Mature Women: Getting Ready for Sex Again

What do you do when you are a woman – say in your late 50’s or 60’s – who has not had intercourse in several years and would like to start having sex again, but cannot due to a shrunken vaginal opening?

In my clinical practice I have spoken to several women with such a concern. Each of them had unique circumstances, but there also were common factors, which I would like to highlight here.

Typically, if a woman 1) goes through menopause, 2) does not opt for hormone therapy, and 3) is not sexually active, she will eventually experience structural changes in her vagina known as vaginal dystrophy or atrophy. Not only does the vaginal tissue become thinner and frailer, but it can begin to shrink, eventually leaving only a tight vaginal opening. These changes are mainly due to decreased estrogen production after menopause.

The first step should be to see a gynecologist or other health practitioner who can perform a vaginal exam. Often times, local estrogen treatment in the form of a cream, vaginal tablets or an estrogen containing intra-vaginal ring can, over time, improve the health of the vaginal tissue. The two key words here are “estrogen” and “time.” Changes do not happen overnight and patience is required. All of the estrogen-containing medications are by prescription only and an in-office health exam is necessary to correctly evaluate the situation and to identify the best course of action.

The second step is for the woman to begin to gently stretch her vaginal opening. Over time, some women are able to stretch their vaginal opening by using their fingers and a lubricant. If the tissue is very frail, vitamin E cream can be used as a lubricant. Others purchase vaginal dilators available at or (the latter website requires prescription from a MD or nurse practitioner and only ships to health care provider’s office). Sometimes it is helpful to have a physical therapist who specializes in pelvic floor muscles (PFM) and vaginal health to assist the woman with gaining better control of her PFMs. She can learn to more effectively relax these muscles, which otherwise may form a tight grip around her vagina, preventing it from opening up completely. Once again, the key word is “time.” Most women do find that their vagina begins to open up as they focus on stretching it and relaxing their PFMs.

When the woman is finally ready to try intercourse, I always recommend starting with her in the on-top position, sitting straddled over her partner who is prone on his back facing her. The reason that this position often works best is that the woman is in full control of how much of the penis she wants to insert into her vagina, how much she wants to thrust back and forth or up and down; and the straddling itself can facilitate the opening of her vagina. If an aging partner does not get enough sexual stimulation of his penis in this position, he may want to ask his own health provider about erection enhancing drugs such as Viagra, Levitra or Cialis. Be sure to use plenty of lubrication in order to make penetration as easy as possible. Being sexually aroused also helps the vagina to open up, so be sure to allow much time for foreplay.

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