Why Painful Sex Can Happen After Menopause

As estrogen levels change during menopause, the vaginal tissues can become thinner, drier, and less elastic. This condition — sometimes referred to as genitourinary syndrome of menopause (GSM) — can lead to:

• Vaginal dryness
• Burning or itching
• Discomfort or pain during sexual activity
• Reduced lubrication

Other factors, such as certain medications, pelvic surgery, or underlying medical conditions, may also contribute to discomfort.

Emotional and Relationship Impact

Painful sex can affect more than just physical comfort. It may lead to:

• Lower sexual desire
• Increased stress or frustration
• Strain in intimate relationships

Open communication with a partner and a healthcare provider is an important part of finding solutions.

Options for Managing Painful Sex After Menopause

There are several approaches that may help relieve discomfort, and the best option will depend on your overall health, medical history, and personal preferences.

1. Vaginal Moisturizers and Lubricants

   Over-the-counter vaginal moisturizers can help improve everyday comfort, while lubricants can reduce friction during sexual activity. Choosing fragrance-free, water-based options may help minimize irritation.

2. Pelvic Floor Therapy

   Working with a pelvic floor physiotherapist can help address muscle tension, improve blood flow, and restore pelvic function.

3. Local Hormone Therapy

   Some healthcare providers may recommend local (vaginal) estrogen therapy to help improve tissue health and reduce dryness. This option is not suitable for everyone and should be discussed in detail with your provider, including possible benefits and risks.

4. Non-Hormonal Prescription Options

   For individuals who cannot or prefer not to use hormones, certain non-hormonal prescription therapies may be considered. Your provider can help determine what may be appropriate.

5. Lifestyle and Self-Care

   Staying sexually active, engaging in regular physical activity, and practicing stress management can help maintain blood flow and overall sexual wellness.

When to See a Healthcare Provider

If you’re experiencing pain during sex — whether it started recently or has been ongoing — book an appointment with a healthcare professional. They can:

• Assess the underlying cause
• Review your medical history and current medications
• Discuss both hormonal and non-hormonal options
• Provide referrals to specialists, such as pelvic floor physiotherapists

The Bottom Line

Painful sex after menopause is common, but it’s not something you have to accept as “normal.” A combination of self-care strategies, over-the-counter products, and medical treatments may help restore comfort and intimacy.

Always consult with a qualified healthcare provider before starting any new treatment. They can guide you toward safe, evidence-based solutions tailored to your needs.