Menopause: When Sex Hurts

Medically Reviewed by Traci C. Johnson, MD on June 12, 2022
3 min read

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 love life can move from ouch back to mmmm.

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 your vagina become thin and dry. Dryness can add friction during sex. Your vagina also stretches less, which makes it 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. Other issues 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 make sex painful.

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. Silicone and water-based products are both 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.

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. They act like estrogen in your body to treat painful sex and help improve some vaginal tissue changes that come with menopause.

If the pain is due to something else:

  • Your doctor can treat a skin rash or urinary tract infection with drugs or ointments.
  • They may prescribe lidocaine, a numbing ointment, to use before or after sex.
  • Pelvic floor therapy may help. This includes techniques like massage to relax and stretch tissue, and exercises to ease tightness and strengthen your pelvic muscles.
  • You might have outpatient surgery to remove some tissue if other options don't help.
  • Your doctor can also refer you to a counselor or sex therapist if emotional issues are causing pain, or if the hurt is putting stress on you and your partner.