Painful Sex After Menopause: Causes and Prevention

Last updated 12.07.2023 | by Dr. Karen Pike | 11 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.


According to the North American Menopause Society, between 17% and 45% of women find sex painful after menopause. 

In other words, almost half of all women could be struggling to enjoy sex in their postmenopausal phase of life. 

But just because we’ve reached the end of our reproductive years, it doesn’t, and shouldn’t, mean the end of our sexuality. That’s why it’s so important for women to understand the reasons behind pain during sex and learn how to find relief. 

Since I began my research into menopause, I’ve spoken with countless women who experience discomfort and pain during sex, and the problem seems to be particularly pronounced after menopause. 

But it’s not just physical discomfort that these women complain of. This type of pain can also cause emotional distress, leading to self-esteem issues and relationship problems. 

So, I decided to dive deeper into the causes of painful sex in postmenopause in an effort to help women regain their sexual well-being and feel confident, happy, and comfortable in the bedroom once again. 

Are you no longer able to enjoy sex like you used to? Do you worry that these physical changes are starting to affect your romantic relationship? Rest assured, you’re not the only one. Millions of women around the globe are also experiencing the same challenges, but thankfully, there are interventions that can help. 

In this post, I’ll explain the connection between menopause and painful sex so that you can identify what’s causing the problem and learn how to find relief.

How Does Menopause Affect Your Sex Life?

During menopause, your ovaries begin producing less estrogen. The amount of this hormone falls throughout perimenopause (the build-up to menopause) before tapering off completely. 

But estrogen doesn’t just regulate your menstrual cycles. It also plays a crucial role in your sexual health. And so, when it begins to disappear, many women notice changes that they’ve never experienced before.

These changes include:

Vaginal Dryness

Estrogen helps to keep the vagina moisturized and healthy. So, when estrogen falls, it’s not unusual for the vagina to feel dryer than ever before.

Dryness makes the vaginal tissues less flexible and more prone to friction, irritation, and injury during sex. This can make intercourse extremely painful.

Vaginal Atrophy

Estrogen also helps to keep the vaginal walls thick and flexible. So, when estrogen levels drop, the vaginal walls become thinner and less elastic. This is a condition known as vaginal atrophy. Vaginal atrophy can cause pain, bleeding, and discomfort during sex. 

Changes to the Pelvic Floor

Before menopause, estrogen maintains blood flow and lubrication to the pelvic floor muscles. But once estrogen tapers off, these pelvic floor muscles no longer receive the same levels of oxygen and nutrients as they once did, making them weaker. Weak pelvic floor muscles can contribute to pain during sex.

Anxiety

Symptoms such as vaginal dryness, vaginal atrophy, and weakened pelvic floor muscles can lead to stress and anxiety when it comes to having sex. These emotional factors can further lower your libido and make sexual activity even more painful.

How to Relieve Painful Sex After Menopause?

For many of the women I’ve worked with, sex after menopause can come with some challenges. So, I decided to dedicate a significant portion of my research to helping women find relief from the pain and enjoy their sex lives once again. 

I’ve talked to countless readers who were willing to share their experiences of what has and hasn’t worked for them. This allowed me to build a picture of the most effective treatments and interventions that really do work. 

Here’s what I discovered:

Talk to Your Partner

The first step to reclaiming your sex life and enjoying intimacy with your partner is open communication. So, talking to your significant other about the changes your body is going through and the emotional impact of menopause can help you both feel more at ease and secure.

Use a Lubricant

Using a lubricant during sexual intercourse is your first line of defense when it comes to preventing pain during sex.

Lubricants come in liquid or gel forms. They’re applied to you and/or your partner’s genitals to help to mitigate the effects of vaginal dryness and prevent friction.

Lubricants are available in water-based, silicone-based, and oil-based formulas. It’s important to note that oil-based lubricants can damage condoms and lower their efficacy. So, if you haven’t yet reached full menopause and still require contraception, stick to a water or silicone-based lubricant.

Try Vaginal Moisturizers

Unlike lubricants, vaginal moisturizers are designed to provide long-lasting moisture throughout the day, not just during sex.

These specially designed moisturizers are safe to use in this sensitive area and don’t affect the delicate pH balance of your vagina.

When used regularly, vaginal moisturizers can help to restore the elasticity of the vaginal walls and tissues and prevent friction and injury during sex.

Some women I work with prefer to use natural moisturizers such as coconut oil or vitamin E. These additive-free alternatives are gentle on your skin and unlikely to cause a reaction in most people. 

Whichever formula you choose, be aware that using vaginal moisturizers can lead to leakage. So, you may want to consider using pantyliners, pads, or period underwear while using these types of products.

Exercise Your Pelvic Floor

Pelvic floor exercises, also known as kegel exercises, can help to tighten the muscles in and around the vagina, which may have become weaker after menopause.

Stronger pelvic floor muscles mean better support for the surrounding organs and potentially less pain during sex.

However, discomfort during sex is sometimes a sign of an overly tense pelvic floor, and certain kegel exercises can make this problem worse. So, it’s best to seek professional guidance so you can find the right exercises for your needs.

Try Self-Stimulation

Regular masturbation can help to increase blood flow to the vagina and increase the amount of natural lubrication you produce.

Some women find that using a vibrator helps to increase pleasure and boost their body’s natural moisture production even further.

Self-stimulation with a vibrator can also help to prepare you for sex with your partner. It allows you to go at your own pace and find what level of penetration is comfortable for you before engaging in full intercourse.

Just be sure to use plenty of lubrication at all times to avoid injury or irritation.

Dedicate More Time to Foreplay

A reduction in estrogen after menopause can cause your libido to dip, and many women find that it takes longer than usual to get turned on. This, combined with vaginal dryness and atrophy, can make sex difficult and painful. So, try dedicating more time to foreplay before diving into penetrative sex.

Practice Mindfulness

Mindfulness practices such as yoga and meditation can help to relieve stress. It’s also an effective way to reduce the symptoms of depression and anxiety, two common side effects of menopause.

One study published in the Journal of Sexual Medicine found that a regular yoga practice alongside breathing and relaxation exercises can increase sexual function. After following the program for 12 weeks, 3 out of 4 of all study participants noticed a marked improvement in their levels of pain during intercourse.

But that’s not all. The women also enjoyed an increase in their levels of arousal, desire, lubrication, and sexual satisfaction. Plus, they had more orgasms too!

The study involved women aged 22 to 55. And while improvements were noted across the entire age range, those aged 45 or older found the most benefits.

Try Other Forms of Intimacy

Penetration is just one way of being intimate with your partner. But if this type of intercourse is painful for you, there are plenty of other ways to practice sexual intimacy. Examples include mutual masturbation, intimate massage, experimenting with vibrators, and oral sex.

Make Healthy Choices

Your lifestyle can have a big impact on your health, including your sexual health. Maintaining a healthy weight, cutting down on alcohol, quitting smoking, and getting plenty of exercise can improve your sexual function and boost a lagging libido.

And that’s not all. Healthy lifestyle habits such as exercise can also relieve many of the other troublesome symptoms of menopause too.

Research shows that working out for one hour three times a week significantly boosts your overall physical and mental health during your menopause and postmenopause years.

Talk to a Therapist

Our mental and physical health are intrinsically tied to one another. And while a drop in libido is completely normal during menopause, the problem is much worse if you’re also suffering from conditions such as anxiety or depression.

That’s why I advise readers and patients to talk to a therapist. A good therapist can help you to alter negative thought patterns, boost your self-esteem, and reframe the way you think about sex.

Certain types of sex therapy or couples counseling can also help you to talk openly and honestly to your partner about intimacy so that you can connect on a deeper level.

Talk to Your Doctor

If painful sex becomes an ongoing problem, talk to your doctor or healthcare provider. They can assess your symptoms, rule out any underlying causes, and help you to find a treatment plan that works for you.

In certain cases, your doctor may prescribe a medicine that can help to boost your libido and improve the symptoms of vaginal dryness and vaginal atrophy that lead to painful sex.

Examples of prescription medications include low-dose estrogen in the form of topical creams or oral tablets and non-hormonal medications such as ospemifene and prasterone.

Hormone Replacement Therapy (HRT)

Hormone replacement therapy (HRT) works by replenishing natural estrogen and progesterone with synthetic versions of these hormones.

This boost in estrogen can reduce symptoms such as vaginal dryness and vaginal atrophy that lead to painful sex.

But while HRT can be an effective treatment for this and many other menopause symptoms, it’s not suitable for everyone.

FAQs

Will sex become less painful in post-menopause?

Most symptoms of menopause, such as hot flashes, night sweats, and mood swings, tend to settle down and even disappear completely once the menopausal process is complete. 
And for some women, the same applies to discomfort during sex. However, not everyone experiences relief from painful sex after menopause, and symptoms such as vaginal atrophy and vaginal dryness can continue well into the post-menopause years.

Is it better to avoid sex after menopause?

If sex is painful, it may be tempting to avoid it entirely. But regular sex can help to boost blood flow to the vagina. This delivers extra oxygen and nutrients to the cells, keeping the vaginal tissues healthy and strong.
Avoiding sex for prolonged periods can also emotionally impact your relationship and make it difficult to regain intimacy in the future.

My menopausal partner is finding sex painful. How can I best support her?

Listen to your partner and let her know that she can be open and honest about her feelings. Take steps to educate yourself about menopause and the related symptoms so that you can best support her, both sexually and emotionally.

Conclusion

Hormonal changes during and after menopause can cause a whole host of challenging symptoms, including painful sex.

But there is some good news. Through my research, I’ve discovered several interventions, including medication, lubrication, and therapy, that can help.

If you’re experiencing pain during sex, the first step is to be open and honest with your partner and your healthcare provider. Remember, with the right support, you can reclaim your sex life and navigate the challenges of menopause with comfort and confidence.

References:

Author

  • Dr. Karen Pike

    Dr. Pike is a senior physician administrator and board-certified emergency room doctor actively working in northern California. She received her undergraduate degree at Dartmouth College, where she graduated Phi Beta Kappa and played collegiate soccer. She attended Georgetown University for medical school and performed her residency in emergency medicine at Stanford University. She was part of the first-ever, women-majority emergency medicine program in United States. Dr. Pike is also the primary medical consultant for “Grey’s Anatomy,” a role she has held since the pilot episode when she partnered with Shonda Rhimes as the show’s original medical consultant. At her hospital, she was the second woman Chief of Staff. Today serves as the Director of the Emergency Department. Whether in leadership or direct patient care, her dedication to excellence in communication, quality, and collaboration is unwavering.