Painful Intercourse after Menopause: 5 Actionable Tips to End Painful Sex

Physical changes after menopause

Your body goes through many physical changes during menopause, many of which can have an impact on sexual intercourse. These changes are primarily due to shifting hormone levels, especially a decrease in the amount of estrogen your ovaries produce.

Some of the physical changes you might experience with menopause include:

• Gradual weight gain
• Thinning hair
• Vulvovaginal atrophy that results in dryness, itching, and pain
• Frequent urination and increased levels of urinary tract infections
• Incontinence
• Pelvic organ prolapse
• Hot flashes and night sweats
• Sleep problems like insomnia

Some or all of these uncomfortable symptoms might negatively influence your sex drive and affect how desireable or pleasurable sex is to you. You might even experience pain or discomfort during sex. In addition to the physical changes, many women experience mood swings and emotional changes before, during, and after menopause.

The good news is that there are ways to keep sex great after menopause. Once you know why you might be experiencing painful sex after menopause, you can explore different treatment options.     

Why sex may hurt after menopause

If you find intercourse painful after menopause, you’re not alone. Between 17 and 45 percent of postmenopausal women experience painful sex, and there are a few possible causes.

Estrogen helps lubricate the vagina and make its walls elastic, so pain during intercourse may be caused by vaginal dryness. The decrease in estrogen can cause the walls of the vagina to become thin, dry, and less elastic, a condition called vaginal atrophy.

The combination of dryness and the narrowing of the vaginal walls can make sex uncomfortable, even painful. Painful intercourse is a condition called dyspareunia. Not all postmenopausal women with dyspareunia have the condition because of a decrease in estrogen, though.

In some cases, painful intercourse can be caused by pelvic floor abnormalities or dysfunction, such as organ prolapse or vaginismus, which is the involuntary spasm of genital tissues. Your doctor will be able to examine you and review your symptoms to help determine the cause of the pain during sex.

Painful intercourse often causes women to feel stressed, depressed, frustrated, or self-conscious. These feelings are often amplified in menopause. It’s important to remember that the changes you are going through during menopause are entirely normal and in many cases, easily treated.   

Ways to treat painful intercourse

Painful intercourse after menopause is relatively common, but that doesn’t mean you have to suffer. There are different ways that you can treat the symptoms associated with dyspareunia, both on your own and with the guidance and support of your doctor.

Lubricants and moisturizers 

One of the easiest ways to ease symptoms of vaginal dryness is to moisturize. Lubricants designed for sexual intercourse can make penetration more comfortable and pleasurable. There are many different types of lube available, so try to choose one with fewer synthetic ingredients, as those can cause further irritation.

In between sexual intercourse, you can also use vaginal moisturizers to help reduce vaginal dryness. Make sure you choose a moisturizer that is formulated especially for the vaginal area, as other moisturizers may contain ingredients that are unsafe for use on the genitals.         

Low-dose topical estrogen

Depending on the severity of your symptoms, your doctor may prescribe a low-dose topical estrogen cream or capsule to apply to the affected areas. The estrogen is absorbed through the skin and vaginal mucosa to provide temporary relief of symptoms like pain, soreness, stinging, and itching.          

Estrogen pills 

In some cases, your doctor may prescribe estrogen pills as a form of hormone replacement therapy. Typically, women will only take estrogen pills if other remedies like lubricants and topical creams haven’t improved their symptoms. Estrogen pills may also alleviate other symptoms of menopause like hot flashes. Estrogen-only pills are only prescribed to women who have undergone a hysterectomy. In other cases, your doctor may prescribe you estrogen-progestin pills to decrease the risks of uterine cancer.

Hormone replacement therapies can cause health risks during menopause, such as heart disease and stroke. Schedule regular health check-ups with your doctor if you’re taking estrogen pills.          

Ospemifene

Ospemifene is a non-hormonal pharmaceutical drug that can be prescribed to treat painful intercourse that’s caused by vaginal dryness or vaginal atrophy. It belongs to a class of drugs called selective estrogen receptor modulators, which activate or block estrogen receptors in certain areas of the body. This drug is approved by the FDA, but it shouldn’t be taken if you have a history of thromboembolism or some types of cancer. Make sure to consult your doctor before taking it.

Foreplay

Foreplay is arguably one of the best natural remedies for painful intercourse after menopause. Some women find it helpful to spend more time on foreplay to help get in the mood and relax their body.

Conditions that can cause painful intercourse

• Vaginal dryness
• Vulvodynia, a condition that causes stinging, burning, and irritation in any area of the vulva
• Vulvar vestibulitis, which refers to the narrowing and thinning of the vaginal walls
• Physical abnormalities like pelvic floor dysfunction, cysts, or growths
• Bacterial infections, such as vaginitis

When to see a doctor 

Thankfully, there are treatment options available to you if you are experiencing painful intercourse after menopause, many of which you can try without needing a prescription. Talk to your doctor about any of your postmenopausal symptoms, no matter how small they may seem. If your pain is severe, lasts long after intercourse, or if there is any bleeding or foul odors, then you should see your doctor as soon as possible.

Try these treatments for painful intercourse after menopause to boost your sex life and enjoy this great new phase in your life!