Painful Sex After Menopause? What to Know

Painful sex after menopause affects up to 45% of postmenopausal women. Yep, it’s really time we talked about it more.

Because the truth is, long after the hot flashes and mood swings have subsided, painful sex is a menopause symptom that doesn’t always retire quietly.

And when you’re ready to start a new chapter in your life and embrace your new evolved physical self, intimacy matters.

So why is sex painful after menopause? And what can you do to ease the discomfort and start enjoying your sex life again?

We’ve got everything you need to know right here.

In this article: 📝

Why does sex hurt after menopause?

The main cause of painful sex after menopause is the drop in your estrogen levels during perimenopause which can lead to your vaginal tissues becoming dryer, thinner, and less flexible.

You might also hear this called “vulvovaginal atrophy.”

As you produce less discharge, the lack of lubrication in your vagina can cause friction during sex, leading to irritation and soreness.

And vaginal tissue that’s thinner and more fragile can easily become inflamed during penetration, even sometimes vaginal bleeding or tearing.

What does pain during sex feel like?

The level of pain during sex after menopause can vary from person to person.

It can range from mild discomfort to a sensation of pain and dryness during intercourse or even tenderness afterward.

Some women describe it as burning during intercourse, while others experience pain so severe both during and after sex it’s enough to rule out penetrative sex altogether.

On top of all that, experiencing pain during sex (also known as “dyspareunia”) can make you feel anxious or fearful about doing it again—understandably.

These negative feelings can make sex more painful—you might find it harder to get aroused and lubricated, or your vaginal muscles might clench, making penetration more difficult.

It’s a vicious cycle.

What causes pain during sex?

Just because you’ve gone through menopause, that doesn’t mean that pain during sex is always a direct result of menopause.

Other reasons that you might experience pain during sex at any age include:

• Vulvodynia: This is chronic pain in the vulva without a clear cause.
  
• Vaginitis: About one in three women will experience this type of inflammation of the vagina in their lives.
  
• Skin conditions: Such as eczema.
  
• Urinary tract conditions: Such as urethritis—the irritation of the urethra (the tube that allows pee to exit your body).
  
• Pelvic Inflammatory disease: PID is an infection affecting the ovaries, fallopian tubes, and uterus.
  
• Endometriosis: In most cases, endometriosis tends to halt after menopause but it still presents in 2% to 5% of women (although this seems to happen mostly in those with a history of hormone replacement therapy (HRT)).
  
• Sexually transmitted diseases: STDs like gonorrhea and chlamydia can cause discomfort during sex.
  
• Mental health concerns: Stress, depression, or even fear of intimacy can take a toll.

If, in your case, menopause and painful sex aren’t connected, then treating the condition that’s responsible for your discomfort could make a world of difference.

No matter the cause, it’s worth chatting with your healthcare provider to get their advice.

No discomfort during sex—not emotional or physical—should ever be simply tolerated.

Your pleasure (and well-being) matters.

How to reduce pain during intercourse (home remedies)

So, let’s talk about how to cure painful intercourse after menopause as naturally as possible.

For mild dryness and irritation in your vaginal area, there are things you can do yourself at home that may help:

1. Keep having sex: In a way that’s comfortable for you. Getting aroused and sexually stimulated can actually improve your vaginal health, increase lubrication, and boost blood flow to the area. So, if penetrative sex is a no-go, embrace the art of foreplay and enjoy some oral sex with your partner. You also enjoy some solo time too.
   
2. Experiment with lubricants: A store-bought lubricant can help you feel more comfortable during sex by temporarily relieving dryness. And you can try a few different ones to see what suits you. If you’re using condoms, opt for a water-based or silicone lubricant since oil-based ones can weaken condoms and cause them to break.
   
3. Try a vaginal moisturizer. These are moisturizers that you apply to your vagina regularly, not just before sex. They can relieve dryness for several days at a time, which may make sex easier and more enjoyable.
   
4. Avoid perfumed products in your genital area: Scented soaps, shower gels, or sprays all have the potential to dry your skin out further and increase irritation. Try simply washing the area gently with plain water.

How to deal with painful sex during menopause?

If the pain you’re experiencing during sex is more severe, it’s best to consult your healthcare provider and see what treatments they recommend.

As starting point, you could ask them about:

Vaginal estrogen

This involves taking a low dose of estrogen in the form of a cream, ring, or tablet inserted into your vagina.

It helps to reverse the thinning and dryness caused by the decline in estrogen around menopause.

One of this treatment’s major plus points is that it has fewer side effects than oral estrogen.

Ospemifene

A once-a-day pill that works in a similar way to estrogen in that it helps to thicken the lining of your vagina.

It’s a lower risk treatment than oral estrogen, but it can cause hot flashes as a side effect.

Oral estrogen

If vaginal estrogen treatment isn’t effective for you, you might be prescribed a higher-dose oral estrogen pill.

Not only can these reverse dryness and thinning in your vagina, but they can also relieve other menopause symptoms.

However, they do cause more side effects than other treatments, and there is a possibility that they could increase your risk of breast or uterine cancer.

Pelvic floor physical therapy

If the pain you’re experiencing during sex is linked to tight, sore pelvic floor muscles, a therapist can work with you to relax and strengthen these muscles.

You might also learn to use a lubricated dilator to help stretch the tissues in your vagina.

Sex therapy or counseling

If painful sex has affected your desire for intimacy, knocked your confidence, or impacted your relationship with your partner, talking to a counselor or sex therapist may help you work through these issues.

A combination of therapy and medical treatment (such as the ones above) could be the key to getting your sex life back on track.

And, at the very least, boosting your mental health and well-being.

If painful sex after menopause is getting you down, know that you’re not alone.

Join the Peanut menopause community for honest sharing, friendship, and support.

We’re in this together. ❤️