary system. As a result, you may get more frequent UTIs, or experience genital prolapse and incontinence. Estrogen loss can also exacerbate other vaginal disorders like vaginitis, vulvitis, or lichen disorders.

There are various methods available to help manage painful intercourse.

Regular sexual activity maintains a healthy vaginal environment and elasticity by increasing blood flow. Lubricants and moisturizers like K-Y and Replens can provide relief during intercourse.

Prescription treatments include vaginal estrogen, which is available as a cream, vaginal ring, or tablet. This form of estrogen is applied locally to the vagina and safer than systemic forms of estrogen.

Oral forms of estrogen include conjugated estrogens (Premarin) and estradiol (Estrace). They provide systemic relief from menopausal symptoms. The risks of this form of therapy should be discussed with your doctor. Estrogen can also be delivered via a patch.

Non-estrogen based medications that improve vaginal thickness include ospemifene (Osphena), a daily pill, and prasterone (Intrarosa), a vaginally delivered steroid insert.

Soy estrogens, natural herbs, and creams. Other modalities that may improve your sex life include regular exercise, getting seven to eight hours of sleep each night, and eating the right foods. Sex therapy and mindfulness have also been proven successful in many couples.

Have a candid discussion with your partner about the ways menopause is affecting you. If you’re experiencing fatigue, vaginal dryness, or a lack of desire, communicating with your partner may help decrease your anxiety about performance.

Tell your partner what’s comfortable and what’s painful. Try discussing it with your primary care physician or OB-GYN. Libido decline and painful intercourse are common. Many times your healthcare provider can help guide you to treatment. Medications and alternative therapies may help.