Painful Sex After Menopause

By Temma Ehrenfeld @temmaehrenfeld
October 15, 2018

Painful sex after menopause is common among women who find that their vaginas become dryer. But painful sex crops up at all ages and under many circumstances.

Pain during intercourse isn’t rare. In fact, large numbers of women experience it during their lifetime, often keeping the problem to themselves. In a study of nearly 7,000 sexually active women in Great Britain, 7.5 percent reported a problem within the last year, and for 2 percent, it had persisted over six months or more.

The cause may be mysterious, or traceable to menopause, childbirth, or a hysterectomy.


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Painful sex after menopause

About half of all post-menopausal women find that their vaginas become dryer as their estrogen levels plunge. Dryness can cause painful sex in up to nearly 80 percent of this group. You’ll need more lube and foreplay than you did in your twenties. Anti-depressants, anti-histamines, and sedatives can make it harder to become lubricated, so you might rethink whether your medication is necessary. Try the over-the-counter product Replens. If the problem persists, get examined and discuss estrogen medication with your doctor.

Taking estrogen directly through your vagina isn’t thought to be a cancer risk, as very little enters your bloodstream.

You can use an estrogen cream, dispense tablets inside your vagina, or wear a ring that dispenses the hormone over three months. There are also pills and patches for hormone replacement therapy that will help with other symptoms.

Non-estrogen options for dryness include a tablet you swallow (Osphena, or ospemifene) and a pill you inject into the vagina (Intrarosa, or prasterone), which arrived in U.S. pharmacies in the summer of 2017.

Gynecologists say the choice among all these options is really yours.

However, even in older women, the problem may not solely be dryness. Skin problems, for example, can make the vagina sore. Fibroids, ovarian cysts, and pelvic inflammatory disease may be a factor.

Painful sex after baby

Nearly all women have pain the first time they have sexual intercourse after childbirth — and almost a quarter still find sex painful after 18 months, a 2015 study concluded.

C-section or vacuum extraction births were about twice as likely to lead to the problem at 18 months postpartum compared to a spontaneous vaginal deliveries.

Painful sex after hysterectomy

Surgery to remove parts or all of your uterus will put your sex life on pause for at least six weeks, but most women say that eventually their sex lives got back to normal or improved. If your ovaries are gone and you’ve entered menopause, your vagina may be dry.

If the pain occurs deep within the vagina rather than on entry, the cause may be scars from the surgery or the lingering effects of endometriosis.

Your attitude counts

Any pain condition can feed on itself by triggering emotions — so look for help managing fear that the pain will never go away or shame or anger.

In studies of a small group of pre-menopausal women who experienced intercourse as painful, cognitive behavioral therapy produced measurable improvement. Physical therapy focused on strengthening the pelvic floor can help, too.

Painful sex doesn’t mean you are with the wrong partner. In the British study, for example, women reporting pain were just as happy with their relationship overall as women who didn’t have pain. So talk to your partner and see how you can address the problem together. You may find that simply adapting how you have sex makes a difference. Do you give yourself time to be aroused or rush things to please your partner? Do you know the best positions for the two of you? Have you tried other kinds of sex besides vaginal intercourse? Be honest and open about what hurts and what feels good, better, and best.


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February 27, 2020

Reviewed By:  

Janet O’Dell, RN