Painful Sex After Menopause: Symptom Guide

October 18, 2023
Medically reviewed by: 

What is painful sex in menopause? 

Painful sex, or post-menopausal dyspareunia, is when intercourse hurts. The pain can be either superficial (feels more like the skin is burning) or deep (muscles deeper inside feel discomfort) with penetration or a combination of both. Estimates by the American College of Obstetricians and Gynecologists indicate that up to 75% of women may experience sexual pain at some point in their lives. 

What causes painful sex during menopause? 

The link between sexual pain and sexual function can sometimes be mysterious. Women frequently express reduced desire or difficulties becoming aroused, but frequently sexual pain is often the underlying issue.

Experiencing painful sex can naturally dampen one’s libido and hinder sexual arousal. Sexual pain can also stem from various issues such as vaginismus (pelvic floor muscle spasm), endometriosis, vaginal dryness, painful bladder syndrome, fibroids, surgical scarring, pelvic floor dysfunction, ovarian cysts, vulvodynia, or postpartum healing. 

While treatment approaches for these conditions may differ, the effects of sexual pain on sexual health are often quite similar. 

What is happening inside your body?

When sexual pain becomes a chronic issue, it can completely rewire these pathways, altering our relationship with sex even before it starts. Pain triggers a protective mechanism in our bodies, causing us to avoid anything that causes pain, much like animals avoiding danger.

When sex becomes associated with this "danger zone" in our brains, the enjoyable aspects of it start to fade away. Pain can make it difficult to become aroused or naturally lubricated, especially during painful phases like penetration.

Repeated negative sexual experiences involving pain rather than pleasure can decrease our desire to engage in these activities. Understandably, this can lead to avoiding sex and intimacy altogether. Many women carry feelings of shame, embarrassment, and self-doubt related to their sexual pain and their identity as a sexual being.

What are some medical-provider-prescribed treatments for painful sex in menopause?

  • Vaginal estrogen: This treatment helps reverse vaginal tissue changes related to loss of estrogen with menopause. MD input here?

What are some non-medical treatments for painful sex in menopause?

  • Pelvic floor exercises: Strengthening your pelvic muscles with pelvic floor exercises can help relieve pain during sex.
  • Lubricants: When applied at the time of sexual activity, lubricants can alleviate pain during intercourse. 
  • Dilators and pelvic wands: These plastic or silicone tools are used to stretch your vaginal tissue to improve the flexibility of your vagina and the strength of your pelvic muscles so that sex becomes more comfortable. 

Healthcare team: Finding a healthcare team that includes a specialist in sexual pain, like a sex therapist or coach for emotional support, and a pelvic floor physical therapist can alleviate pain. 

Other treatments for sexual pain vary based on the causes and can involve different therapies and timeframes. 

What should you do next?

Let’s get you prepared to be paired with your provider! 

Select and submit all of the symptoms you are currently experiencing so your doctor can assess and provide a tailored treatment plan for you.


A study states the main reasons why between 17% and 45% of postmenopausal women say they find sex painful, a condition referred to medically as "dyspareunia.