What You Can Do About Painful Sex During Menopause

It’s hard to be intimate when having sex hurts. Yet, it’s a problem that affects the sex lives of nearly half of postmenopausal women. Many may not realize the issue is treatable.

“Painful sex is very common among postmenopausal women,” says psychologist Sheryl Kingsberg, PhD.

The problem stems from genitourinary syndrome of menopause (GSM), a new term used to describe the genital, urinary and sexual symptoms associated with menopause, Dr. Kingsberg says.

Waning Estrogen Levels

One symptom of GSM is vulvovaginal atrophy (VVA), which results from waning estrogen levels and changes in the vaginal and vulva tissue. Left untreated, VVA can worsen over time and lead to:

• Painful sex
• Loss of libido
• Avoidance of intimacy

"Once the pain is there, women often become anxious and anticipate pain,” Dr. Kingsberg says. “As a result, they may also lose their desire for sex. VVA is an under-reported, under-recognized and under-treated problem that causes emotional distress and affects the quality of life for many couples.”

Treatments Available

Even though safe, effective treatments are available, many women aren’t aware of them or are embarrassed to discuss vaginal and sexual concerns.

“Women are uncomfortable talking with their healthcare providers about sex,” Dr. Kingsberg says.

Additionally, many healthcare providers compound the problem by failing to initiate discussions about menopausal changes, including VVA symptoms, during routine visits.

Your doctor can prescribe any of several VVA treatment options for your symptoms, depending on severity and whether it's related to sexual activity, Dr. Kingsberg says. These can include over-the-counter (OTC) therapies and/or prescription treatments, such as:

• Non-hormonal, long-acting vaginal lubricants and moisturizers.
• Lifestyle modifications, such as quitting smoking.
• More frequent sexual activity. Arousal stimulates your natural lubrication, which helps the vaginal tissue remain healthy. This, in turn, wards off VVA symptoms and helps to keep the vaginal tissue more elastic and flexible.
• Pelvic-floor physical therapy and/or vaginal dilator therapy.
• Low-dose vaginal estrogen therapy, as a cream, pill, ring or softgel capsule.
• Low-dose vaginal DHEA suppositories.
• Oral ospemifene, a non-estrogen medicine.

“Of the 64 million women in menopause, GSM may affect as many as half of them in some form,” Dr. Kingsberg says. “There’s no reason to suffer in silence when there are treatments available to help you.”

Related links

The Female Sexual Health Program at University Hospitals is dedicated to addressing all of the sexual health concerns women may have throughout their lifetime. Our primary goal is to provide a unique and open environment of care where women feel empowered, confident and comfortable discussing this important aspect of their health.