What everybody should know to enjoy sex and to prevent urinary incontinence until age 100 or more.

 At menopause, women’s estrogen secretion decreases, and women often think that 2 years after menopause, they are done with the side effects of the lack of estrogen. Unfortunately, this isn’t so because what is important is the cumulative effect, year after year of the lack of estrogen. As years will go by, sex will become more painful and urinary incontinence might develop.

A study done by Stacey Lindau MD and colleagues published in the New England Journal of Medicine shows that out of 3005 US participants, 73 percent were still having sexual activity between 57 and 64 years of age but only 53 percent were still sexually active among the 65 to 74 years of age and only 26 percent among the ones 75 to 85 years of age. Women were significantly less likely than men at all ages to report being sexually active, but few talked about this to their therapist or their physician.

Yet sexual intimacy with a partner could be important for a satisfying emotional relationship and a satisfying emotional relationship could be important for happiness as well as good health.

So, how can we keep having a satisfying sexual intimacy with our partner as we get older?

The most important is to know the female physiology of aging and act preventatively:

When women go through menopause, their body starts secreting less estrogen which can trigger hot flashes. Those hot flashes tend to decrease as years go by. But what doesn’t decrease is vaginal dryness. In fact, as years go by, vaginal dryness will tend to increase slowly year after year, itchiness might start as well as decreased elasticity. And then intercourse might ultimately become painful. Women will usually not consult their physician and will just stop having sex altogether which could make their partner very unhappy and sexually frustrated which could put a strain on the relationship.

 Women will consult their physician when, in addition to vaginal dryness, women start having urinary symptoms like urinary incontinence which starts with stress incontinence while coughing, sneezing or during physical exercise. Both urinary and vaginal symptoms might get worse year after year but are preventable.

How can painful sex after menopause, vaginal dryness and urinary incontinence be prevented without increasing the risk of cancer?

Studies by Dr. Constantine and colleagues published in the journal Menopause in 2019 show that low dose vaginal estrogens can be used without increasing the risk of cancer.

Physicians usually prescribe 1 gram of estradiol vaginal cream (or the equivalent in the form of vaginal inserts, capsules or tablets) to be used with an applicator one to three times a week.

But one gram of cream is a lot of cream and that much cream might not be necessary.

In fact, vaginal dryness and stress urinary incontinence can be prevented by using a very small lentil bean-size dose of vaginal estrogen cream at night one to three times a week, applied with a finger just at the entrance at the vagina. Usually after a few months of using the vaginal cream, urinary incontinence will most likely improve, sex will often stop being painful and will become pleasurable again and the romantic relationship will blossom.

If vaginal secretions increase too much during the day, I recommend using the vaginal cream only once a week or once every two weeks or even once a month.

If vaginal dryness doesn’t improve, use a pea-size dose (instead of a lentil-size) of vaginal estrogen cream two to three times a week.

If vaginal estrogens are contra-indicated, use an over-the-counter vaginal moisturizer containing hyaluronic acid 2 or 3 evenings a week.

In addition to those, make sure you use an over-the-counter vaginal lubricant as needed during intercourse.

And if your man has trouble with arousal, use his body’s biological clock:

Because men have their biological testosterone secretion peak in the morning, sex in the morning after a good night sleep and a light breakfast are the best bet for successful intercourse as men get older.


Sexual pleasure during intercourse can continue long after menopause even in our seventies, eighties, and nineties. Yes, pain during intercourse, vaginal dryness, and urinary incontinence after age 50 can happen but those are treatable even if addressed late and preventable if addressed early. Don’t hesitate to talk to your doctor about those issues. They are worth addressing to keep a romantic pleasurable relationship with your partner as you get older, which is one of the secrets for a long, happy, and healthy life.

 Disclaimer: This post does not create a physician-patient relationship between the reader and Dr. Gilbert. What is written in this post does not apply to everybody. You should consult your physician before relying on or using any of the content of this post.

Copyright 2022 @ Chris Gilbert, MD, PhD (www.DrChrisGilbert.com)