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Menopause: When Sex Hurts

You know the old saying "love hurts"? Sex can hurt, too. After menopause, up to half of all women have pain before, during, or after sex. With care, though, your sex life can move from ouch back to mmmm.

Why It Happens

At menopause, you're most likely to have pain from:

  • Hormone changes. Dwindling estrogen due to menopause is the No. 1 reason for sex pain at midlife and beyond. Hormone shifts make the tissues in the vagina become thin and dry. Dryness can add friction during sex. The vagina also stretches less, making you feel tight.
  • Fear and worry about pain. Once painful sex happens, you may dread its return. Fear can make your muscles tight and add dryness.
  • A health problem. Otherissues not due to menopause may be at fault, like chronic pain syndrome in the vulva, the area around the entrance to your vagina. Or you may have a urinary tract or yeast infection, or a skin problem. Being stressed or depressed, problems with your partner, or past sexual abuse can also trigger painful sex.


What You Can Do to Relieve Pain

Try these tips to boost your sexual pleasure:

  • Go for more glide. Use a lubricant before and after sex to ease pain due to dryness. For good glide that's not sticky, look for a water-based lubricant, sold over the counter. If one brand bothers your skin, try others.
  • Moisturize. A vaginal moisturizer can ease dryness over the long term. Use it routinely, not just before sex.
  • Make time for foreplay. Spending more time getting aroused makes you wetter. Don't focus just on The Big Act. Take time to caress, have oral sex, or try varied positions. Talk to your partner about what feels good and what doesn't.
  • Wash with care. Avoid using soaps, shower gels, bubble bath, and bath oils in the vaginal area. These can dry skin. A warm water rinse will do the job. Also skip sprays and perfumes. When you're having problems, wash your underwear in mild soap. Make your undies white cotton, too.
  • Have more sex. "Use it or lose it" is true when it comes to the health of your sex organs. Being aroused improves blood flow. So when you have sex often, you're less dry. Self-pleasure can help if other sex acts hurt.

How Your Doctor Can Help

Don't be shy about getting help. And don't think sexual pain is just part of menopause. Sex should never hurt. Get an exam to help pinpoint the cause. This will help steer you to the right treatment.

If the pain is due to menopause:

  • Your doctor may prescribe low-dose estrogen to ease vaginal dryness. Three types -- a cream, tablet, and ring -- go right into your vagina.
  • Estrogen-like pills may also be an option. In 2013, a pill was approved that acts like estrogen to treat painful sex and help improve some vaginal tissue changes that occur at menopause.

If the pain is due to something else:

  • A skin rash or urinary tract infection can be treated with drugs or ointments.
  • Your doctor may prescribe lidocaine, a numbing ointment, to use before or after sex.
  • Pelvic floor therapy may help. This includes techniques such as massage to relax and stretch tissue, and exercises to ease tightness and strengthen pelvic muscles. 
  • Outpatient surgery to remove some tissue may help if other options don't.

Your doctor can also refer you to a counselor or sex therapist if emotional issues are causing pain, or if pain is putting stress on you and your partner.

WebMD Medical Reference

Reviewed by Brunilda Nazario, MD on May 05, 2014

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