topical anesthetics
A black woman over 50 suffering menopause

7 Solutions for Menopause and Painful Intercourse

You know, it’s actually quite common for women who have gone through menopause to experience some discomfort or even pain during sex. The fancy medical term for this is “dyspareunia,” but let’s just call it what it is – painful sex.

Identifying the Underlying Cause

One of the main reasons this happens is because of changes in our bodies during and after menopause. We produce less estrogen, which can cause vaginal dryness, or what doctors call “vaginal atrophy.” Basically, the tissue in and around the vagina becomes less moist and elastic.  It’s a bit like how your skin gets drier as you age, only it’s happening in your intimate area. This lack of moisture and flexibility can make sex uncomfortable or even painful. This can be totally frustrating.

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Intimate Discomfort

You might have an infection, like a yeast infection or a urinary tract infection.

There’s also something called interstitial cystitis, which is a painful bladder condition.

Or it could be irritable bowel syndrome, fibroids in the uterus, inflammation in the pelvis, or even side effects from cancer treatments that can all mess with the health of your vaginal tissues and cause discomfort during sex.

Painful Mysteries

In short, there’s a whole laundry list of potential reasons why sex might be painful for you. But the important thing to remember is that you’re not alone, and there’s help available. So, don’t suffer in silence – reach out to your doctor or healthcare provider. They can guide you to find the right solution to bring the joy back into your sex life.

Overcoming Vaginal Dryness

You know, a lot of women after menopause find themselves dealing with vaginal dryness. It’s pretty common and is often due to the big hormonal changes that happen during menopause, especially with the drop in estrogen. This hormone drop can even cause the walls of the vagina to become thinner – a condition known as vaginal atrophy. And let me tell you, this can make sex feel downright painful.

Managing Dryness

Vaginal dryness is a common symptom experienced by many postmenopausal women, often linked to hormonal changes, particularly the drop in estrogen levels experienced during menopause. These changes can also lead to vaginal atrophy, where the vaginal walls thin, causing painful intercourse. Lack of lubrication in the vaginal area can also be due to inadequate sexual arousal, or from certain medications that reduce natural lubrication.


Firstly, over-the-counter water-based lubricants can be used as an immediate solution. They are typically safe and can significantly improve sexual comfort and pleasure by providing the much-needed lubrication during sexual activity. Using a water-based lubricant during sexual activity or a vaginal moisturizer regularly can provide temporary relief from dryness and make intercourse more comfortable.

In addition to lubricants, regular sexual activity can help maintain natural lubrication as it promotes blood flow to the vaginal walls and aids in maintaining the health of vaginal tissues. Also, certain lifestyle changes, like staying well-hydrated and avoiding irritants such as perfumed soaps in the vaginal area, can aid in maintaining natural moisture.

Hormone Replacement Therapy

For long-term solutions, you can consider topical estrogen or hormone replacement therapy, after discussing with your healthcare provider. These treatments can help restore natural lubrication, rejuvenate the vaginal lining, and even improve sexual desire. These estrogen treatments can come in various forms such as creams, tablets, or rings inserted into the vagina and they work by directly restoring estrogen in the vaginal area, improving moisture, and reducing discomfort during sex.

While the use of topical estrogen is generally safe for most women, it is essential to discuss potential side effects with your healthcare provider, especially for women with a history of certain cancers or blood clots. Remember, overcoming vaginal dryness is a key step towards reclaiming a pleasurable sex life during and after menopause.

Physical Therapy for Pelvic Pain

Chronic pelvic pain, which can manifest as a frequent pain or severe pain during intercourse, can be caused by a variety of conditions such as tight or weakened pelvic floor muscles, interstitial cystitis, or a history of pelvic surgery. These conditions can result in pelvic muscle spasms, reduced blood flow, and decreased flexibility in the pelvic region leading to discomfort or pain during sexual activity.

In such cases, physical therapy can be a beneficial treatment option. A physical therapist specializing in pelvic health can guide women through a regimen of pelvic floor exercises, similar to Kegel exercises, to help strengthen the pelvic muscles, improve blood flow to the genital area, and alleviate the discomfort associated with sexual activity. Regular pelvic floor exercises can also promote better control over these muscles, enhancing sexual pleasure and orgasmic function.

Additionally, the physical therapist may suggest the use of vaginal dilators for women who experience pain at the opening of the vagina or with penetration. Vaginal dilators are tube-shaped devices that come in various sizes. They are gently inserted into the vagina to help stretch the vaginal tissues and improve flexibility, making intercourse more comfortable. This process of using dilators can also desensitize the area to touch, reducing pain associated with penetration.

In some cases, myofascial release, a type of manual therapy, might be suggested to help ease tight muscles and relieve deep pain that occurs during sexual activity. This therapy focuses on relaxing contracted muscles, improving blood and lymphatic circulation, and stimulating the stretch reflex in muscles.

Physical therapy can be a holistic approach, not only addressing the physical discomfort but also considering the emotional and psychological factors that may contribute to painful intercourse. The goal of physical therapy is to help women regain control over their bodies, restore function, and improve their sexual health and overall quality of life.

Treating Underlying Medical Conditions

Certain medical conditions, such as yeast infections, urinary tract infections, ovarian cysts, pelvic surgery, scar tissue, or even history of sexual abuse can result in deep pain during sexual activity. In many cases, these conditions lead to inflammation or irritation of the vaginal tissues causing discomfort and pain.

Yeast Infections

One example is a yeast infection, a common type of vaginal infection that can cause itchiness, discomfort, and painful intercourse. Antifungal treatments can help clear up these infections, improving comfort during sexual activity.


For postmenopausal women, urinary tract infections can be more frequent due to changes in the urinary tract and lower estrogen levels. If left untreated, these infections can cause pelvic pain and discomfort during intercourse. Thus, it’s important to diagnose and treat these conditions promptly with antibiotics.

Ovarian Cysts

More complex conditions like ovarian cysts or endometriosis might require more extensive treatments, such as hormonal therapies or even surgery, to remove the cysts or endometrial tissue causing the pain.


Pelvic inflammatory disease, a type of infection that can affect the uterus, fallopian tubes, or ovaries, can also cause painful intercourse. This condition requires immediate medical attention and usually is treated with antibiotics.

In some instances, painful intercourse may be a side effect of cancer treatments, such as chemotherapy or radiation, which can lead to changes in the vaginal walls, causing dryness and discomfort. In these cases, a healthcare provider may suggest specific treatments or strategies to help manage these side effects.

Sexual Abuse

Lastly, if the pain is related to a history of sexual abuse or trauma, seeking help from a mental health professional or a counselor is recommended. These professionals can provide strategies to cope with the emotional distress and its physical manifestations.

Addressing Psychological Issues and Fear of Intimacy

Fear of intimacy, psychological issues, or history of sexual abuse can lead to painful intercourse. If the pain is more associated with deep penetration, it may be due to emotional factors rather than physical ones. In these cases, sex therapy can be beneficial. A sex therapist can help individuals and couples navigate these complex issues, enabling a more pleasurable sexual experience.

Emotional Impact

In these situations, the pain may be more associated with deep penetration, but it is often more of a reflection of emotional factors rather than physical ones. Understanding and acknowledging these emotional factors is crucial in managing and treating this form of pain.


Counseling or psychotherapy can be extremely helpful in these situations. Cognitive-behavioral therapy (CBT) is a type of talk therapy that can help individuals understand and change thought patterns that lead to harmful behaviors or feelings of distress. With the help of a trained therapist, CBT can help address negative patterns and enhance sexual health.

In addition to individual therapy, couples therapy can also be beneficial. A therapist can help couples improve their communication around sex, address any fear of intimacy, and work on enhancing the sexual relationship.

Sex therapy is another avenue that could be explored. A sex therapist specializes in treating sexual issues and can provide techniques and exercises to help improve sexual function and reduce pain during intercourse. They can also help couples explore different positions or techniques that may make sex more comfortable and pleasurable.


In some cases, prescription medications, such as antidepressants or anti-anxiety medications, might be helpful in addressing underlying psychological issues. However, some of these medications can have side effects, including reduced sex drive, which should be discussed with your healthcare provider.

It is important to remember that overcoming psychological barriers to a healthy sex life can take time and patience, and it is okay to seek help. Your sexual health is a vital aspect of your overall well-being, and you deserve a fulfilling and comfortable sexual experience.

Lifestyle Changes and Home Remedies

Diet and lifestyle can also play a significant role in sexual health. Regular exercise can help increase blood flow and improve sexual arousal. Moreover, maintaining a healthy diet can regulate hormone levels, reducing symptoms like hot flashes, and increasing sexual desire. Home remedies, like warm baths before sexual activity, or experimenting with different positions can also alleviate discomfort.


Regular exercise is crucial for maintaining overall health and enhancing sexual function. Exercises, particularly those targeting the pelvic floor muscles, like Kegel exercises, can help strengthen these muscles and improve sexual comfort. Activities that promote improved blood flow, such as yoga or walking, can also aid in increasing natural lubrication and sexual arousal.


Diet also plays a significant role in managing menopause symptoms and promoting sexual health. Eating a balanced diet rich in fruits, vegetables, lean proteins, and healthy fats can help regulate hormone levels and increase energy. Certain foods, such as soy products, flaxseeds, and other phytoestrogen-rich foods, can help balance estrogen levels and alleviate symptoms like hot flashes. Staying well-hydrated can also improve natural lubrication and reduce symptoms of dryness.

Home remedies

Home remedies can also play a part in managing symptoms. Warm baths before sexual activity can help relax the pelvic muscles and increase blood flow to the genital area. Using water-based lubricants or vaginal moisturizers can also provide temporary relief from vaginal dryness and make sexual activity more comfortable.

Sexual positions

Experimenting with different sexual positions can also be helpful. Some positions may allow for shallower penetration, reducing discomfort, especially for women who experience deep pain during intercourse. For example, the woman-on-top position can give the woman more control over the depth of penetration.


Reducing stress through mindfulness practices like meditation, deep breathing exercises, or yoga can also help improve sexual arousal and desire. These techniques can help address the emotional aspects of sexual pain by reducing anxiety and improving one’s connection with their body.

Finally, it’s important to maintain open communication with your partner about your experiences and any discomfort you may feel. Together, you can explore ways to ensure your sexual experiences are comfortable, pleasurable, and satisfying.

By integrating these lifestyle changes and home remedies into your daily routine, you can improve your overall sexual health and well-being, enhancing not only your sex life but also your quality of life.

Prescription Medications and Medical Treatments

Painful intercourse can sometimes be alleviated through prescription medications or medical treatments, especially when the underlying cause is hormonal changes, vaginal atrophy, certain medical conditions, or a side effect of treatments like chemotherapy.

estrogen levels

For postmenopausal women who experience painful intercourse due to low estrogen levels leading to vaginal dryness and atrophy, local vaginal estrogen treatments can be an effective solution. These come in various forms like creams, tablets, or rings, and are typically applied directly to the vaginal area. Local vaginal estrogen treatments help replenish the estrogen levels in the vaginal tissues, improving the thickness and elasticity of the vaginal walls and increasing natural vaginal lubrication.

Such treatments are approved by the Food and Drug Administration (FDA) and have been proven to effectively alleviate vaginal dryness and discomfort during intercourse. They also have the advantage of providing localized hormone therapy with minimal systemic absorption, reducing potential side effects.

topical anesthetics

Topical anesthetics can be a handy prescription option. Apply them to the genital area to numb it and reduce pain during intercourse. But remember, use them sparingly and always under a healthcare provider’s guidance to prevent any allergic reactions or irritation.


“If you’ve had cancer treatments like chemotherapy or radiation, they can change your vaginal tissues, leading to painful intercourse. Healthcare providers often recommend using vaginal dilators to stop the vagina from narrowing, or they might suggest hormonal or non-hormonal treatments to manage these side effects.


Some oral medications, like certain antidepressants, can lead to vaginal dryness. If you think your meds might be causing discomfort, definitely talk to your healthcare provider. They can tweak your dosage or switch you to another medication that doesn’t have this side effect.

Before starting any prescription medication or medical treatment, it’s important to discuss with your healthcare provider the potential benefits, risks, and side effects to ensure the treatment is the best fit for your needs and health condition.

Remember, you do not have to endure painful intercourse. There are numerous medical treatments available, and a solution can often be found with the help of your healthcare provider. Don’t hesitate to seek help and explore your options. Your sexual health is an important part of your overall well-being.


Final Thoughts

The good news is that painful sexual intercourse is treatable and the American College of Obstetricians assures that women need not live with this discomfort. Communicating with your healthcare provider about your symptoms, sexual pain, and concerns is vital to diagnosing and treating the root cause of the problem. Whether the solution lies in a water-based lubricant, physical therapy, prescription medications, or lifestyle changes, remember that your comfort and pleasure should never be compromised. So, take the step today towards a more fulfilling and pain-free sex life.

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