Perimenopause doesn’t arrive with a single dramatic bang. Instead, it tiptoes in—sometimes as early as your mid-30s—bringing with it subtle hormonal shifts that can affect everything from your mood to your libido. For many women, the biggest question is: What does this mean for my sex life?
The short answer: a lot can change. But not all of it is bad.
“The loss of estrogen and testosterone associated with perimenopause and menopause causes Genitourinary Syndrome of Menopause — otherwise known as GSM — which can bring on a range of symptoms that directly affect sexual wellness,” Dr. Amanda Neri, a pelvic floor therapist and the founder of The Pelvic Institute, tells us.
Sound confusing? Well, it doesn’t have to be. Together, with expert help and the Reddit group r/Perimenopause, let’s break down what those changes look like and what real women (like you!) are saying about navigating them.
Vaginal Dryness and Painful Sex: You’re Not Imagining It
One of the first things women notice during perimenopause is vaginal dryness. Surprise! This symptom can sneak up during foreplay, or make penetrative sex suddenly feel uncomfortable when it didn’t before.
“Because our genitals are used to an acidic environment, the shift to a more alkaline pH often leads to dryness in the vagina and vulvar vestibule and greater susceptibility to UTIs,” explains Dr. Neri. “The combination of dryness, thinning tissues, and inflammation can make sex painful.”
Reddit is full of women swapping stories about this exact experience:
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“It felt like sandpaper sex overnight. One month everything was fine, the next I was wincing halfway through.”
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“I thought something was wrong with me because lube stopped working the way it used to. Turns out it was perimenopause.”
The truth is, though, dryness doesn’t have to be the end of intimacy. Using a hydrating vaginal insert — like Playground’s Miracle Melts — can actually help replenish moisture and soothe irritation from the inside out, while pairing them with a high-quality lube can make a big difference.
Libido Shifts: Up, Down, or Sideways
Another symptom? Libido shifts. If your desire seems to be fluctuating, you’re not alone. Hormonal changes don’t just affect vaginal tissues; they also influence brain chemistry and energy levels.
“With less estrogen and testosterone, women often report reduced libido, but it’s not universal,” says Dr. Neri. “Some women actually find that their sex drive increases as they feel freer from pregnancy concerns or the pressures of early adulthood.”
Redditors echo this wide range of experiences:
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“I legit thought I was broken. My doctor said: Welcome to perimenopause.”
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“Weirdly, I’ve wanted sex more since my periods got irregular. Like my brain is saying ‘get it while you can.’”
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“My husband thinks it’s him. It’s not, it’s my hormones. And some nights I’d rather sleep than have sex, and that has to be okay.”
Luckily, there are ways to bring desire into new shapes and sensations and feelings. When desire is low, try leaning into new forms of intimacy other than just what you think is sex — like massage, outercourse (AKA no penetration), or incorporating toys — can help reignite your steamy connection.
For women and non-binary folks wanting to explore more playful, body-safe ways to reconnect with pleasure, using mixing a lubricant like Free Love (which can be a gentle but powerful addition to a solo or partnered night) with a fave vibrator.
Pelvic Floor Changes: The Invisible Piece of the Puzzle
It’s not just dryness or desire, either. Your pelvic floor plays a big role, too.
“Reduced estrogen weakens elasticity in the vaginal walls, which can add to feelings of pelvic floor weakness,” Dr. Neri explains. “In response, many women unconsciously clench their pelvic muscles to guard against pain or to ‘hold on.’”
This over-clenching, she adds, creates more tension, and it’s why pelvic floor therapy during perimenopause and menopause often focuses on downtraining, re-coordination, and restoring healthy tone to support both comfort and sexual health.”
As one Redditor put it:
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“Nobody warned me that peeing when I sneeze would make me avoid sex. But pelvic floor therapy honestly saved my sex life.”
Pairing therapy with hydration support and lube can make pelvic floor work more comfortable and sex more pleasurable, too.
Emotional Shifts: The Bedroom Meets the Brain
It’s impossible to talk about perimenopause and sex without acknowledging the mental load. Mood swings, anxiety, or just feeling “different” in your body can all dampen desire.
One Redditor summed it up:
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“I didn’t want to be touched because I didn’t feel sexy anymore. My husband was patient, but I had to relearn intimacy on my terms.”
Dr. Neri emphasizes that sex during perimenopause is not just about surviving symptoms:
“Perimenopause is an opportunity to get curious about your body and your desires. For many women, exploring new ways of connecting—whether that’s more focus on clitoral stimulation, using toys, or trying positions that reduce discomfort—can actually enhance intimacy.”
Perimenopause Isn’t the End of Your Sex Life
Yes, perimenopause can bring challenges: dryness, painful sex, shifting libido, pelvic floor changes. But it can also open doors to new ways of experiencing pleasure and intimacy.
Or, as one Redditor optimistically shared:
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“I thought perimenopause meant no sex. Instead, it’s meant better sex—because I finally advocate for what I need.”
With the right support—including pelvic floor therapy, vaginal moisturizers like Miracle Melts, and pleasure-forward tools like Free Love—women can not only maintain their sex lives through perimenopause, but thrive.
“These changes are real, but they’re also manageable,” says Dr. Neri. “With the right support, women can not only maintain their sex lives through perimenopause—they can thrive.”
