Discomfort, Sex, and Menopause

As I frequently work with women and couples discussing their frustrations with a lack of information related to the changes women go through during their lifetime, I found that I wanted to write a blog dedicated to women's sexuality and to provide resources related to these topics. Since these changes affect both women and their partners, it is very important that they both are open to discussion. These situations can be as challenging and frustrating for the partners as it is for the women they love. I sat down with Kama Jensen, LPCC to discuss this important topic.


Can you tell me a little about yourself and your clinic?

I started practicing in 2003. In 2007, I opened my own clinic as a generalist therapist. As my business evolved, I focused on two areas that are overlooked in treatment; anxiety and depression disorders. I wanted to develop a laser-like focus on what is commonly ignored at a clinical level. There are specific, effective treatments for anxiety and depression disorders. Walking the path with my patients took me in so many directions, and I was really able to deepen my understanding of physical health and medical conditions. It's such great work, Heather! That is one of the reasons I wanted us to share the same office. In my work, there is a focus on the healthy individual, capable of having loving and bonded relationships. Your work focuses on teaching couples how to bond well.


When working with couples in therapy, they often discuss sexual concerns. A common area of concern that is often difficult to broach is when women transition through menopause. Couples often struggle with this transition, but don't discuss it openly. What do you think is important for couples to know as this transition begins?

So, let's talk about the menopause transition. First, no two women are the same. We can talk about experiences and patterns, but the human body and spirit are unique. I know that we want to discuss sexual intimacy and menopause today, so let me focus on that aspect.

The top complaints I hear are interwoven shifts in identity with a changing body. I find a lot of women don't take action or talk with their partners about these changes. I see many women in a type of shock and grief about the transition. In addition to changes in skin, hair, muscle tone, energy levels, and brain activity, women can also experience changes with vaginal and urinary function. The vagina can lose plumpness and become drier. Women are often surprised to find that sex becomes uncomfortable. 

It's frustrating that in an age with all this information, as women we still don't understand what happens to our bodies. I wish medical providers would focus more on prevention and body education. I believe that will be the next great shift in our consciousness as consumers. We will want to be educated, not just "fixed." It's possible to have a better life after menopause. However, a woman will not have a better vagina! The vagina will most likely benefit from additional care and attention now.


Another topic people want to talk about regarding this transition is sex! So let’s talk about intercourse. What can women do to keep a healthy sex life during the transition?

Let's go there, Heather. Okay, this has to be personalized of course. Obviously, women should find a good medical provider to discuss options. Please have that conversation and do your own research. Make sure that you look for the most current research, ideally from the current or previous year. Often people will have inaccurate information due to relying on out-dated initial search results. Additional observational and thorough research leads to more helpful or accurate results.

Self-education also includes keeping up with your mental and physical health. Think good thoughts and exercise often. The knee-bone-is-connected-to-the-thigh-bone. The vagina is connected to your concept of sexual expression and vaginal health. Respect the mind-body connection and you'll always have the best outcome.

Heather, you and I both know that what's happening in the bedroom is a reflection of what's happening outside the bedroom. So, if you have problems in your relationship or marriage, start there first. Don't start sex therapy talking about sex. You need two people loving in a mature, healthy way to have the fullest, most satisfying lovemaking pre- and post-menopause. 

Of course, since sexual health is also about our genitals, ladies, we need good self-care habits.


What do you recommend to keep your vagina healthy?

If you're a single gal enjoying your sexuality, OR you're communicating with your partner and the relationship is emotionally safe, let me share my top 10 recommendations for vaginal health:

1. Spend at least 10 hours researching your body and treatment options. There is an entire online world talking about this topic. Online research offers you privacy and a wonderful opportunity to connect with other women. I'd start with the Google search 'menopause blogs' or 'perimenopause blogs'. Everyday heroes compiling research to share with other women create some of the best online sites. Also,, is a good sexual health resource.

2. Hydrate! Pre- and post-menopause, you'll find that you need to drink water throughout the day. You need more water now that estrogen levels or lower. Natural lubrication is slower now. If you're able to produce significant lubrication, it will most likely take at least 5 minutes. In a younger body, it can take a few seconds. That's a pretty big change. Take time to prepare yourself for your partner or talk to your partner about what you need during this warm-up, engine-revving time. Don't rev up too fast or hard. Skin tears can lead to nasty, uncomfortable infections. Think of it more as a slow-building fire.

3. Allow yourself to change. Many women find that their sexual fantasies shift during this time. Fantasies become, well, less pornographic. Many women report pornography is repulsive after menopause, even if they enjoyed it at a younger age. Fantasies can shift to love, bonding, and connection. Heather, you can see how this is a problem if the relationship feels emotionally unsafe for a woman.

4. Pre- and post-menopause, you may experience less blood flow to the reproductive areas making the tissue more fragile. Keeping regular blood flow to the vagina is helpful. Get in the habit of daily vaginal self-stimulation. You don't have to self-stimulate to the point of climax. It can be a couple circles around your clitoris or spanking the vagina tissue during your morning shower.

5. Also, you can consider products like suction cupping or a research-supported product like Fiera Arouser. Remember, for sure, the days of forceful penetration are over. Take your time with your lover. Don't let him or her hurt you. Don't hurt yourself.

6. You'll want to start or keep doing kegel exercises for pelvic floor and healthy urethra tissue. You can also do kegel exercises during sex and it may help to initiate an orgasm. Products to consider trying are KGoal or Elvie. Or, apps like MyKegel or Kegel Kat.

7. Do your best to keep the tissue moist. A high percentage of women experience vaginal dryness pre/post-menopause. It can be a shock when this changes. Keep your vagina moist for tissue health and to prevent infections. Take a less is more approach to keep your tissue elastic and strong. You can use water-based lubricants or products like Replens or Good Clean Love.

8. Many women swear by the faintest touch of coconut oil or olive oil. Certain products can disrupt vaginal balance, so you'll want to experiment and see what's best for you. Keeping moist may also help prevent atrophy. Once you're in the habit of staying hydrated, it's easy to keep it up. It's like your face cream... easy to remember because it feels good.

9. Talk with your gynecologist. There are a few medications that provide estrogen to the vaginal tissue. Even if you have a family history of cancer, I still recommend discussing this with several of your medical providers. Keep in mind that many providers are not current with pre/post menopause care, so do your research before these conversations. We're lucky to have several local experts who focus on pelvic floor issues and vaginal discomfort. If you want to learn more, I recommend contacting Apex Physical Therapy & Wellness and asking about their services.

10. If you're considering hormone therapy or interested in herbal supplements to reduce symptoms, InHealth Compounding Pharmacy offers quality over the counter products and bio-identical hormone therapy consultation. Don't purchase supplements from a large retail store. If you're unsure about which company offers quality ingredients, I recommend looking at InHealth's product line.


I really appreciate you taking the time to educate my readers about this transition. It’s a transition that isn’t well known by most but has such an impact on relationships. Thank you so much for all of your resources and valuable information. What a positive impact this information can have for couples!

Thanks, Heather!  Best of luck to all your readers as they take control of their menopause journey and take action to increase pleasure during sex.