Why Intercourse Can Be Painful After Menopause and What You Can Do

Menopause is a condition where menstruation has stopped for at least 12 consecutive months. Changes during and after menopause can result in painful intercourse, also known as dyspareunia, for many women. However, it can be managed and treatable with a better understanding of the issue and support from healthcare providers.

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The body undergoes many changes during and after menopause. The main cause of painful intercourse during menopause and postmenopause is the decline in estrogen levels.

Estrogen is a sex hormone found in both men and women, but women have a greater amount of it. One role of estrogen is to stimulate natural lubricant release and new cell growth in the vagina. Without adequate estrogen, lubricant and cell growth decrease, leading to a dry and less elastic vagina. The lining of the vagina also thins and shrinks.

The resulting dryness and thinning of vaginal tissues can cause penetration and intercourse to be uncomfortable. This discomfort can be a feeling of vaginal tightness or severe pain during sex. After sex, some women feel soreness or burning in their vulva or vagina.

While all of these changes and effects can lead to painful intercourse, it’s important to note that menopause isn’t the only possible cause of pain during sex. About three out of four women report experiencing painful intercourse at some point in their lives, and the causes vary.

Superficial and Entry Pain

Entry pain during intercourse occurs in the exterior and immediate interior of the vagina. Causes of this pain include:

  • Vaginal dryness
  • Vaginismus, the body’s automatic reaction to the fear of some or all types of vaginal penetration
  • Vaginal injury, trauma, irritation
  • Infection
  • Inflammation
  • Vaginal abnormality

Deep Pain Causes

Deep pain is when pain is felt inside the pelvis. Common causes of deep pain during intercourse include:

  • Pelvic inflammatory disease (PID)
  • Endometriosis, when the cells on the inside of the uterus grow outside of it
  • Fibroids, noncancerous growths in the uterus that can develop during a woman’s childbearing years
  • Irritable bowel syndrome (IBS)
  • Constipation
  • Pelvic floor dysfunction

Pain during intercourse may also be the result of emotional causes. These include stress, anxiety, depression, or history of abuse.


Pain during sex can lead to issues with self-image, mood, or relationships. The good news is there are treatments that can help women return to less or no pain during sex.

Treatment will start with a medical evaluation and history to determine the cause of the pain. Evaluation can include a pelvic exam and additional testing of the blood or urine.

Your doctor will determine the cause of pain and prescribe treatments accordingly. The most common ones for painful intercourse involve increasing estrogen levels and hormone therapies.

Low-Dose Estrogen

Estrogen therapy is a low-dose, short-term treatment that can be administered orally, topically, vaginally, or via injection. This treatment can come in a cream, tablet, or ring form.

Many women who experience painful intercourse due to menopause usually start with topical estrogen applied directly to the vagina to promote lubrication. It can thicken the vaginal tissues and help with elasticity as well.

Oral estrogen is another option, but to avoid full-body side effects, it’s usually not tried until other options have been explored.

Non-Hormonal Option

If you’re experiencing too many side effects or are at high risk for breast cancer, blood clots, stroke, or liver disease, your doctor may prescribe a non-hormonal treatment. The only Food and Drug Administration-approved non-hormonal option is ospemifene, which can treat vaginal dryness. The dose is one pill each day.


Preparing for the changes in your body and a decrease in estrogen levels can help you avoid painful sex. Similarly, it’s important to understand that just because pain happens once doesn’t mean it will continue. You can potentially prevent painful intercourse with the following strategies.

Talk About It

Talking about pain with intercourse may feel embarrassing or awkward, but it’s the first step in preventing or treating it. Talk to your partner and healthcare provider, and work together to solve this problem.

Use Vaginal Lubrication

One way to prevent dryness and allow for pain-free sex is by using lubrication. There are many options, but use of a water-based lubricant is recommended.

Non-hormonal vaginal moisturizers and lubricants can reduce friction and tearing. Use lubrication just before sex, and for added benefit use a vaginal moisturizer regularly.

Add Foreplay

Foreplay is a critical component of sex, and one that can increase natural lubrication of the vagina. Note that foreplay may cause pain as well, and using lubricant during this step can help ease the discomfort.

Try Masturbation

Women can prepare for intercourse and prevent pain with masturbation. Masturbation helps release tension and promote blood flow. It helps to prepare the vagina and women for penetration, and blood flow can lead to increased natural lubrication.

Change Positions

Changing position may help with arousal, which promotes natural lubrication. You can also change the direction and avoid painful areas. For example, women who experience deep pain can control the depth of penetration when on top.

If you’re having more sex, your vagina can get used to it and you’re more likely to find what works best for you.


Painful sex after menopause is temporary for some, chronic for others. Speak with your doctor to better understand the underlying cause of your pain, and try different strategies to help.

While there are quick tips for prevention, there are also great long-term things to help with pain during intercourse. These include sex therapy and pelvic floor therapy.

Again, a major part of diagnosing and getting treatment for your pain is starting with being open and honest with your partner and healthcare provider. Painful sex during and after menopause isn’t your fault and can be treated.

Frequently Asked Questions

What are the symptoms of postmenopause?

Menopause and postmenopause can cause many symptoms, and everyone will experience postmenopause differently. However, the most common symptoms are vaginal dryness, hot flashes, night sweats, and mood swings.

How long do the symptoms of postmenopause last?

Symptoms of postmenopause can last years, with each woman having a unique experience. On average, symptoms last one to two years.

How does regular sex help maintain the vagina postmenopause?

Having regular sex keeps the vagina flexible and promotes blood flow, helping to boost natural lubrication and avoid vaginal dryness and fragility.


Menopause causes many changes in a woman’s body, and one of them is vaginal dryness, which can contribute to painful intercourse. Dryness is a result of decreasing estrogen levels during this transition. You can reduce this discomfort by taking hormonal and non-hormonal therapies. Making certain changes in your sex life like using lubricants more regularly can also help.

A Word From Verywell

During and after menopause, women’s bodies change inside and out. While you may feel anxious or embarrassed by pain during intercourse, it’s helpful to know it is common and treatable.

By knowing the common symptoms of menopause and the remedies that can help, you can manage this discomfort and even implement prevention measures sooner. Talking to your healthcare provider is a great way to create a treatment plan that meets your specific needs.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. The North American Menopause Society. Pain with penetration.

  2. The American College of Obstetricians and Gynecologists. When sex is painful.

  3. Archer DF, Simon JA, Portman DJ, Goldstein SR, Goldstein I. Ospemifene for the treatment of menopausal vaginal dryness, a symptom of the genitourinary syndrome of menopause. Expert Rev Endocrinol Metab. 2019;14(5):301-314. doi:10.1080/17446651.2019.1657008

  4. Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry. 2015;57(Suppl 2):S222-S232. doi:10.4103/0019-5545.161483

By Kimberly Charleson
Kimberly is a health and wellness content writer crafting well-researched content that answers your health questions.