Painful sex after menopause: Causes, symptoms & relief tips

How does menopause affect sexuality?

As you age, what feels good during sex might change — which is completely normal. However, there are some physiological changes that take place during perimenopause that may make sex after menopause more painful, or less enjoyable. It’s important to know that whilst these changes are common, if you’re worried about your sex life, there are practical steps you can take alone or in consultation with your doctor to make sex enjoyable for you. Before we get into some solutions, let’s first look at what could be causing these changes. So, what can cause painful sex after menopause?

Vaginal dryness

During your reproductive years when you have your menstrual cycle, estrogen, one of the key sex hormones responsible for the menstrual cycle, levels are relatively high. During this time, estrogen maintains vaginal lubrication (wetness), as well as the structure of the vagina. Towards the end of your reproductive years, your ovaries stop producing as much estrogen. This hormone drop is essential in stopping your periods, but also contributes to changes to your vaginal anatomy. As many as 60% of postmenopausal women will experience some degree of vaginal atrophy (the thinning, drying, and inflammation of the vaginal walls), as a result of the drop in estrogen levels [1]. Without sufficient naturally-produced lubrication as a result of vaginal atrophy, sex may become more uncomfortable or painful.

Vaginal tightness

Another symptom of vaginal atrophy is vaginal tightness. The decline in estrogen levels lead to thinning, dryness, and a loss of elasticity in the vaginal walls. This can make the vaginal opening feel tighter than before menopause, and may make sex more uncomfortable. Some women may experience bleeding due to vaginal atrophy, which can feel alarming. If you do experience this, you should consult with your doctor. The good news is that lubricants and other interventions can be used to ease feelings of dryness and tightness, should you wish to have sex [1]. 

Loss of libido or decreased arousal

During and after the menopause, many will experience a decrease in their arousal or a loss of libido. Estrogen is a key culprit in this change in libido as low estrogen levels can reduce a person’s sexual desire [2]. The physiological changes listed above, like vaginal dryness and tightness can also make sex more uncomfortable and contribute to a reduced desire to have sex in the first place.

Another important factor that could contribute to your lowered libido is the fact that during menopause, you may experience feelings of stress or fatigue, which could contribute to a lack of desire to engage in sex [3,4]. 

It is important to remember that everyone’s experience with sex after menopause is different, and that if you experience a positive change in libido and arousal after the menopause, this is also normal and a totally valid experience.

Orgasm after menopause

If you have noticed that it’s become a bit harder to orgasm after menopause, you’re not alone. Let’s unpack what may be causing this change, and what you can do about it. 

What might make orgasm more difficult during this time?

Declining estrogen levels during and after menopause impact arousal, and may make it more challenging to achieve orgasm in many ways. Physiologically, vaginal atrophy and decreased lubrication can cause discomfort or pain that makes it harder to reach a state of arousal. The hormonal changes can also reduce blood flow to the genitals and affect the functioning of the nerves in this area, contributing to a loss in sensitivity during sex [5,6]. 

Additionally, as you age, the pelvic floor tends to become weaker. When these muscles become weakened, orgasms can become harder to reach, or less intense when they do happen.

What you can do about it

Struggling to orgasm after going through menopause can be distressing. Rest assured, If you’re interested in having sex and finding ways to achieve orgasm, some of the tips below might help you to have sex that is both pleasurable and enjoyable to you.

• Try a water-based lubricant: After menopause your body likely doesn’t naturally produce as much vaginal lubrication when aroused as it once did. Adding in a water-based lubricant to sex to reduce the effects of vaginal dryness, whether solo or partnered, may make sex more enjoyable. Though they are not suitable for use with sex toys or condoms, some doctors may recommend a more robust lubricant that is oil or silicon-based.

• Pelvic-floor physiotherapy: Pelvic floor physiotherapy has been shown to be effective in improving sexual function in postmenopausal women. Vaginal dilators may also be helpful alongside or as part of pelvic-floor physiotherapy if vaginal atrophy has caused the vaginal canal to shrink You should discuss these options with your doctor, to ensure they are right for you.

• Communication with your partner(s): Communicating with your partner(s) about your changing desires and physical sensations during sex can help to manage expectations around your changing sexuality. It’s important to acknowledge that not everyone who has gone through menopause will want to continue having sex, or are not interested in regularly having sex, and that’s okay. There are other ways to explore physical connection with a partner if you’d like, which include cuddling, or sharing a bed.

• Sex toys & foreplay: Introducing sex toys into solo or partnered sex, and prolonging foreplay, can help to enhance stimulation and build up arousal. Adding in water-based lubricants when using sex toys can make using them even more pleasurable.

• Menopausal hormonal therapy: After consultation with your doctor, they may recommend local vaginal creams that contain hormones to help reduce vaginal dryness, which should help to reduce the pain you may experience with sex, and help make sex more pleasurable. Depending on whether you are experiencing other menopause-related symptoms, systemic hormone therapy may be recommended as well.

When to see a doctor

For many people, changes to the way they experience sex after menopause is inevitable. Symptoms like pain with sex after menopause and changes to your libido are common, and for this reason, many don’t speak with their doctor. However, many of these symptoms are treatable and can be managed with the appropriate knowledge and tools. You deserve to feel confident and supported during the post-menopausal time, and have the sex you want (or don’t want) to have in a way that feels good for you. If your menopausal symptoms are impacting your quality of life or your relationships, we recommend you consult with your doctor to establish the best treatment plan for you. Increasingly, doctors who specialize in menopause are becoming more common, so if you think you would benefit from getting some specialist support, it may be worth looking into this option.

Track your perimenopause symptoms with Natural Cycles

Thanks for reading up on painful sex after menopause. Keeping track of your symptoms, like changes to your sex life, can help you have constructive conversations with your healthcare provider while keeping you informed about the changes and cycles happening during perimenopause and beyond. It may also be a useful way to track patterns that can be shared with your sexual partner(s). See if working with a tool like Natural Cycles can support you during this transitional time.