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Topical estrogen—as a cream, a suppository, or a ring that releases the hormone over three months—can help plump up vaginal tissues and aid lubrication. However, it may take several weeks or months of physical therapy to substantially alleviate the problem. Water-based lubricants and longer-lasting silicone-based lubricants can also make penetration less painful. In addition, when blood flow to the genitals and pelvis is diminished or nerves are damaged, it can be difficult to achieve either. Becoming increasingly common at midlife, depression notoriously dampens desire. Dyspareunia—pain during intercourse—affects about half of postmenopausal women and is one of the most common reasons women shy away from sex. Antidepressants, particularly SSRIs, can also impede orgasm.

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