The Truth About Sexual Health During Perimenopause—From An Expert

Sexual health during perimenopause is one of the most overlooked and misunderstood aspects of this life transition. 

Many women (probably most) quietly experience discomfort, changes in libido, urination, or pain during intimacy without realizing these symptoms are common and treatable. Even worse, misinformation often prevents women from seeking proper support and guidance.

Let’s break down what I believe are the five most common misconceptions of sexual health during this time. Great ready for some hard truths backed by science.

Many women will notice a decrease in sexual desire during perimenopause. As estrogen and testosterone levels fluctuate, changes in libido and sexual responsiveness are completely normal. 

As estrogen levels fluctuate and decline, it can affect arousal, vaginal blood flow, and lubrication. These physical changes often lead to decreased interest in sex. 

Vaginal discomfort and pain during intercourse isn’t just “normal aging”, it is a sign of genitourinary syndrome of menopause (GSM). This occurs when declining estrogen leads to thinning and drying of the vaginal tissues, making sex uncomfortable and possibly painful. It can also include urinary symptoms like urgency, frequency, or infections.

This is the most asked about topic, so we will spend more time here. The North American Menopause Society (NAMS) stresses that GSM does not get better on its own. 

Hormone replacement therapy (HRT) is a powerful tool for some women, but it’s not the only solution. Treatment should be individualized, especially for those who may be higher risk. There are several non-hormonal and low-risk treatment options available, many backed by clinical research.  

1. Vaginal Moisturizers and Lubricants

Over-the-counter vaginal moisturizers, especially those made with hyaluronic acid, can help replenish vaginal moisture, improve elasticity, and reduce discomfort. These are different from lubricants and should be used regularly, not just before sex. 

Choose water- or hyaluronic acid–based products that are fragrance- and paraben-free. Natural lubricants made from aloe vera, flaxseed, or coconut oil may also be helpful, especially for women with sensitivities to synthetic products. Be careful with oil-based preparations as they could dissolve condoms. 

2. Vaginal estrogen 

Low dose vaginal estrogen is available in several forms, including creams, a slow release intravaginal ring and an estradiol vaginal tablet and insert. Vaginal creams have minimal systemic absorption and have a more favorable risk profile than using systemic estrogens. 

Low dose vaginal estrogen creams should be used at the lowest dose and the lowest frequency to achieve a desired effect. 

3. Ospemifene (Osphena)

Ospemifene is an FDA-approved oral selective estrogen receptor modulator (SERM) specifically designed to treat moderate to severe dyspareunia caused by GSM. It mimics the effects of estrogen on vaginal tissue without affecting the uterus or breast tissue. 

4. Vaginal DHEA (Prasterone)

Many women avoid talking about changes in their sexual health because they feel embarrassed or assume nothing can be done. Unfortunately, this silence leads to prolonged frustration.

Daily activities have a direct impact on how you feel sexually. Exercise improves circulation and boosts mood. Mindfulness and stress reduction support hormonal balance. And pelvic floor exercises (yes, Kegels!) can improve blood flow and sensitivity in intimate areas.

Perimenopause is not the end of your sex life, it’s just a new chapter. Understanding your body and educating yourself is the first step toward reclaiming pleasure, intimacy, and connection. 

Whether through medical treatments, lifestyle changes, or simply starting a conversation, support is available.