If pain is disrupting your sex life during menopause, it’s not something to ignore. Painful sex can come from many causes: some more serious than others, and all worth your attention.

Let’s discuss menopause, pain after intercourse, and the treatments that can help.

How menopause can make sex painful

Painful sexual intercourse is a common complaint among peri- and postmenopausal women. You might experience pain just before, during, or after sex.

You might experience (Streicher, 2023) (Streicher, 2023):

Superficial pain: affecting the vaginal opening, vulva, or labia (the “lips” around the vaginal opening)
Deep pain: affecting the vaginal canal, pelvic floor muscles, or lower abdomen

Pinpointing exactly how many postmenopausal women deal with sexual pain is difficult: estimates fall anywhere between 13 and 84% (Streicher, 2023) (Streicher, 2023).

While this is a broad range, it’s safe to say: if you’re dealing with painful sex, you’re not alone.

Sex of any kind can cause pain

If you’ve spent any time Googling causes of painful intercourse, you’ve probably run across the term dyspareunia. Dyspareunia is the medical term for painful sex, but we must say: the definition is quite narrow.

Dyspareunia specifically refers to pain during vaginal penetration. While this is certainly one form of sexual activity, plenty of other forms exist. And these forms, including digital, anal, and oral sex, can all cause pain.

What causes pain during sex?

The genitourinary syndrome of menopause (GSM) causes several uncomfortable symptoms, and painful sex is a major one. However, this doesn’t automatically mean GSM is responsible for your symptoms: many other factors can be at play.

When it comes to resolving your pain, it’s essential to 1) understand potential causes, and 2) talk with your healthcare provider about your ongoing pain symptoms.

With that in mind, let’s take a closer look at GSM and other possible contributors.

Some causes of sexual pain include:

Genitourinary syndrome of menopause: Low estrogen levels can cause some unpleasant symptoms, including vaginal dryness, itching, urinary issues, and dyspareunia (Faubion, 2017) (Faubion, 2017). Together, these symptoms make up GSM, formerly known as vulvovaginal atrophy.
Lichen sclerosus (LS): This chronic inflammatory skin condition typically affects the vulva and surrounding areas and requires lifelong treatment. While LS is relatively rare, it most commonly occurs in postmenopausal women (Steben, 2022) (Steben, 2022).
Pelvic floor dysfunction: Your pelvic floor muscles greatly impact your sexual functioning, and when they aren’t working properly, they can make sex painful. Pelvic floor dysfunction is an umbrella term for a variety of problems with these muscles. Two common pelvic floor problems that can cause discomfort with sex include:
- Pelvic organ prolapse: internal organs, such as the bladder, drop down and push against the walls of your vagina.
- Pelvic hypertonicity: when your pelvic floor muscles are too tight and can’t relax fully (Streicher, 2023) (Streicher, 2023).
Sexually transmitted infections (STIs): Taking care of your sexual health is a lifelong endeavor. If you’re not using condoms during sex, you’re susceptible to infections that can cause pain. These include genital herpes, syphilis, chlamydia, and trichomoniasis (Streicher, 2023) (Streicher, 2023).
Vestibulodynia: This is the term for pain at the opening of the vaginal canal. It may occur as a result of GMS (Streicher, 2023) (Streicher, 2023).
Vulvar cancer: Occurring almost exclusively in postmenopausal people, vulvar cancer can cause pain during sex and vulvar irritation (Streicher, 2023) (Streicher, 2023). But remember: this is a relatively rare condition, and there are plenty of other causes of painful sex.
Hysterectomy: This procedure can cause surgical menopause and related GSM symptoms. In addition, pain can also result from post-surgery structural changes, such as a shorter vaginal canal (Streicher, 2023) (Streicher, 2023).
Cancer treatment: Chemotherapy, radiation, and surgery can wreak havoc on your pelvic health. Depending on the types and locations of these treatments, they can cause a decline in estrogen, scar tissue inside the pelvis, or shortening of the vagina, any of which may make sex painful (Streicher, 2023) (Streicher, 2023).

How to treat painful sex during menopause

If having sex hurts, it’s not something to ignore or brush off as “normal." GSM symptoms rarely improve without treatment, and many treatment options are available (Christmas, 2024) (Christmas, 2024).

Talking with your healthcare professional can help you determine the best option for your specific needs.

Vaginal moisturizers and lubricants

The North American Menopause Society recommends vaginal moisturizers and lubricants as a first-line therapy for GSM symptoms(Burton, 2022) (Burton, 2022). If your symptoms are mild, using moisturizers and lubricants may be enough to resolve them.

Moisturizers are hormone-free and available over the counter. This makes them easy to access, and they’re a great option if you’re unable to use hormonal treatments.

Regardless of your level of sexual activity, experts recommend that you use vaginal moisturizers at least 2-3 times per week to help hydrate the vaginal tissue (Christmas, 2024) (Christmas, 2024). Applying lubricants before intercourse can help make sex more comfortable by reducing skin-to-skin friction.

Different moisturizer formulas exist, each with its own benefits. Options include (Christmas, 2024) (Christmas, 2024):

Hyaluronic acid-based: Shown to rehydrate vaginal tissue. Hyaluronic acid (aka HLA) may even stimulate the production of collagen, a compound critical for a healthy, supple vagina (Buzzaccarini, 2021) (Buzzaccarini, 2021).
Polyacrylic acid- and polycarbophil-based: Offer a protective coating for the vaginal tissue.
Vitamin E and vitamin D: Can be combined with other non-hormonal moisturizers.

Lubricant options include (Christmas, 2024) (Christmas, 2024):

Water-based: Safe for use with latex condoms and silicone toys, but can dry out quickly
Silicone-based: Safe for use with latex condoms, but not silicone toys
Coconut and other oils: many are natural, but none are safe for use with most condoms

Pelvic floor physical therapy

If you suddenly experience pain with sex, this can cause your pelvic floor muscles to seize up in a “protective response." This, in turn, leads to more pain and discomfort. Without treatment, these muscles may remain contracted, and pain doesn’t fully disappear (Streicher, 2023) (Streicher, 2023).

A pelvic floor physical therapist works to identify the source of your pain and where you're holding tension. From there, they can perform exercises to loosen muscles and improve sexual functioning (van Reijn-Baggen, 2022) (van Reijn-Baggen, 2022).

Pelvic floor therapy has shown benefits for women with dyspareunia. One review of 10 studies on pelvic PT found that it (van Reijn-Baggen, 2022) (van Reijn-Baggen, 2022):

Improved muscle function
Reduced pain during sex
Improved sexual function
Reduced vulvar pain

Hormone therapies

Several menopause hormone therapies can help alleviate the GSM symptoms of menopause, including painful sex. These options include (Streicher, 2023) (Streicher, 2023):

Vaginal estrogen: This option can help relieve GSM symptoms and is administered locally, which means its effects on your system are minimal. Vaginal estrogen is available as a cream, ring, tablet, or insert.
Ospemifene: This medication is FDA-approved to treat both moderate to severe dyspareunia and vaginal dryness. You take Ospemifene as an oral pill, which means it has a greater effect on your system than vaginal estrogen.
Dehydroepiandrosterone (DHEA): Also called prasterone, DHEA is FDA-approved to treat dyspareunia from menopause. DHEA may also increase sex drive and make it easier to orgasm, and it’s available as a daily vaginal insert that gradually dissolves into the tissue.

Certain conditions that cause painful sex benefit from a combined approach to hormonal treatment. For example, some people develop pain right at the entrance into the vagina (the “vestibule”) in response to the hormonal changes of the menopause transition. Some clinicians prescribe a special gel with a mix of estrogen and testosterone to treat this condition, called hormonally-associated vestibulodynia.

Vibrators

Having sex regularly can help maintain your vaginal health if that sex is pain-free (Faubion, 2017) (Faubion, 2017). Here’s where using a vibrator therapeutically can help.

Vibrators can stimulate blood flow and keep your vaginal muscles healthy, with or without a partner (Faubion, 2017) (Faubion, 2017). Studies have also shown that regular vibrator use can improve pelvic floor functioning, mental health, and overall quality of life (Dubinskaya, 2024) (Dubinskaya, 2024).

You can also gently stretch the vaginal tissue with a vibrator or a vaginal dilator. Don’t be afraid to use plenty of lube to make the process more comfortable!

Lidocaine

Lidocaine is a topical anesthetic gel that your provider may prescribe for you. Applying lidocaine to your vaginal opening a few minutes before penetrative sex can reduce pain, and you can use it alongside moisturizers and lubricants (Faubion, 2017) (Faubion, 2017).

Cannabidiol (CBD)

While there are no studies about its impact on dyspareunia, CBD may help reduce pain and inflammation (Streicher, 2023) (Streicher, 2023). Locally administered CBD options are available, including a vaginal suppository, spray, and oil.

A survey of over 300 women who use cannabis for help with menopausal symptoms found that:

33% used cannabis specifically to relieve pain and vaginal dryness.
87% of those who used cannabis for painful sex and dryness found it helpful.

Another small study found that 27% of menopausal women were using cannabis to help with symptoms (Streicher, 2023) (Streicher, 2023). However, there isn’t any solid science to support using CBD for menopause relief, and you should always speak with your provider before starting a new treatment.

Suffering in silence no longer: Why tracking is important

If you’re dealing with painful sex and other symptoms like vaginal dryness or irritation, it’s not something to endure in silence. Treatment options can help. Finding the right one for you is easier when you track your symptoms.

Listening to your pain is often the first step. You might begin experiencing painful intercourse suddenly, or it might get worse over time. Maybe it feels like a sharp or deep pain, or maybe you feel itchy and dry.

Tracking exactly how you’re feeling—and how long the feeling lasts—helps you get the personalized care and individualized treatment you deserve.

Questions to ask your provider

I’ve been noticing some issues besides painful sex. I’ve felt some severe itching at night and after sex, and it’s been painful to urinate.
I’ve been tracking my symptoms of painful sex with my smartwatch for quite a while now. Can I get your opinion on them and discuss appropriate treatment options?
I’m interested in visiting a pelvic floor physical therapist to help with my symptoms. Is there one you trust and can refer me to?

DISCLAIMER

This article is intended for educational purposes only, using publicly available information. It is not medical advice, and it should not be used for the diagnosis, treatment, or prevention of disease. Please consult your licensed medical provider regarding health questions or concerns.

When Intimacy Hurts: Understanding Painful Sex in Menopause