8 Ways to Treat Painful Sex During Menopause

Highlights from this article

• Painful sex (dyspareunia) is a common symptom of menopause.
• Decreasing levels of estrogen during menopause make vaginal tissues drier, thinner, and less elastic, which can make sex painful.
• Lower levels of estrogen can also weaken your pelvic floor muscles and can potentially lead to pelvic organ prolapse, which also causes discomfort during sex.
• Although it’s common, you don’t have to tolerate painful sex during menopause. There are many ways to alleviate any discomfort you’re having.  
• Treatments for painful sex caused by menopause include vaginal moisturizers, lube, hormonal treatments, pelvic floor exercises, and trying new things in bed.

Painful sex can be one of the many symptoms of menopause, but luckily there are many ways to make sex enjoyable again!

Pain before, during, or after intercourse is called dyspareunia. Although dyspareunia can happen at any age, it’s an especially common problem during and after menopause.

If sex is giving you more pain than pleasure, keep reading for eight ways to treat painful sex during menopause.

Why does menopause trigger painful sex?

One word: estrogen. Specifically, the lack thereof. The hormone estrogen keeps the tissues in and around your vagina and vulva thick, lubricated, and healthy.

As estrogen levels decline in the lead-up to menopause, the vagina and vulva become thinner and drier. As well as being drier, the vaginal tissue can become less elastic, making any sort of penetration super uncomfortable — this is known as vaginal atrophy or atrophic vaginitis. This is the main driver of dyspareunia in menopausal women or people assigned female at birth (AFAB).

The natural decrease in estrogen can also lead to pelvic organ prolapse. This is when your pelvic floor becomes weaker and can’t properly support your pelvic organs anymore, leading them to bulge into the vagina. As you probably guessed, pelvic organ prolapse can also cause pain during intercourse.

How to treat painful sex during menopause

Menopause is a natural (and an unavoidable) part of life for women and AFAB people, but that doesn’t mean your sex life has to suffer. Below are eight treatments for dyspareunia brought on by menopause.

Hormone replacement therapy

Hormone replacement therapy (HRT) is a common treatment for managing menopause symptoms. Since dyspareunia in menopause is often caused by a decrease in estrogen, HRT simply replenishes your body’s supply.

HRT are prescription medications containing man-made versions of estrogen and progesterone, the two main female reproductive hormones. You can be prescribed HRT in the form of a pill, gel, or patch depending on your lifestyle and severity of symptoms.

Since HRT releases estrogen throughout the whole body, not everyone can take it. HRT isn’t recommended for anyone with a history of:

• Stroke
• Breast, ovarian, or uterine cancer
• Heart disease
• Blood clots

Vaginal estrogen

Sometimes referred to as topical or local estrogen, vaginal estrogen treatment involves administering estrogen directly into the vagina via a gel, pessary, or ring.

Local estrogen treatments release a very low dose of estrogen directly into the vaginal blood supply without being absorbed in the rest of your body, so it carries fewer side effects and is a safe option even for people who aren’t eligible for HRT.

Interestingly, when it comes to vaginal symptoms, vaginal estrogen has been shown to be more effective than systemic estrogen. Determining which option is best for you is thus dependent on if you are experiencing other menopause symptoms, and how severe your vaginal symptoms are comparatively. Talk to your doctor to determine which - if either - of these options is right for you.

Vaginal moisturizers

Vaginal moisturizers are a great non-hormonal alternative to topical estrogen. They act by keeping the vaginal lining hydrated and less irritated — much like a facial moisturizer would for your skin!

Vaginal moisturizers need to be used regularly (daily or every few days), and they’re safe to use with condoms.

Lubricants

Lube can be for anyone and everyone, regardless of age! Lube is applied to the vagina during sex and helps ease penetration, increase sensation, and prevent any tearing. Lube can be:

• Water-based
• Oil-based
• Silicone-based

What lube is best for you comes down to personal preference, just remember that oil-based lubes can damage latex condoms.

When choosing a vaginal lube, make sure to opt for a body-safe option, with a pH as close as possible to vaginal pH (between 3.8-4.5).

Prioritize foreplay

This is another handy tip that’s often only realized way later in life than it should. You can try to increase natural vaginal lubrication by ensuring you’re fully turned on. Instead of rushing into sex and going straight for penetration, try giving foreplay it’s time in the limelight. While it can be tempting to get right to the action, spend time playing around you and your partner's body. There are lots of pleasure zones within the body, many of which can help arouse your vagina before any type of penetration.

Pelvic floor exercises

If dyspareunia is caused by a pelvic floor issue like pelvic organ prolapse. Kegels or a course of pelvic floor physiotherapy can help strengthen the pelvic floor muscles and make sex more comfortable.

Pelvic floor exercises can easily be done by yourself and from the comfort of your own home, but it’s best to speak to your OBGYN or a pelvic floor specialist so they can help you with a targeted exercise routine.  

Ospemifene and prasterone  

Ospemifene and prasterone (DHEA) are two FDA-approved treatments for painful sex in menopause.

Ospemifene is a daily oral drug that acts like estrogen to make the vaginal lining thicker and more hydrated.

Prasterone, or DHEA,  is a steroid that is inserted daily into the vagina. Its exact mechanisms aren’t fully understood, but studies have shown that it’s effective in treating menopause-related dyspareunia.

Masturbate

We saved the best for last! Despite what society wants us to believe, intercourse is not the be-all and end-all of a healthy sex life. Sex acts that provide clitoral stimulation, like masturbation (mutual or solo) and oral sex, are just as enjoyable — if not more — as intercourse, and a great alternative if penetration is too uncomfortable.

FAQs

How to stop sex from hurting?

The solution to dyspareunia will depend on what’s causing pain or discomfort during sex. If the issue is vaginal dryness, using lubricant will make penetration more enjoyable. If you’re in menopause, your healthcare provider can recommend vaginal estrogen or hormone replacement therapy (HRT) to manage vaginal dryness. If the pain is caused by vaginismus or pelvic floor dysfunction, you might benefit from a combination of pelvic floor therapy, medication, and vaginal dilators. The frustrating truth is that dyspareunia has many causes and in many cases, treatment requires a lot of trial and error.

What exercises reduce pain during sex?

Exercises that focus on strengthening and relaxing the pelvic floor muscles can help reduce pain during sex. Pelvic floor exercises, also known as Kegels, are particularly beneficial as they improve muscle control and blood flow in the pelvic region, which can alleviate discomfort. 

How to make sex less painful during menopause?

To make sex more comfortable during menopause, it's important to focus on keeping the vagina moisturized and elastic. Using water-based or silicone-based lubricants during sex can help with vaginal dryness, which is a common issue due to decreased estrogen levels. You can also use vaginal moisturizers regularly to keep the tissue hydrated. Hormone therapy, such as low-dose vaginal estrogen creams or rings, can be effective in replenishing estrogen locally and reducing dryness and discomfort. Don't forget to do regular pelvic floor exercises and make sure to have plenty of foreplay to increase natural lubrication. If you're still experiencing pain, it's important to speak with a healthcare provider to explore personalized treatment options.