Let's Talk About Sex (Again): Intimacy and Sexual Health in Midlife
During this session, dr Dinda Derdameisya and sexologist Zoya Amirin explored how intimacy and sexual health can change during perimenopause and menopause. The conversation addressed hormonal changes, sexual desire, vaginal health, discomfort during intimacy, and available treatment options. Participants were encouraged to recognise sexual wellbeing as an important part of overall health and to feel more comfortable discussing concerns, seeking support, and understanding their options.
Key Takeways
01. Sexual Health Can Change During Perimenopause and Menopause
Hormonal changes during midlife can affect different aspects of sexual health, including desire, arousal, lubrication, orgasm, satisfaction, and physical comfort.
Some women may notice reduced sexual desire, changes in their response to stimulation, or discomfort during intercourse. Others may experience different changes or none at all.
These experiences do not automatically mean something is wrong. Understanding how your body is changing can help you recognise what is happening and identify when additional support may be helpful.
02. Declining Estrogen Can Affect Vaginal and Urinary Health
As estrogen levels decline, vaginal tissues may become thinner, less elastic, and less naturally lubricated. Changes in blood flow, moisture, and vaginal pH can also affect comfort.
These changes may contribute to Genitourinary Syndrome of Menopause (GSM), a condition associated with symptoms such as:
Vaginal dryness and irritation
Discomfort or pain during intercourse
Changes in vaginal tissue
Urinary symptoms
Recurrent urinary tract infections
Recognising these symptoms is important because treatment and support options are available.
03. Testosterone Plays a Role in Sexual Desire, but It Is Not the Whole Picture
Testosterone is also present in women and contributes to several bodily functions, including sexual desire.
However, changes in libido are not always caused by hormones alone. Stress, sleep quality, mood, relationship dynamics, and overall wellbeing can also influence sexual interest.
The session highlighted that testosterone therapy has an evidence-based role for appropriately assessed postmenopausal women with Hypoactive Sexual Desire Disorder (HSDD), a condition involving persistently low sexual desire that causes personal distress.
Testosterone treatment requires individual assessment, appropriate prescribing, and medical monitoring. It is not a universal treatment for every change in sexual desire.
04. Pain During Sex Is Not Something You Have to Accept
Discomfort or pain during intercourse should not automatically be considered an unavoidable part of ageing.
Pain can arise from several factors, including:
Physical causes: Vaginal dryness, tissue changes, pelvic floor dysfunction, or infections.
Hormonal causes: Reduced estrogen affecting vaginal moisture, elasticity, and tissue health.
Emotional and psychological factors: Stress, fatigue, anxiety, fear of pain, or changes in body image.
More than one factor may contribute to discomfort, which is why understanding the underlying cause is important.
If intimacy becomes painful, seeking professional guidance can help identify appropriate treatment and support options.
05. Treatment Options Are Available for Vaginal Discomfort and Sexual Health Concerns
Managing menopause-related sexual health symptoms requires an individual approach based on symptoms, medical history, and personal needs.
The session introduced several possible treatment and support options:
Local Vaginal Therapy: Low-dose vaginal estrogen may help manage vaginal dryness and other symptoms of GSM when medically appropriate.
Hormone Replacement Therapy (HRT): Systemic hormone therapy may be considered for women experiencing broader menopause symptoms, following an individual assessment of benefits and risks.
Non-Hormonal Support: Vaginal moisturisers and lubricants can help improve comfort and reduce friction during intimacy.
Pelvic Floor and Psychological Support: Pelvic floor therapy, psychological counselling, or sexual health support may be helpful when physical or emotional factors contribute to discomfort.
The most suitable approach depends on the individual. Treatment should be discussed with a qualified healthcare professional.
06. Know When to Seek Medical Advice
Sexual health concerns deserve the same attention as other aspects of physical health.
Consider consulting a healthcare professional if you experience:
Persistent vaginal dryness, irritation, or burning
Pain during intercourse
Recurrent urinary tract infections or urinary discomfort
Symptoms that interfere with daily life or intimacy
Changes that significantly affect your confidence or relationships
Bleeding after menopause or after intercourse should always be medically evaluated rather than assumed to be a normal menopause symptom.
You do not need to wait until symptoms become severe before seeking help.
07. Open Conversations Can Help You Understand Your Options
Sexual health can be difficult to discuss, particularly when concerns involve intimacy, discomfort, or changes in desire.
The session encouraged women to approach these conversations as part of taking care of their overall health.
When preparing for a medical consultation, consider bringing information about your symptoms, medications, family health history, recent health screenings, and any questions you would like answered.
Being open about what you are experiencing can help healthcare professionals better understand your concerns and recommend appropriate care.
08. Intimacy Does Not Have to End With Menopause
Menopause may change how women experience intimacy, but it does not mean that sexual connection or satisfaction must come to an end.
Understanding physical changes, addressing discomfort, and recognising the influence of emotional and psychological wellbeing can help women navigate these changes with greater confidence.
The session reinforced that sexual health deserves attention throughout every stage of life.
Seeking information, discussing concerns, and exploring appropriate support are meaningful steps towards maintaining comfort, confidence, and connection.
What You Can Do Next
Take a moment to reflect on any changes you may have noticed in your sexual health, physical comfort, or experience of intimacy.
If you are experiencing vaginal dryness, discomfort, changes in desire, or other concerns, consider documenting your symptoms and discussing them with a qualified healthcare professional.
Remember that sexual health involves both physical and emotional wellbeing. Understanding what is happening in your body can help you make informed decisions about your care.
You deserve to feel comfortable asking questions, expressing concerns, and exploring the options available to you.
Your sexual health is part of your health. You do not have to normalise pain or discomfort. Open the conversation and know your options.
These takeaways are based on dr Dinda Derdameisya and Zoya Amirin's presentation materials for Rise & Bloom 2026 and are intended for educational purposes. Personal medical concerns and treatment decisions should be discussed with a qualified healthcare professional.
