What Pain During Sex After Menopause Can Mean

Just when you thought you’d seen the worst of menopause (looking at you, hot flashes and night sweats), something new shows up: painful sex.

If you haven’t felt like yourself in a while, it’s easy to assume this is just part of the process. But while painful sex is common after menopause, it’s not something you have to accept as normal.

“Women have the right to enjoy comfortable sex and not have pain during sex,” says Risa Kagan, M.D., FACOG, MSCP, an OB/Gyn with Sutter.

Menopause and Painful Sex

During menopause — defined as 12 months after your last period — and the years leading up to it (perimenopause), estrogen levels decline, especially estradiol, which helps explain many menopause symptoms.

“The earlier and most common symptoms we hear about are hot flashes and night sweats,” Kagan says. “But over time, many women also develop symptoms related to genitourinary syndrome of menopause [GSM], which can include painful sex.”

GSM refers to the vaginal, vulvar and urinary symptoms related to menopause. As estrogen levels fall, the vaginal tissue becomes thinner and less elastic, with reduced blood flow and lubrication, especially during arousal.

“And for some women, that can lead to irritation, bleeding and pain,” Kagan says.

What Painful Sex Can Feel Like

Pain during sex can show up in different ways. For example, you might notice:

• Burning or aching
• Discomfort with tampon use or other forms of insertion
• Pain during penetration or with certain movements
• Pain that continues after sex

Understanding where and when the pain occurs can help guide next steps.

“We encourage women to get to know their bodies and where they’re experiencing discomfort,” Kagan says.

Your provider may also ask:

• How long have you been having pain?
• When was the last time you remember not having pain during sex?
• Do you have pain only in certain sexual positions?

Other Possible Causes

While hormonal changes are a common reason for discomfort, they’re not the only cause. Other factors may include:

• Cancer treatments
• Certain medications that affect arousal
• Emotional or psychological factors, such as stress or anxiety
• Inflammation, infection or skin conditions
• Injury or past trauma
• Pelvic conditions, such as endometriosis or fibroids
• Previous pelvic surgery

If you’re experiencing pain, a provider can help you sort through these possibilities and find the cause.

Options That May Help

The good news is that for both pre- and post-menopausal women, there are various treatment options available to help prevent pain during sex.

Non-hormonal options. Vaginal moisturizers can help maintain moisture over time, while lubricants can reduce friction during sex.

Hormonal options. Some people find relief with menopausal hormone therapy, including low-dose vaginal estrogen or other prescription options.

Pelvic floor therapy. Working with a specialist may help improve muscle function and reduce discomfort over time.

You don’t have to figure this out on your own. Your provider can help you understand your options and choose an approach that feels right for you.

“We have many options for peri- and post-menopausal women,” Kagan says. “If you’re having discomfort, it’s worth being seen. There are many possible causes — and many ways to help.”

Pain during sex can feel isolating, but support is available — and relief is possible with the right care.