The path to menopause is paved with a number of inconvenient symptoms, including hot flashes, mood swings, insomnia, and more. And after you’ve officially made the transition into menopause, not all of those symptoms fully subside. One example? Painful sex. But, plenty of strategies exist to help ease discomfort and support a healthy sex life.
What’s the Link Between Painful Sex and Menopause?
During
menopause, your body loses estrogen, a hormone that helps keep the vaginal tissues healthy, says
Mary Jane Minkin, MD, a clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale University School of Medicine, in New Haven, Connecticut. When your
estrogen levels decline, you can also experience
vaginal dryness, which can lead to
painful sex.
Vaginal dryness and soreness or burning during penetration “often occur further out from menopause,” says Dr. Minkin. “Whereas a woman may experience hot flashes that get better, vaginal dryness tends to get worse over the years.”
Left untreated, the problem can become so severe that some women give up intercourse entirely because it’s too dry and uncomfortable to be pleasurable. Compounding the confusion, says Minkin, is that “since it occurs later, many women don’t associate this with menopause at all. They think dryness is inevitable with aging.”
5 Tips for Easing Painful Sex After Menopause
The good news is that there are many things you can do to improve vaginal lubrication, reduce pain, and make sex feel good again. Here are five options to try:
1. Get a Vaginal Moisturizer
Polycarbophil gel, which is available over the counter, is a good first remedy, says Minkin. The product works mainly by adding water to the tissues, she says, and because it’s applied two or three times per week, you don’t have to remember to use it every time you’re intimate. The gel can be applied with an applicator into the vagina. Research supports the idea that polycarbophil gel can reduce symptoms of
vaginal atrophy in postmenopausal women, including pain during sex.
You can also apply some vaginal moisturizers externally. The labia can become dry too, explains Minkin, which can make intercourse uncomfortable.
2. Try a Lubricant During Sex
Intimacy can be even better if you combine polycarbophil gel with a lubricant during sex, says Minkin. There are plenty of lubricants available on the market, and finding the right one can take some trial and error.
“I tell patients not to go out and buy the giant, economy size bottle until you know it will agree with you,” says Minkin. Many contain fragrances, which can irritate sensitive vaginal and vulval tissues. Also, if you’re using condoms to protect against sexually transmitted infections, be aware that an oil-based lubricant can degrade the latex; in that case, choose a water-based or silicone lubricant.
3. Get Into Foreplay
A quickie might not work for you anymore — but that doesn’t mean sex is off the table. Rather, dedicate more attention to your warm-up routine. “The more foreplay, the better, whether you’re pre- or postmenopausal,” says Minkin. “It gets the [vaginal] tissue revved up.”
Similarly, it may also help revamp your definition of sex. If intercourse is painful because of dryness, you might find that oral sex (which, yes, is still sex) is more pleasurable and allows you to be intimate with your partner.
4. Try a Toy
One word: vibrator. “I’m a big fan of recommending vibrators to my patients,” says Minkin. “Anything that will increase pelvic blood flow will increase moisture to the vagina.”
There are many styles and functions of vibrators on the market, from base models with only a few different intensities to those with multiple speeds, patterns, and extra features. Check out our guide to the best sex toys to start your journey of identifying which works best for you.
5. Ask About Medication
For some women, all it takes to relieve dryness is a good vaginal moisturizer. Others might need a prescription. If that’s the case for you, talk to your doctor about vaginal estrogen, which Minkin specifies as “quite safe” for almost everyone to use.
Vaginal estrogens work by increasing moisture to the tissue via vaginal suppositories, rings, or creams, based on personal preference, she says.
A vaginal suppository with the hormone DHEA, which is converted into estrogen and testosterone, may be another Rx option for you, she says. One study found that women using DHEA suppositories reported an improvement in vaginal dryness and pain during sex, compared with those who used a placebo. However, newer and broader research is needed to confirm the effectiveness of DHEA for treating dryness and pain.
Finally, ospemifene tablets are a once-daily nonhormonal prescription medication that treats both vaginal dryness and
painful intercourse due to menopause by increasing certain cells (and decreasing others) in the vaginal tissue.
Other Causes of Painful Sex During Menopause
Keep in mind that pain during sex can have other causes beyond vaginal dryness, such as a vaginal infection. It can also be a symptom of ovarian cancer (as can bloating, pelvic or abdominal pain, and feeling the urge to urinate more often) or vulvodynia, a chronic pain condition.
The bottom line: Be up front with your doctor about your discomfort. A good sex life is one part of being in good health.
Rachel Green
Rachel Davis
Derek Schulz
Sophia Martinez
Dr. Amara Okafor