If you’ve just given birth, you’re breastfeeding, or you’re going through perimenopause or menopause, your hormones will have shifted significantly.

All of these changes can leave your body and your mind, in a state of stress, which can have a big impact on your sex life.

Sex isn’t just physical, it’s psychological. For many people, the physical and hormonal changes experienced during certain phases of life (such as during pregnancy or perimenopause and menopause) can leave them feeling overwhelmed emotionally. And, we all know, when we aren’t feeling good about ourselves, the last thing we want to do is have sex.

In this sense, how hormones affect our sex life is complicated. Sure, hormonal changes have a physical impact on the body, but these shifts can also lead to complex emotional feelings. Figuring out how to help your hormones get back on track is just one part of the puzzle and it’s unlikely to be a total fix, particularly if your relationship needs some TLC. Great sex is about great communication. So, if you’re feeling stressed, uncomfortable or overwhelmed, talk to your partner about this – it can bring you closer together, which in turn can make your sex life more enjoyable!

The good news is, when it come to the physical symptoms you may experience due to hormonal shifts (such as vaginal dryness or pain during sex) there are lots of treatments available. This article is going to give you the run down of how your hormones and your sex life are connected, as well as giving you some tips and trick of things you can try, to make sure things stay comfortable and consensual.

The hormone estrogen is key to:

  • ensuring your vagina stays lubricated and produces more lubrication when you’re aroused
  • helping your vagina expand during sex when you experience pleasure
  • maintaining the right balance of bacteria to help ward off infection
  • keeping the tissue plump and skin on your vulva and in your vagina in good condition.

When estrogen is in short supply or lower than usual (like after a birth, while breastfeeding or during perimenopause and menopause), you may experience vulvovaginal symptoms such as dryness, soreness, or itching. The tissue in this area may become thinner, leaving it more prone to tears or cuts.

Estrogen also helps your bladder and helps with the passing of pee. When estrogen levels are low in the body it:

  • thins and weakens the neck of the bladder and the urethra
  • this can cause you to need to pee more often
  • feel more desperate to pee suddenly
  • have occasional leaks of pee, especially when coughing, sneezing, laughing or jumping
  • increases the chances of infections like a urinary tract infection (UTI) or yeast infection.
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Vulvas of all shapes and sizes

The hormone, testosterone also plays an important role, specifically when it comes to your libido (sex drive) and your ability to feel aroused and have an orgasm.

When testosterone is low, you may not feel:

  • ‘in the mood’ for sex.
  • Able to orgasm or you may have less powerful climaxes.

Arousal is really important when it comes to sex. Feelings of desire are what tell our bodies to ‘react’ sexually. If you’re not aroused you may find that when things do get going, your vagina’s natural lubrication and relaxation does not cooperate, and that vaginal penetration is uncomfortable and sometimes painful.

The relationship between arousal and physical response is again complicated. You may find you are not necessarily interested or thinking about sex, but that once you start kissing or engaging in intimate touching your body responds.

The important thing to remember is that sex should always be consensual. You should never feel pressured into having sex when you don’t want to, or responsible for your partner’s sexual satisfaction. If you are struggling to become aroused or feeling disconnected from your body or your partner, you may want to think about talking to a sex therapist, or perhaps trying some intimacy exercises with your partner. If you want some ideas to get you started, check out our intimacy exercises resources.

When you experience lower levels of estrogen for a longer period of time (like during perimenopause and menopause or after menopause), it’s common to notice some changes to your vulva and vagina and how they feel. In fact, it’s estimated that 80% of women after menopause suffer with vaginal dryness or other related symptoms.

When you experience symptoms connected with your vulva and vagina due to low hormone levels, you may be told you have a condition called genitourinary syndrome of menopause or GSM. These symptoms can begin during perimenopause, or at any time your sex hormones are low for other reasons, like after certain treatments for cancer.

Certain medications such as antidepressants can also cause symptoms like vaginal dryness. Using a lubricant can help to address this when you have sex.

  • vulval and vaginal dryness
  • irritation, burning, or itching around the vulva or vagina
  • less lubrication, and discomfort or pain during sexual activity
  • reduced vaginal elasticity
  • bleeding during or after sex
  • less sexual desire, arousal and difficulty orgasming

You may find:

  • sitting down is not as comfortable, especially on harder chairs
  • wearing tight fitting trousers or underwear is not comfortable
  • you always need to be near a bathroom in case of an urgent need to pee
  • you suffer with recurring UTIs that make you very unwell at times.
  • peeing more often or feeling like you have to pee urgently
  • the inner labia thins or gets smaller
  • the vaginal and vulval tissue thins, making it more fragile.  This means the skin may tear more easily.
  • experiencing recurrent UTIs

Once symptoms of GSM start during or after menopause, they tend to get worse if left untreated, as they don’t usually go away on their own. For this reason, it’s best to act on GSM symptoms sooner rather than later.

The vaginal hormone treatments listed below are the recommended medications for GSM and will really help you if your sex life is suffering at menopause.

The best thing to do if you are experiencing symptoms connected to low hormone levels, is to add back in some of what you are missing.

This can be done by taking hormone therapy (HT). HT comes in lots of different forms. There are patches, creams, gels and tablets. HT circulates in your bloodstream and will reach your vulva and vagina. The most effective treatment though is hormone treatments that are applied directly onto your vulva, and inside the vagina.

These treatments are perfectly safe to use and offer a lot of relief for women experiencing debilitating symptoms.

Vaginal hormone treatments

Estrogen, (or more specifically estradiol or estriol) are contained in these medications. There is also a treatment that converts to estrogen and testosterone once inside the vagina. But what they all have in common is they’re inserted inside the vagina so are termed vaginal (or sometimes ‘local’) estrogen treatments.

Here are the vaginal hormone treatment options you can choose from:

Pessaries or Vaginal Suppositories

A pessary is inserted into the vagina with an applicator or your finger. The pessary will dissolve and only needs to be inserted once or twice a week.

Cream or gel

The product is applied with a finger or an applicator. At first, you may want to use the cream or gel daily to get maximum relief.

After 2 weeks you can reduce this to a maintenance dose of 2-3 times a week.

With the cream and gel, you can also spread it around your vulva if this area is sore or irritated.

Always follow any guidance as directed on the packet or by with advice from a healthcare professional. 

A vaginal ring

A soft silicone ring is inserted by you or your doctor. This ring will release estrogen slowly over a three month period. The option of a ring is often preferred by women who don’t like the idea of using a cream or gel regularly.

The ring does not need to be removed for sex, however if it bothers you you can opt to remove it.

You may want to avoid sex on the evenings you use vaginal treatments, as it can get a little messy and small amounts of estrogen may be absorbed through the skin, potentially impacting your partner (which is best to avoid). 

It can take a few months for symptoms to improve, so it’s worth persevering with vaginal treatments for a while. The benefits are usually well worth it and your symptoms are unlikely to resolve on their own. Symptoms will also most likely return if you stop using these treatments.

Remember to always read the information provided with whatever product you purchase. Follow the application and dosage instructions clearly and do not refer to this information as a substitute for that which is provided by the product manufacturer.

While we may think of testosterone as ‘the male hormone’ women produce testosterone too. Just as with estrogen, testosterone drops during perimenopause and menopause. This has an impact on our sex lives as testosterone is a hormone intimately connected to our ability to feel aroused and to have orgasms.

When we no longer produce enough testosterone, we may find we lose interest in sex, or experience less pleasure when we do have sex. Some women choose to take testosterone as part of their HT regime in order to help their sexual desire and arousal return.

Something to consider is that no hormone will prove to be a ‘silver bullet’. If you don’t feel connected or attracted to your partner, good about yourself, or you have other sexual vulnerabilities to address, testosterone is unlikely to solve these problems for you.

Hormones can help, but when it comes to the essentials – working on ourselves and our relationships, that’s up to each and every one of us!

You can read more about testosterone therapy here.

In the US, testosterone is not FDA approved for women to use as part of their menopause hormone therapy, but some menopause specialists prescribe it due to the benefits patients report.


  • If penetrative sex is uncomfortable, make sure to invest in a good quality lubricant.
  • There are lots of options available, and it’s worth doing your research.
  • Try to opt for options that are kind to your skin.
  • These will be ones that don’t contain glycerin, petroleum, parabens, scents, flavors or dyes.

Lubricant tips

  • Be generous with the amount of lubricant you use (even if it means things get a bit messy).
  • Use lubricant over your vulva as well as inside your vagina.
  • If you’re having penetrative sex make sure lubricant is applied to anything that is going to be entering your vagina.
  • Doing this will help penetrative sex feel more comfortable and enjoyable. It will also reduce pain and discomfort from friction.

Some women express feeling worried about talking to their partner about using a lubricant. This is because of concerns it could hurt their partners feelings, or be misunderstood as a comment about how attracted they are to their partner.

Unfortunately, our bodies don’t always respond in the ways we want them to and it’s incredibly common to use products such as lubricants in these moments. Lubricants not only help to address concerns such as dryness, they also make sex more enjoyable.

So, if you’re worried about breaching the topic of topicals with your partner, try to talk to them in terms that are focused on increasing pleasure, as opposed to fixing a problem. Having a good time is what you both want, so if a little thing like lube can get the job done, that’s something they are likely to be on board with.

Vaginal moisturizers

If you’re suffering with dryness and discomfort, you may also want to think about using a vaginal moisturizer. These moisturizers are a bit of a well-kept secret but they can help to balance the pH in your vagina (how acidic your bodily chemicals are). They also encourage your cells to retain water, making everything feel more hydrated. These moisturizers are often made with hyaluronic acid, vitamin E, and/or various oils such as jojoba or almond, though other ingredients may be used. Some can be safely used with condoms, though others cannot, so make sure you verify the specific directions of use and follow accordingly.

Vaginal moisturizer tips:

  • Vaginal moisturizers need to be used regularly
  • You can vary how often you apply them according to how impacted you feel by your dryness and discomfort on any given day
  • Moisturizers help with the sensitivity around your vulva too
  • There’s no reason why you can’t use vaginal moisturizers, while also using vaginal estrogen – just ensure you use them at different times.
Vulvas of all shapes and sizes

If you want more tips on keeping your vulva and vagina happy, take a look here.

Want to know more about sexual health, sexual pleasure and play?
Read our Hello Hormones article on intimacy.