Menopause and sex life: how to restore intimacy to your relationship?

Menopause is a time when a woman’s intimate areas are particularly vulnerable to changes resulting from oestrogen deficiency. Reduced elasticity of the vaginal and perineal tissues, weakening of the pelvic floor muscles, dryness and sensitivity of the mucous membranes, and poorer blood supply to the genitals can make sexual intercourse less comfortable. Women often experience pain or burning during intercourse, reduced sexual satisfaction, and urinary incontinence during penetration. These symptoms can lead to avoidance of intimacy, which affects the relationship with the partner and reduces the sense of attractiveness and self-confidence in bed.

Atrophic changes in the urogenital tract, referred to as Genitourinary Syndrome of Menopause (GSM), affect a significant proportion of postmenopausal women. It is estimated that these symptoms occur in approximately 50% of women over the age of 60, significantly reducing their quality of life and sexual relations. The first symptoms, such as vaginal dryness, burning, itching, irritation or dyspareunia (painful intercourse), may appear as early as the perimenopausal period, usually between the ages of 40 and 50.

Studies show that after the age of 55, dyspareunia occurs twice as often as before the age of 40. It is worth noting that, unlike the vasomotor symptoms of menopause, such as hot flushes, which usually subside over time, GSM symptoms are chronic and progressive if appropriate therapeutic measures are not taken. Currently, both pharmacological methods (e.g. local oestrogen therapy, selective oestrogen receptor modulators) and non-pharmacological methods, such as lubricants, moisturisers and modern aesthetic gynaecology procedures (e.g. fractional laser therapy and radiofrequency) are used to treat GSM.

Urogynecological physiotherapy offers tools that support intimate health during menopause, improving both physical comfort and the quality of sexual life. The therapy uses a variety of methods, which are selected by the physiotherapist depending on the patient’s needs.

• Pelvic floor muscle training
  Exercises selected by a physiotherapist improve the tone and strength of the muscles responsible for sexual pleasure, as well as blood supply and oxygenation of tissues.
• Manual therapy and tissue mobilisation
  Gentle work on scars (e.g. after an episiotomy or caesarean section), loosening excessively tense structures or improving vaginal elasticity can reduce pain and increase pleasure during intercourse.
• Education and learning conscious relaxation
  Tension in the pelvic floor can be subconscious. Breathing and relaxation exercises and body awareness techniques help to regain freedom in experiencing pleasure.
• Support in choosing accessories and treatments
  A physiotherapist can advise on safe lubricants, dilators or massagers that facilitate sexual stimulation and improve comfort during intercourse. In addition, physiotherapy is supplemented by treatments using radiofrequency, electrotherapy, low-intensity shock waves or biofeedback.

During the perimenopausal period, gynaecologists often recommend hormone replacement therapy (HRT) to restore hormonal balance. This treatment can improve blood flow and elasticity in the vagina, lower its pH, promote epithelial regeneration and increase vaginal secretion, which reduces symptoms associated with dryness and discomfort in the intimate areas. However, the decision to implement HRT should be made on an individual basis, after a doctor has assessed the benefits and potential risks for the patient.

Hormone replacement therapy (HRT) is a treatment method used in women during and after menopause. Its purpose is to supplement sex hormone deficiency – primarily oestrogen, and in some cases also progesterone.

The decline in the levels of these hormones, resulting from the natural decline in ovarian function, leads to the appearance of characteristic symptoms of menopause, such as:

• hot flushes and night sweats,
• insomnia and sleep disturbances,
• irritability, low mood and concentration problems,
• vaginal dryness and pain during intercourse,
• faster bone loss, increasing the risk of fractures and osteoporosis.

HRT involves the use of appropriately selected hormonal preparations – in the form of tablets, patches, gels or vaginal rings. This makes it possible to alleviate menopausal symptoms and protect women’s health in the long term.

Importantly, HRT cannot replace exercise or working with a urogynecological physiotherapist, as it does not strengthen muscles. Physiotherapy, on the other hand, does not affect hormone balance, so it will not alleviate hot flushes, for example. The best results are achieved by combining both methods – oestrogens improve tissue quality, while physiotherapy teaches how to strengthen and control them.

During menopause, there is often a decrease in sexual desire, which is a natural result of hormonal and physiological changes occurring in a woman’s body. However, sexuality during menopause does not have to lose its quality – a holistic approach to health is key. Regular physical activity, a balanced diet rich in phytoestrogens, stress reduction, relaxation and intimacy with your partner can support the body’s natural mechanisms. It is also worth considering consulting a gynaecologist who will help you choose the right therapy to support your comfort and sexual satisfaction during menopause.

The psychological factor is equally important. Many women in menopause face a reduced sense of attractiveness, a decline in self-esteem, or fear of changes in their appearance and bodily functions. In addition, social stereotypes about menopause can reinforce the belief that their sex life is coming to an end, which discourages intimacy. Techniques for working on body acceptance, mindfulness training, and open communication with your partner about your needs and expectations can be helpful.

For some women, the support of a psychotherapist or sexologist may be crucial. A specialist will help them work through difficult emotions, reduce tension and rebuild a sense of security in their relationship. Studies show that couples who maintain good communication and emotional closeness find it easier to cope with the challenges of menopause. Despite biological changes, women are more likely to engage in sexual activity and derive satisfaction from it.