Painful sex after menopause: Why it hurts and what you can do

It’s no secret that menopause involves a host of physical changes that can have a huge impact on your everyday life. Not everyone struggles, but for some people, symptoms such as mood swings, hot flashes, and brain fog can be difficult to live with. So, if you’ve already gone through menopause, it might feel like a relief to be on the other side.

Frustratingly, reaching menopause doesn’t always signal the end of all your symptoms. Some people, for example, find penetrative sex painful in the postmenopause phase of life, which can leave you feeling a little disheartened. For many of us, sex is an important part of life that helps us to release stress and bond with our partners. If sex starts to hurt, it can lead to insecurity, loss of intimacy, and in some cases, even a reduced quality of life.

If your sex life has been affected by menopause, it may help to know that you’re not alone. In the lead-up to menopause, 15% of women will experience changes to the lining of their vagina, known as vaginal atrophy. Even more postmenopausal women — over half — notice these changes. Symptoms include bleeding after sex, burning, itching, and painful sex, also called dyspareunia. But don’t lose hope. With the right treatment, painful sex after menopause is manageable, and you don’t have to put up with it. 

Of course, it’s always possible that you might be finding sex uncomfortable for reasons other than menopause, such as vaginismus, a yeast infection, or a sexually transmitted infection. Here, Dr. Brandye Wilson-Manigat, obstetrician, gynecologist, and CEO of Brio Virtual Gynecology, California, US, shares everything you need to know about painful sex after menopause. But if you have any questions or concerns about your sexual health at any stage of life, always speak to a doctor.

Key takeaways

• Almost three-quarters of women experience pain during sex at some time during their lives, and up to 45% of women report painful sex after menopause.
• Hormonal changes are believed to contribute to vaginal dryness and discomfort from sex.
• Hormone therapy (also known as hormone replacement therapy or HRT) has been found to ease painful sex symptoms for many people if a drop in hormones is the cause.
• Simple additions to your routine, including using lube and vaginal moisturizer, can help to ease pain and dryness.
• Left unchecked, painful sex often gets worse, so don’t delay speaking to your doctor about treatment options.

Is it normal to experience painful sex after menopause?

Painful sex can happen at any life stage but — because of declining hormone levels — it often spikes during perimenopause and after menopause. 

As a reminder, perimenopause and menopause are two separate things. Perimenopause refers to the years leading up to when menopause (your final period) is confirmed. It usually begins somewhere between your late 30s and 50s — most often in your 40s. You’re diagnosed as having gone through menopause when you haven’t had a period for 12 months (usually between the ages of 45 and 55). From then on, you are postmenopausal.

If you’re struggling with perimenopause symptoms — whether it’s painful sex or anything else — support from like-minded people can really help. Flo’s safe community space, Secret Chats, enables you to chat about your experiences with other people who know what it’s like. Download the app to get involved in these helpful conversations, keep a note of your symptoms, and more.

Painful sex during perimenopause or after menopause is usually “persistent or recurrent pain or discomfort that occurs during or as a result of intercourse,” explains Dr. Wilson-Manigat. The pain can be “localized externally to the vulva or internally to the vagina, pelvis, or lower abdomen,” she adds. 

Menopause might impact the way you feel about sex and your body, but it’s important to remember that it is still possible to enjoy a pleasurable sex life as you approach the end of your periods and postmenopause. So, if penetrative sex is important to you and something you want to keep doing, make an appointment to see your doctor. Treatment options are available, and you don’t have to live with the pain.

What causes painful sex after menopause?

Just like other, more widely known perimenopause symptoms such as hot flashes and brain fog, painful sex is largely related to a drop in hormones. That’s because in perimenopause, your estrogen levels start to change and eventually reduce.

Estrogen plays a vital role in keeping your vaginal walls elastic and moist. When your estrogen levels decline during perimenopause and postmenopause, you might lose this elasticity, and the lining of your vagina might get drier, making tearing or bleeding more likely. “The tissues become thinner and less able to stretch,” explains Dr. Wilson-Manigat. “The vaginal canal shortens and narrows. Blood flow to the genital tissues can also decrease, leaving you drier during sex.”  

The result of all this? Sex might feel uncomfortable. “Depending on the area of the pain, it may feel like tearing, burning, friction, or a rubbing sensation, or like pressure or aching,” Dr. Wilson-Manigat adds. Hormonal changes can also impact pH (which in turn can affect acidity levels) in your vagina, which can lead to recurrent urinary tract infections in some people, causing further discomfort. 

If you experience any type of chronic pain during or after sex, don’t shrug it off. Left untreated, it often gets worse. “Unlike other symptoms of menopause like hot flashes/night sweats, which diminish over time, painful sex due to menopausal changes does not go away,” advises Dr. Wilson-Manigat. “Without treatment, the symptoms will worsen over time.” That’s not to say your sex life is doomed from the moment you become menopausal. There are things you can include in your everyday routine that may help.

8 ways to manage painful sex after menopause

Menopause is a process that anyone born with a female reproductive system will go through. But if it’s causing you pain, don’t feel like you have to live with it. 

Everyone is unique, and no two people have the exact same symptoms, so there isn’t a one-size-fits-all approach to managing painful sex after menopause. To get started, you might need to experiment with different treatment options until you find the one that works for you.

Speak to your doctor

Asking your doctor for help figuring out the underlying cause of painful sex is the first step to getting it resolved. “Sex should not be painful,” says Dr. Wilson-Manigat. “There are many potential causes and treatments available, so if you are having pain, you should see your doctor.” They will be able to help you figure out what’s going on or refer you to a specialist if necessary.

And if you feel awkward or embarrassed about discussing this intimate topic, that’s totally understandable. But it can help to remember that your doctor has had similar conversations with countless other patients before, so there’s likely to be very little that could faze them. 

Try vaginal moisturizers 

Just like the skin on your face and body, if your vagina feels dry, then applying a few drops of vaginal moisturizing cream might help to rejuvenate the area. Hyaluronic acid-based moisturizers have been shown to work particularly well. “Vaginal lubricants and moisturizers are first-line treatments for those experiencing painful sex due to menopause,” says Dr. Wilson-Manigat. “Vaginal moisturizers are used regularly over time and provide a protective layer to the vaginal tissues, helping to minimize discomfort.”  
 

Use lube during sex 

For many people, sex is painful because they have less natural lubrication than before. If this is the case, taking plenty of time to build arousal and applying a pea-sized blob of lube before you get started might be enough. “Vaginal lubricants work by reducing friction during penetrative intercourse, minimizing pain and discomfort,” says Dr. Wilson-Manigat. 

Lube generally comes in four types: water-based, silicone-based, oil-based, and hybrid. Generally, silicone-based lubes are recommended for postmenopausal vaginal dryness over water-based ones. That’s because water-based lubes are thought to change the microbiome in your vagina, which may cause problems at this stage of life. 

Medical treatments for vaginal dryness

Your doctor might also recommend the following:

• Estrogen therapy: If regularly using lube and a vaginal moisturizer isn’t doing the trick, talk to your doctor about hormone therapy, says Dr. Wilson-Manigat. “In some cases, both may be needed for complete relief of symptoms,” she explains.
• Intravaginal dehydroepiandrosterone (DHEA): Another type of hormonal therapy, this works by “increasing vaginal wall thickness, vaginal secretions, and the integrity of the vaginal tissues,” says Dr. Wilson-Manigat.
• Ospemifene: This non-estrogen therapy works by boosting your vaginal wall thickness, which can reduce the severity of painful sex symptoms, adds Dr. Wilson-Manigat.

Talk to your partner 

Sex is about pleasure and enjoyment for both of you, so if you’re experiencing pain or discomfort, share this with your partner. Worrying can actually make it worse, so communication is important. Finding ways to work around it together may help you to relax and unwind, making the whole thing more pleasurable. In some rarer cases, anticipating pain can lead to an involuntary tightening of your vagina known as vaginismus, which makes penetration even more difficult. Sex therapy, Kegel exercises (more on that below), and vaginal dilators may help you if you’re experiencing this.

Consider physical therapy for pelvic floor

Your pelvic floor is a group of muscles and ligaments that support your bladder, vagina, and bowel, and they can weaken with age. Pelvic floor exercises can help to prevent incontinence and vaginal prolapse. “Although it does seem to improve sexual dysfunction overall,” these exercises are unlikely to solve painful sex in its entirety, notes Dr. Wilson-Manigat. If you’re considering trying therapy for your pelvic floor, chat with your doctor first to make sure you avoid anything that could inadvertently make your sexual pain worse.

Rethink what counts as sex 

Don’t stop having sex altogether — unless you want to. Regular stimulation increases blood flow that can boost your vaginal health. It can help to reframe your idea of partnered sex, too. Enjoyable sex doesn’t need to include penetration, so consider exploring alternative ways to enjoy intimacy with your partner, such as kissing, mutual masturbation, and oral sex. 

Using sex toys together can also be a gentler way to enjoy sex. There are many styles of toys, so shop around until you find one that suits your needs. You could try clitoral-targeted sex toys that don’t require penetration to achieve satisfaction or experiment with different-shaped toys made from different materials that might feel gentler to touch.

Try sex therapy

Sex may be a physical act, but how you think and feel can have a huge impact on your sexual experiences. If it’s been worrying you, it could help to talk to someone. “Treatment by a mental health specialist or sex therapist can definitely help manage the anxiety and other emotional and mental roadblocks that may develop as a result of painful sex, particularly if it’s been going on for a long time,” says Dr. Wilson-Manigat.

When to speak to a doctor about painful intercourse

If you experience any type of pain during or after sex, make an appointment with your doctor. They will first try to figure out the cause of your discomfort and then recommend the best way to treat it. You might need to have some tests, like scans or a blood test, but these should help your doctor recommend specific treatments based on the likely cause of your pain. 

“Once treatment begins, you can expect improvement within a few weeks,” says Dr. Wilson-Manigat. Estrogen therapy can start to take effect in four to six weeks, she explains, while other medical treatments including DHEA and ospemifene may take up to 12 weeks.