Painful Sex During Menopause: What to Know

Medically Reviewed by Traci C. Johnson, MD on January 23, 2022
3 min read

As you go through menopause, you may notice that sex doesn’t feel as good as it used to. Anywhere from 17% to 45% of postmenopausal women say they have painful intercourse, or dyspareunia. Commonly, the cause is vaginal thinning and dryness. But other medical and mental issues can affect how sex feels.

You don’t have to quit having sex or live with the pain. But if you ignore your symptoms, they could get worse the longer you’re past menopause. Talk to your doctor if you’re not sure what’s going on with your vagina. They can help you find and treat the source of your discomfort.

Less estrogen. Everyone’s hormone levels are different. But estrogen levels drop in all women who go through menopause. This lowers blood flow to your vagina. You may get vaginal atrophy. That’s when the tissue gets dry, thin, and fragile. When you have intercourse, you may have pain at the opening of your vagina.

The inside of your vagina may:

  • Feel like “sandpaper”
  • Tear and bleed during sex
  • Itch
  • Burn 
  • Feel dry all the time
  • Get shorter and narrower

Your vagina also gets more acidic. That makes painful vaginal and urinary tract infections (UTIs) more likely. The skin outside of your vagina (your vulva) may get irritated, too.

Pelvic floor dysfunction. The muscles that surround your bladder and vagina can spasm. They can also get loose or tight.

  • Tension: Uncomfortable sex can cause your pelvic floor muscles to contract. It’s your body’s way of protecting you from penetration. It’s not something you do on purpose. You’ll feel a deep pain when you have sex. It may seem like your partner is hitting something or that your vagina has gotten smaller. You may ache after sex.
  • Weakness: Your pelvic floor might become less stable after menopause. Your bladder or uterus can push on your vagina.

Not enough sex. It’s normal to avoid things that hurt. But comfortable sexual activity, whether alone or with your partner, can be good for your vaginal health. It increases blood flow, which helps with lubrication and strengthens vaginal tissue. That’s why it’s important to treat the source of your pain.

Other health problems. Medical issues like untreated diabetes, heart disease, and high blood pressure can all lower blood flow and affect sexual function. 

Less arousal. The tissue in and around your vagina fills with blood when you’re turned on. That triggers lubrication. But with less estrogen, you may not get aroused as fully or as quickly as you used to. You may think about sex but have less sensation and wetness. That may lead to less “out of the blue” desire in the future.

And it’s easy to see how things like hot flashes, mood swings, and sleep problems can lower your interest in sex.

Other things that may dampen your desire include:

  • Not enough foreplay
  • Relationship problems
  • Depression
  • Stress
  • Worries about aging
  • Low self-image
  • Weight gain
  • Lack of exercise
  • Medication, like antidepressants

Scar tissue. Some women say they feel pain around hard skin that formed during surgery or childbirth. These scars may hurt a little more after menopause because the tissue around your vaginal opening is thinner.

You can have non-menopausal reasons for painful sex, including:

Vaginismus. Fear of painful sex may cause you to involuntarily tighten your vaginal muscles. This can make intercourse impossible. You may also feel pain when you have a pelvic exam or use a tampon. 

Vulvodynia. The outside of your vagina may sting or burn when it’s touched or during sex. This condition can affect women of any age.

Skin conditions. Eczema, psoriasis, lichen sclerosis, or genital sores can bother the vaginal skin.

If lubricants and vaginal moisturizers don’t give you enough relief, make an appointment with your gynecologist or OB/GYN.