What is Menopause? 

Menopause is defined as the last menstrual period. When it’s been 12 months since your last period, that’s when you’re said to have reached menopause. Fom then on, you’re considered “post-menopausal.” Usually people reach menopause in their late 40s or early 50s — the average age of menopause is 51 — but it can happen at a younger age, too. Menopause is a major physical change in a person’s life. It primarily affects your hormones, genitals, and reproductive system, so, unsurprisingly, it can have a big affect on your sex life.

Painful sex after menopause: why it happens and what to do

Sex should be pleasurable, not painful, but unfortunately pain during sex is all too common. While pain can affect your sex life at any age, there are some specific factors that can make vaginal penetration or vulva stimulation painful after menopause. 

Pain can put you off having sex, make you avoid intimacy, or might make you forgo specific sexual activities that you enjoy. The fear of pain can also cause anxiety, making the lead-up to sexual activity stressful. 

The good news is that often the pain can be treated. Read on to find out more about common causes of pain during sex post-menopause and ways to treat and manage these issues.

Why is intercourse often painful after menopause?

The hormonal changes at menopause affect the body in a number of ways: your bone density, your hair growth, your sleep, and so on. Since hormones play a big part in sexual function, this is one of the areas that is most affected by the hormonal changes of menopause. Some people might experience no change or minimal change, whereas others might find their genitals and sexual response are significantly affected. It just depends on your personal hormone levels and the particulars of your body.‍

These are some common reasons for painful sex after menopause and some suggestions for treatment:‍

Vaginal dryness

Often the vagina produces less natural lubrication after menopause. You might feel excited, turned on by your partner, or eager to enjoy your new vibrator, but your vagina may not respond like it used to. Lubrication is important to reduce friction, and without it, sex is likely to be painful. 

Treatments

Definitely start by buying a good quality lubricant. Consider which type of lube is best for you, and maybe try a few different lubes to help you test the different varieties before you decide which will be your go-to lube to keep in the top drawer. You can also try Pulse lubricant, which is designed specifically for use around and after menopause. Apply as much as you want and as often as you need.

Thinning of the vaginal walls

After menopause the walls of the vagina are often thinner and more fragile due to reduced estrogen levels. This thinning can change the sensation, making penetration less comfortable, it also means that the tissues are more vulnerable to painful tears and abrasions.

Treatments

Using a good lubricant is really important, but for some people it’s not enough on its own. While lubricant reduces friction, it doesn’t change the fragility of the vaginal tissues, which is caused by lower estrogen. Hormonal creams and medications can be used to make the vaginal lining thicker and more elastic again. There are, however, a number of potential side effects from hormonal treatments, so it’s important to discuss thoroughly with your doctor before deciding what’s right for you.

Skin irritations or vulvodynia (vulva pain)

Pain during sex is not limited to penetration. Pain, or discomfort, may also be felt on the external tissues of the vulva, such as the labia, clitoris, or around the vaginal entrance, and can affect people at any age — including after menopause. There are a number of possible causes of vulva/vagina pain such as a sensitivity to various products or underwear fabrics, a skin condition, or more complex causes of chronic vulvodynia such as nerve problems.

Treatments

Initially, you may want to try changing bath products, lubricants, condom brands, or try switching to cotton underwear to see if you get some relief. If that doesn’t help, it’s time to see a medical professional to get your condition diagnosed. There are a number of vulvodynia treatments, such as exercises, medications, and surgery.

Resuming sex when it’s been a while

At any age, it can take time to get back into the swing of things when you start having sex after a long-ish period without it. But after menopause, it can be especially difficult to restart your sexual response after a break. Over time, the vagina can get shorter and narrower. Especially if you haven’t been sexually active for a while, or if you haven’t included vaginal penetration in your sex life for a while. Sexual arousal and activity brings blood flow to the genitals, and without doing it regularly the vagina can get out of practice, especially after menopause when hormonal changes affect the genital tissues.

Treatments

After menopause there’s some truth to the sayin, “use it or lose it.” Maintaining regular sexual activity helps with blood flow to the genitals and keeps your body in practice for getting aroused and having sex. If you don’t have a partner, or don’t want to have partnered sex, but do want to maintain your sexual function, then masturbation and/or using sex toys is also effective. 

If you haven’t had sex for a while and your body is out of practice, but you now want to resume sex, then go slow, use a quality lubricant, take your time receiving oral sex or penetration with a finger or small toy before moving to something bigger. If you find you’re still having trouble after a few attempts, then it’s a good idea to see a health care provider to give you more tailored advice.

It could be an infection or STI

Vagina/vulva infections can occur at any age and may be contracted through sex (like gonorrhea or herpes) or might just happen for no obvious reason (like a yeast infection or bacterial vaginosis). Symptoms for sexually transmissible infections (STIs) can include pain, itching or burning sensations, there might be a visible rash or discharge. If you’ve started a new relationship, or had sex with someone new in the last few months, then it’s a good idea to get a test for STIs.

Treatment

You can get an STI test from your family doctor or at a sexual health clinic. If an infection is diagnosed you may be given a script for medication. It’s important you take the medicine as directed to clear up the infection completely. You should also let your recent partner(s) know and abstain from sex until your back to health. 

The bottom line

Many older adults continue to be sexually active and deserve their sex lives to be as pleasurable, pain-free, and exciting as they were in earlier years. While it may take more planning, time, and adaptability than before, sex after menopause can be just as enjoyable and satisfying.