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Painful Sex After Menopause Is Not ‘Normal’ — What Women’s Health Experts Want You to Know 

Sex is a fun way to build intimacy and relieve stress. But during menopause, what used to be pleasure-inducing can become downright painful. So much so that many women experience a decline in libido or avoid sex altogether. Researchers estimate that up to 84% of women suffer from painful sex after menopause. Thankfully, the condition is almost always reversible. Here, we explain why painful sex after menopause occurs and provide expert-approved tips for relief.

What causes painful sex after menopause?

Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine and the medical director of consumer education at Midi Health, says painful sex can occur at any age. However, the problem often worsens during menopause because the body stops producing estrogen.

Since estrogen helps keep the vaginal tissues moist, many women experience “dryness, thinning of the tissue and a loss of elasticity,” Dr. Streicher explains. “This means that sexual activity, especially intercourse, can be painful because the tissue becomes inflamed, dry and irritated.”

Many menopausal women also experience pelvic floor weakness, in addition to hormonal changes and thinning tissue, says Heather Jeffcoat, DPT, a doctor of physical therapy and the author of Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve. This weakness can make the pelvic organs change position (or prolapse) causing a bulge in the vagina and “creating discomfort during sex, as well as during daily activities.”

Symptoms of painful sex after menopause

Menopausal changes affecting the vagina and vulva cause two types of symptoms, according to Dr. Streicher –– non-sexual and sexual symptoms.

Nonsexual symptoms

“These symptoms include vaginal dryness, irritation and itching. Some women also experience urinary urgency, that ‘gotta-go’ feeling,” Dr. Streicher explains.

Sexual symptoms

These symptoms occur during sexual intercourse, typically during penetration. “Whether it’s with a penis or a toy, as soon as you try to put something in your vagina, it’s just too painful,” says Dr. Striecher.

Vaginal pain varies in sensation and severity, but Dr. Striecher says many women describe it as a sharp, stabbing or burning sensation.

To prevent discomfort, many women choose to avoid sex altogether. But this can actually make the problem worse. When it comes to sex, the term “use it or lose it” applies. Regularly having intercourse increases blood flow to the vaginal tissues and supports vaginal lubrication, making sex more comfortable, while reducing the risk of vaginal atrophy (inflammation of the vaginal walls).

5 Remedies for painful sex after menopause

Senior couple embracing in kitchen of suburban home after overcoming painful sex after menopause

Even though many menopausal women experience painful sex, Dr. Streicher says it doesn’t have to be normal and no woman should have to put up with it. “We can reverse these symptoms almost 100% of the time with the right treatment,” she adds. Here’s how to get started:

1. Reduce friction with a lubricant to ease painful sex

Consider an over-the-counter lubricant if you experience mild pain or dryness during sex. “A lubricant is something that’s applied to the vagina and the penis or a toy that makes things more slippery,” explains Dr. Streicher. “It doesn’t change the [vaginal] tissue, but it decreases friction, making intercourse more comfortable.”

There are several types of sexual lubricants, including water, silicone, oil and hybrid lubricants. The one that will meet your needs depends on various factors, including what you plan to use it for (e.g. toys or penetrative sex) and whether you have sensitive skin or allergies. Some experts recommend starting with a water-based lube, but these often have high osmolality (a measurement of dissolved particles in a liquid). High osmolality lubricants can cause the vaginal cells to lose water with repeated use, drying out the vagina even further, and resulting in more pain and discomfort.

A better bet? Silicone lubricants. Though usually more expensive, silicone lubricants don’t have osmolality, so they’re less likely to irritate the vaginal tissue. They’re also slipperier than water-based lubes, significantly reducing friction.

2. Use a vaginal moisturizer to hydrate

You might benefit from a long-acting vaginal moisturizer if you continue to experience painful sex after menopause even after introducing lube. Long-acting vaginal moisturizers aren’t used during intercourse. Instead, you apply them twice a week to your external and internal vaginal tissues, including the inner and outer labia and vulva.

After application, “these products increase the moisture content of the [vaginal] cells, which in turn causes increased lubrication and elasticity,” Dr. Strieicher says. Though effective, don’t expect a vaginal moisturizer to work instantly. It takes several weeks of regular application for the tissue to rehydrate. Be patient, use the product regularly and follow the instructions on the label.

3. Do these exercises before having sex

Remember how we said painful sex can cause your pelvic floor muscles to tense up and shorten? You can counteract some of these effects with a quick warmup. Bijal Toprani, PT, DPT, a doctor of physical therapy at Hinge Health recommends two yoga poses in particular — Happy Baby and Malasana (or garland pose).

This video explains how to do ‘Happy Baby’:

This video explains how to do ‘Malasana’ or ‘Garland Pose’:

“Perform one or both of these poses for 30 seconds, two times, while doing belly breathing and closing your eyes,” Toprani says. “This will not only stretch the muscles of your vagina, open up your hips and help stretch them out, which can be beneficial for many sex positions, but also calm down your nervous system which can reduce pain overall.” Toprani recommends doing these stretches just before sex for the best results, but incorporating them into your daily routine isn’t a bad idea. Doing so promotes healthy blood flow and can even help reduce pelvic pain.

4. Breathe like this

Another easy way to reduce pelvic floor tension, and in turn, painful sex after menopause, is to focus on your breathing during penetration. Toprani’s advice: “Inhale deeply as the penis [or sex toy] enters your vagina. Inhaling pushes your diaphragm down and helps your pelvic floor stretch and relax.”

To optimize these results, practice regularly. Toprani says breathing deeply throughout the day can help you become more aware of your pelvic floor muscles and make it easier to relax in the moment. Research backs up this thinking. A study in the journal Pain concluded that slow, deep breathing reduced pain compared to uncontrolled breathing patterns.

5. Consider other options

Many of us equate sex with penetration, but that association isn’t necessary. It’s possible to achieve orgasm and build intimacy in a variety of other ways. “Incorporating new elements, such as erotica or other forms of intimacy, like massages and cuddling, can rejuvenate the sexual experience,” says Rhiannon John, a certified sexologist and ambassador.

Avoiding penetration prevents pain, but it can also make sex more enjoyable. A study in the Journal of Sex and Marital Therapy found that the majority of women (78%) said some orgasms feel better than others, and most of the time, penetration has nothing to do with it. Instead, respondents associated increased pleasure with foreplay (taking time to build arousal) and having a partner who knows what they like.

Experimenting with your partner and maintaining open lines of communication can help you develop a sexual relationship that’s both rewarding and pain-free.

When to see an expert about painful sex after menopause

Many women who experience painful sex after menopause see a significant reduction in symptoms after trying one (or several) of the provided recommendations. If the pain continues or worsens, make an appointment with your doctor or someone who specializes in menopause and sexual medicine. A thorough exam can determine if you’re a candidate for other treatments, like hormone replacement therapy or pelvic floor therapy.

No matter your symptoms, you don’t have to settle for painful sex after menopause. “There are tools you can use and providers you can see that can help you restore your sexual function,” Jeffcoat says.

For more tips on improving sexual health:

If You Suffer From Urinary Leaks, Unexplained Constipation and/or Painful Sex, You Could Have This Sneaky Pelvic Problem

More Feel-Good Guaranteed: The Natural Remedies That Cure Low Libido In Women

Top Doc: Your Vagina *Does* Get Smaller After Menopause + The Lubricants That Women Over 50 Should Never Use

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

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