*Content reviewed by HotPause Health  Pelvic Health Therapist, Tanya Goodrich, PT, DPT

Painful Sex During Menopause

Menopause marks a significant transition in a woman’s life, often accompanied by symptoms that can affect her quality of life, including painful sex. This discomfort isn’t just a minor inconvenience; it can significantly impact intimacy and personal well-being. Here’s a comprehensive look at why painful sex occurs during perimenopause and menopause, its symptoms, and what you can do about it.

Why Does Painful Sex Happen in Perimenopause & Menopause?

The root cause of painful sex during peri/menopause primarily lies in decreased estrogen levels. Estrogen plays a crucial role in maintaining the health and elasticity of vaginal tissue. As menopause approaches and estrogen levels drop, vaginal tissues become thinner, less elastic, and less lubricated. This condition, known as vaginal atrophy, can make sex uncomfortable or even painful. Moreover, reduced estrogen can weaken the pelvic floor muscles, further complicating sexual activity.

Symptoms Associated with Painful Sex

Discomfort during intercourse (i.e. painful sex!) can range from mild irritation to severe pain. Other symptoms can include:

• Dryness or a feeling of vaginal tightness
• Itching or burning sensations in the vaginal area
• Mild bleeding post-intercourse
• Recurring urinary tract infections

These symptoms can lead to a decrease in sexual desire, not necessarily out of a loss of interest or low libido, but due to the anticipation of pain.

Managing and Treating Painful Sex During Menopause

Symptomatic Relief Strategies

• Vaginal Moisturizers and Lubricants: Regular use of vaginal moisturizers can help maintain vaginal moisture, while lubricants can be applied before intercourse to reduce discomfort and friction.
• Pelvic Floor Physical Therapy: This therapy focuses on strengthening and relaxing pelvic floor muscles, improving their functionality and reducing pain during sex.
• Vaginal Dilators: These devices are useful for stretching the vaginal tissues, making them more flexible and less painful during intercourse. They can also aid in strengthening pelvic floor muscles.
• Pelvic Wands: These devices often have vibration options that can help relax the pelvic floor.
• Sex Therapy and Counseling: Professional guidance can help address psychological and emotional factors affecting sexual health and intimacy during menopause.

Hormonal Treatments

• Vaginal Estrogen Therapy: This treatment helps replenish estrogen directly to the vaginal tissues, alleviating dryness and discomfort. Vaginal Estrogen is available in estradiol tablets, creams, gels, and vaginal rings. It’s important to consult with a healthcare provider as these treatments are generally safe and do not significantly increase breast cancer risk.
• Combined Estrogen Therapy: For broader symptom management, standard doses of systemic estrogen therapy can be combined with local treatments like vaginal creams.

Non-Hormonal Treatments

• Prasterone (Intrarosa): This vaginal insert provides DHEA, a precursor to estrogen and testosterone, helping to alleviate pain during intercourse by improving vaginal health without using estrogen.
• Ospemifene (Osphena): This oral medication acts as a selective estrogen receptor modulator (SERM) that helps rebuild vaginal tissue, easing painful intercourse for women with moderate to severe genitourinary syndrome of menopause (GSM). However, it’s typically not recommended for women at high risk for breast cancer.

Painful sex during peri/menopause is a significant issue that deserves attention and care. Understanding the underlying causes and exploring comprehensive treatment options can help women regain their sexual health and improve their overall quality of life during menopause. HotPause Health is dedicated to providing the resources and support you need to navigate this complex phase with confidence and knowledge.