Painful Intercourse in Postmenopause: What You Need to Know

During perimenopause, you might have noticed changes in your body that affected your sexual wellness, including vaginal dryness and discomfort during sex. As you transition to menopause, vaginal dryness and other symptoms may cause increased discomfort and even painful intercourse. Fortunately, multiple options exist to manage and treat vaginal dryness and other reasons for pain during sex so you can enjoy sex as you age. 

Why Sex Gets More Painful in Postmenopause

Estrogen plays a vital role in the lubrication of the vagina during your fertile years. It stimulates the cervix to produce mucus. This, in turn, protects the vagina from pathogens, in addition to maintaining the health of the vaginal walls. 

Once estrogen levels drop during perimenopause and menopause, the cervix stops the production of its protective secretions. This drier vaginal environment can lead to the Genitourinary Syndrome of Menopause (GSM.)  Up to eighty-four percent of women in menopause experience GSM. 

GSM, also known as vaginal atrophy, can include such symptoms as vaginal dryness, thinning of the vaginal walls, dyspareunia, shortening of the vagina, and increased urinary tract and vaginal infections. Changes in vaginal sensation and the vaginal microbiome due to increasing pH and vaginal itching or burning may also occur.

Dyspareunia, which is persistent or recurrent genital pain that occurs just before, during, or after sex, can occur for many reasons, ranging from insufficient lubrication to endometriosis to stress.

Vaginismus is the involuntary tensing or contracting of muscles around the vagina, which can make sex more painful. 

Treatment Options for Easing Painful Sex

There are multiple over-the-counter and prescription options for making sex more comfortable. Finding the right combination on your own can take some time. For faster relief, scheduling an appointment with a menopause specialist will help get to the root cause of your problem and provide more specific guidance on the right options for you.

Water-Based Lubricants

When used right before sexual activity, over-the-counter water-based lubricants can ease sexual discomfort caused by vaginal dryness. A lubricant is usually the first line of defense against vaginal dryness, but as women age and progress through postmenopause, lubricants may not be sufficient.

Vaginal Moisturizers

Vaginal moisturizers are used daily or every few days and are effective at maintaining vaginal health and moisture levels. Think about this option like you would putting moisturizer on your face each day to alleviate and prevent dry skin. Like lubricants, moisturizers are usually the first go-to option for vaginal dryness.

Vaginal Dilators

Vaginal dilation is an effective, non-pharmacological treatment that helps restore elasticity and relax the vaginal walls to make sex more comfortable. Newer devices like the Milli from Materna Medical have replaced the basic dildo approach for a more modern and personalized treatment experience.

Vaginal Estrogen

When used regularly, low-dose vaginally applied estrogen creams, tablets, or rings are highly effective at maintaining the health and lubrication of vaginal tissues. Some may even minimize some of the urinary symptoms that are a component of GSM. 

Hormone Therapy

Menopausal hormone therapy can help arrest the progression of vaginal atrophy as well as ease vaginal dryness. Osphena is an oral prescription medication used for moderate to severe dyspareunia. It is considered a safe and effective treatment for people who can’t take estrogen-based products. 

Tips for Enhancing Sexual Pleasure in Midlife

Midlife sexuality can feel complicated, but with a little education and flexibility, you can create a meaningful sex life. Sexual pleasure may look different from how it was in your younger years, but it can be just as satisfying, if not more so. Many women report feeling more comfortable in their own skin and confident in sharing with their partner what they want and need from sexual encounters. Self-pleasure has also gone mainstream, and midlife women feel freer to take charge of their own pleasure with and without a partner. 

Take Care of Your Physical Well-Being

Sex probably won’t be too much fun if you’re afraid of pain with penetration. Talk to your healthcare provider and make use of all the treatments available to you to find what works best to ease any physical discomfort. 

Explore Intimacy 

How can you and your partner cultivate intimacy and closeness in new ways? Sexual intimacy can be great, but it’s not the only way to strengthen the bond between you and your partner.    

Communication with your partner is key. Your body has changed, and your needs aren’t what they once were. Free and open communication with your sexual partner about new needs, concerns, and desires can go a long way to improving your sex life. 

Keep in mind that penetrative sex isn’t necessarily the all-important element of sexual expression. Explore all the other ways you and your partner can give each other pleasure. You might learn some satisfying new things about how you can give and receive. 

Have Fun With Toys and More!

The sexual wellness industry has exploded in the last few years. There are thousands of sex toys out there that can make climaxing easier for a menopausal body and can help add a sense of playfulness to your sex life.

Get creative with positions. What once felt good might not anymore. That doesn’t mean nothing will ever feel good again. Try out some new positions that might be more comfortable than what was standard for you in the past. You might find a new favorite. 

If getting in the mood is more difficult, erotica is a hot category with a wide variety of content styles to suit different preferences.

Therapeutic Support

If the over-the-counter strategies mentioned above aren’t working to relieve the discomfort and pain during sex, make an appointment with a menopause-certified care provider to discuss prescription options. 

There’s also the option of sex therapy if your difficulties with sexual pleasure are more connected to your relationship with your partner, stress, or psychological barriers. Seek a qualified sex therapist to help you overcome your barriers and support you on the path to sexual wellness.

Menopause changes so much about our bodies and lives, but you don’t have to give up a great sex life because of it. Have a look at the Midday menopause app for more information about how to stay sexually healthy and fulfilled long after menopause.   

Jennifer Turkyilmaz, RN, BSN, is a medical writer who worked for many years in women’s health as a high-risk pregnancy nurse. She is also a newly menopausal woman who wishes she had known more about what to expect before it happened to her.