Painful Sex After Menopause? What to Know

Painful sex after menopause affects up to 45% of postmenopausal women, so it’s really time we talked about it more.
Long after the hot flashes and mood swings have subsided and you’re ready to start a new chapter in your life, painful sex is a menopause symptom that doesn’t always retire quietly.

But 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: 📝

What causes painful sex after menopause?

The main cause of painful sex after menopause is the drop in your estrogen levels that happens during the few years leading up to menopause, aka perimenopause.

So, even though you might technically not be menopausal yet – i.e. you haven’t had a period in 12 months – you might have menopausal symptoms, including painful sex, in the years leading up to that milestone.

Due to this drop in your levels of estrogen, your vaginal tissues can become dryer, thinner, and less flexible. You might also hear this called “vulvovaginal atrophy.”

This can cause problems if you want to have penetrative sex.

Lack of lubrication in your vagina can cause friction during sex, which can lead to irritation and soreness.

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

The level of pain felt during sex after menopause can vary from person to person. It can range from mild discomfort, dryness, or soreness after sex, to pain that might be severe both during and after sex.

For some women, 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.

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.

Other causes of painful 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 (chronic pain in the vulva).
• Vaginitis (inflammation of the vagina).
• Skin conditions, such as eczema.
• Urinary tract conditions, such as urethritis (irritation of the urethra—the tube that allows pee to exit your body).
• Stress, depression, or other mental health concerns.

It’s worth chatting with your healthcare provider to get their advice.

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.

How can I make sex more enjoyable after menopause?

So, let’s talk about how to make sex less painful after menopause.

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

• Experiment with lubricants. A store-bought lubricant can help you feel more comfortable during sex by temporarily relieving dryness. Try a few different ones to see what suits you. And if you’re using condoms with your partner, go for a water-based or silicone lubricant, since oil-based ones can weaken condoms and make them less effective.
  
• 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.
  
• 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.

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. 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.

One last thing…

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.

📚 More on menopause:
Introducing, Peanut Menopause
What Happens During Menopause?
How to Deal With Menopause
When Does Menopause Start?
How Long Does Menopause Last?
Unusual Menopause Symptoms You Might Not Know
Why Are My Breasts Getting Bigger After Menopause?
Are You Getting Cramps After Menopause?
Menopause Weight Loss: What to Know
What are the Signs Perimenopause is Ending?
Menopause and Sexless Marriage: Is There a Link?
Can You Get Pregnant After Menopause?
Who Feels More Pleasure: Male or Female?
Does Female Masturbation Cause Hormonal Imbalance?