Painful Sex After Menopause

By Ashley Henshaw. May 7th 2016

Whenever the topic of menopause comes up, the main complaints from women include aggravating symptoms like night sweats and hot flashes. However, some women shy away from the topic of sex after menopause because of the many issues it can bring up. Painful sex is one challenge that many post-menopausal women face. In this article, we’ll explore why painful sex occurs after menopause and how it can be treated.

Why It Happens

There are several factors that may cause sex to become painful or uncomfortable after a woman experiences menopause. The main reason for this issue is vulvovagina atrophy, also known as vaginal atrophy. After menopause, the vagina does not have the same level of moisture and natural lubrication that it had before menopause set in. This occurs because the decreased levels of estrogen that occur after menopause lead to a decrease in the blood supply to the vagina. The result is a vagina that has drier and thinner tissues. At the same time, vaginal tissues can also become less elastic and flexible after menopause. Vulvovaginal atrophy also makes the vagina less acidic, similar to how it was before puberty.

While vulvovaginal atrophy is the main factor contributing to painful sex after menopause, the change in the size of the vagina is another reason for this issue. When a woman doesn’t have vaginal intercourse or other vaginal sexual activity regularly after menopause, her vagina can become shorter and narrower. The lower third of the vagina can begin to shrink, making it more painful when she does have sex.

Atrophic vaginitis may also cause sex to become painful after menopause. This condition, which is characterized by redness and inflammation of the vagina, occurs as a result of the lower estrogen levels a women has after menopause.

The combination of these factors can lead to painful sex, sometimes even when a lubricant is used. The vaginal tissues may even become so fragile that they are prone to injury, tearing or bleeding when the vagina is penetrated.

Treatment Options

Painful sex is perhaps one of the most difficult post-menopausal issues that women face. In fact, The North American Menopause Society reports that between 17 percent and 45 percent of postmenopausal women find sex painful. Fortunately, there are several treatment options for this situation, including:

  • Menopausal hormone therapy (MHT): Women can take estrogen and progesterone in order to combat vaginal dryness and discomfort. However, there are some health risks associated with MHT, including an increased risk of breast cancer, blood clots and heart attack. For this reason, low-dose topical estrogen is often prescribed for painful sex after menopause (it’s safer than oral estrogen). However, this may not be a permanent solution since some doctors advise against using MHT for more than a short amount of time. For more information, see Menopause And Hormone Therapy: Risks VS Benefits.
  • Pelvic floor physical therapy: More research is needed to confirm this therapy’s effects, but massage and gentle pressure from a physical therapy may be able to relax and stretch tightened tissue in the pelvic area. Certain exercises can also be completed to strength pelvic floor muscles.
  • Surgery: A new procedure called laser augmentation of the vaginal area (LAVA) may be able to loosen and reshape the outer layer of the vagina. This makes vaginal penetration easier and less painful. Not all doctors agree with the procedure, which is only offered in certain states, and few women are good candidates. Surgery should be considered a “last resort” for serious cases.

In addition to these treatments, women can also try some lifestyle changes that may decrease vaginal dryness or discomfort. One of the ways women can ease these symptoms is to treat vulvar skin very gently. This means washing only with mild soaps or plain water (don’t use perfumed products, take bubble baths or use douches). Wearing cotton underwear and avoiding tight-fitting clothing can also relieve vaginal discomfort.

A counselor may be helpful for certain women who are experiencing issues like poor communication with their partner or anxiety, both of which may exacerbate the problem of painful sex. Finally, women should consider trying to have sex regularly before and after menopause occurs. Regular vaginal sexual activity helps keep vaginal tissues thick and moist. It also helps maintain the vagina’s length and width.

Remember that menopause-related vulvovaginal symptoms may not appear right after menopause occurs. In some cases, sex doesn’t become painful until several years of lower estrogen levels (or they don’t experience it at all). If you are experiencing painful sex after menopause, talk to your doctor. There are other possible causes of painful sex which may not be related to menopause and require different treatments. In any case, your doctor is the best resource for deciding how to best deal with this issue and get back to enjoying your sex life as you did before menopause.


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