After menopause, sex may be less comfortable. There are several reasons why. The most common is vaginal dryness. But the skin in and around your vagina (your vulva) may itch or burn. Some medical conditions can affect your blood flow. And midlife stress and anxiety can also play a role.

The best way to feel better is to find the source of your pain. If you don’t know why sex hurts, bring it up with your doctor.

Some treatments will ease your symptoms right away. Others take longer to work. Talk to your doctor about what to expect.

Add Some Wetness

Lubrication is a fast and easy way to get your wetness back. It relieves vaginal dryness that can lead to friction during intercourse. There are a lot of lubes on the market. You may need to try a few to find one that works for you.

You’ll need to put it in your vagina and on your partner’s penis, fingers, or a toy each time you have sex.

You doctor may suggest a vaginal lubricant that is:

  • Water-based: These work well if you need to lessen a lot of friction. But you may have to reapply during sex. 
  • Silicone-based: These last longer than lubes made from water. But they’re also more expensive. Since silicone can stain your sheets, you may want to put a towel down. Don’t use this kind of lube with silicone toys. It’ll damage the material.

The chemicals in some lubes can cause burning or irritation. Find one with as few ingredients as possible. You may want to stay away from:

  • Glycerin 
  • Parabens
  • Propylene glycol
  • Chlorhexidine
  • Perfumes or flavors
  • Ingredients that cause cooling or warming

Don’t use petroleum jelly as a vaginal lubricant. It can raise your chances of infection. You should also stay away from mineral, olive, and baby oils. They can irritate your skin or cause an allergic reaction. And any oil-based option will degrade condoms. That’ll make them less effective against sexually transmitted diseases.

Use a Moisturizer

You usually use a hormone-free moisturizer every 2 or 3 days for all-day moisture. They may also help improve the tissue in and around your vagina. You can buy them over the counter.

Some women like to use natural products like vitamin E and coconut oil. These are generally safe for your skin. But there aren’t studies to show how they’ll affect the inside or outside of your vagina. And oils can stick around for a while. That gives bacteria a place to grow. For some people, this can make infections more likely. 

Keep in mind that moisturizers can leak out. You may want to use them at night or wear protective underwear. Panty liners or pads may make your vulva drier.

Ask Your Doctor About Medicine

Lubricants and moisturizers may not ease all of your dryness and pain. If you've been using them for a few weeks and still have symptoms, bring it up with your doctor. There are prescription medications that may help, including:

  • Vaginal estrogen
  • Vaginal DHEA, another hormone
  • Estrogen-like drugs
  • Hormone replacement therapy (HRT)

All drugs can have side effects. Talk to your doctor about what’s safe for you.

Try Pelvic Floor Therapy

The muscles that support your bladder and vagina can get weak or tight. Both can make sex uncomfortable.

There are exercises that can help you retrain your pelvic floor. They're called Kegel exercises. But you need to know the right ones to do since they can make tight muscles even tenser. Ask your doctor for a referral to a pelvic floor physical therapist for the right diagnosis and treatment.

If your vagina is narrow, your therapist may also suggest dilator therapy to slowly stretch the muscles around your vagina. The dilators are tube-shaped devices that come in different sizes.

Try Yoga and Meditation

Yoga and meditation may help your libido and your orgasms. That’s partly because they tend to lower stress, anxiety, and depression. But mindful activities can also help you become more aware of the subtle changes in your body.

Use Massage and Vibration Therapy

Regular stimulation can pump up blood flow and lubrication to the inside and outside of your vagina. You may want to use a vibrator with a lubricant several times a week. Don’t forget to use a lubricant every time you use one.

Pick one that’s long enough to reach the top of your vagina and has a smooth surface.

Have More Sex

Once you can have comfortable sex, you should try to have more of it. That’s because it helps with blood flow and moisture to your vagina. Don’t be afraid to change up positions. You may find that sex feels better when you’re on top. That way you can decide what depth and speed feels good for you.

Spend Time on Foreplay

After menopause, it can take a little longer for you to get turned on. But that’s normal.

Foreplay can be a fun way to trigger your “responsive” desire. That’s when you don’t want sex “out of the blue,” but you enjoy intimacy once you get started. You may want to take more time to kiss or touch before you jump into sex.

Try Other Sexual Play

Intercourse isn’t the only way to share intimacy. If penetration hurts too much, add more oral sex. You can also masturbate or experiment with vibrators.

See a Therapist

It’s normal to lose interest in sex if you’re stressed out or have a problem with your relationship. Depression or anxiety about aging can also leave your sex drive lagging. A counselor or sex therapist can help you find ways to manage your mental health. They can also help you connect with your partner.

To find a certified sexual specialist, check with the American Association of Sexuality Educators, Counselors and Therapists (www.aasect.org). 

Make Healthy Lifestyle Changes

Try to get in at least 30 minutes of exercise a day. Physical activity can get your blood flowing. It may help you lose weight, if you need to, and boost your self-esteem. Make sure to get treatment for any other medical conditions. Uncontrolled diabetes, high blood pressure, and heart disease can impact your sexual function. And if you smoke, quit. It can damage your blood vessels.

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