Complete Symptom Guide to Painful Sex and Menopause | Stella

Menopause and painful sex


It can feel distressing and upsetting when a pleasurable experience becomes painful. Painful sex can often wreak havoc on your libido, sense of self, and relationships. It can often make you want to avoid sex. Thankfully, it isn’t all doom and gloom – there are several potential causes of painful sex during and after menopause, and in nearly every case, it is treatable.


In medical terms, recurrent, or persistent genital pain that occurs before, during, or after sex is referred to as dyspareunia. This pain widely varies and can be: 

  • Felt on entry or deep penetration 
  • Vary in intensity from mild to excruciating
  • Occur occasionally or every time

Sexual pain that is associated with menopause is often due to genitourinary syndrome of menopause or GSM – the medical term for some of the vaginal and urinary changes that occur during menopause. 

GSM is thought to affect up to half of the people who go through menopause, many of whom report their vagina feels dry, rough, or raw. The tissue in the vagina may also feel fragile and it may bleed more easily. 

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  • If you experience painful sex, you are not alone
  • Three-quarters report painful sex at some point and it is particularly common during and after menopause
  • Although painful sex is common, you don’t need to accept it as your new normal

Read more about the stages of menopause.


External pain on your vulva (the external genital area that touches your underwear)

Internal pain in your vagina, uterus, or pelvis

Pain may be described as sharp, burning, stabbing, aching or throbbing (although everyone’s experience will be different)

Painful sex during or after menopause may leave you with feelings of shame or that something is wrong. 


Sexual pain associated with the changes of menopause can often be easily and successfully treated.

Tune in with your body

If something hurts or doesn’t feel good, don’t force it or try to push through the pain. You need to love and respect your body. 

Try a vulvar or vaginal moisturiser

These can help to increase moisture and the tissue quality of the vulvar and vaginal tissues. You can buy them without a prescription, and your pharmacist will be able to advise on which products to try.


Lube can help decrease pain during sex and can be applied as needed. Be aware that lubes and vaginal moisturizers work in different ways, so try a few and see what works best for your body. Read more about lubricants and sex.

Think outside the box

Sex can be so much more than just penetration. Try sexual activities such as touching, oral sex, or mutual masturbation. 

Increase foreplay

Although foreplay alone rarely cures painful sex in menopause, it may help you become more aroused which decreases your pain response. 

Have sex with yourself

Just because you are having painful sex does not mean that you can’t pleasure yourself. It is important to remind yourself that you can feel good in your body.

Communicate about sexual pain

Sexual partners are not mind readers – so it is important to communicate about painful sex, particularly if some positions feel more painful and can be avoided. Avoiding positions that inflict pain can help teach your body not to anticipate pain with sex. 

Improve your washing and grooming habits

Avoid soap, loofahs, douches, or sprays to clean the vulva or vagina. These can dry out and irritate the tissues even more.

Take pain-relieving steps

To reduce pain on deep penetration, you can try something like the Ohnut rings to adjust the penetration depth to what feels comfortable. Other preventative steps include taking a warm bath or painkiller before sex. After sex, apply an ice pack to the vulvar area.

See a healthcare provider

If you have painful sex, you should always go to see a healthcare provider for review. They will be able to help you figure out what is causing the pain, and how best to treat it. Depending on the cause of your painful sex, seeing a sex therapist or pelvic floor physiotherapist may also be helpful. See your healthcare provider urgently if you have any bleeding after sex, bleeding in between periods, sores on the vulva or vagina, or any other symptoms that are worrying you. 

Consider topical estrogen

This comes in the form of creams, pessaries or vaginal suppositories, or rings and is applied directly to the vaginal area. This is an effective, low-risk form of HT and is used to treat menopausal changes in the vagina and surrounding tissues that could be causing your pain. Speak to your healthcare provider for further advice about this and other forms of HT. 

Quit smoking

Smoking can worsen dryness and contribute to painful sex.


Experiencing painful sex often results in a fear cycle around sex. Your body has a good memory and if it expects to experience pain then it sets up an involuntary reaction of tensing up which can worsen the pain. You may start to fear or feel anxious about sex and even avoid it altogether. 

The best way to break this cycle is to find sexual activities that don’t hurt and to create clear boundaries with your partner so that when you do have sex, you know that it won’t hurt.

If you experience sexual pain from intercourse or any other activity, stop doing it… today. Many believe that if they could just push through the pain it will get better. However, doing this is actually counterproductive. 

Continuing to have painful sex can exacerbate the pain and you are also creating a link in your head between pain and sex. To stop doing anything sexual that hurts you might mean that you need to explore new ways to have sex for a while. There are so many types of sex that you can have that don’t involve penetration.

During perimenopause and menopause, painful sex often is associated with changes in hormone levels which can cause:

  • Less moisture and lubrication in the vagina
  • Thinner and less elastic vaginal tissues 
  • Changes to the vagina including narrowing and tightness

You may experience vaginal irritation, dryness, itching, and burning. Over time, sex without sufficient lubrication can result in inflammation and a greater risk of tearing or bleeding – and of course painful sex. 

Your sexual pain may be related to other causes, such as:

  • Vaginismus
  • Pelvic floor dysfunction
  • Gynecological conditions – such as endometriosis, fibroids, or ovarian cysts
  • Vaginal infections or sexually transmitted infections (STIs)
  • Partner techniques
  • Psychological causes – such as stress or anxiety
  • Past injury – such as childbirth
  • Genital washing practices
  • Skin conditions

Due to the wide range of causes of sexual pain, we always recommend that you see your healthcare provider for a physical exam and investigations. 

Some go from healthcare provider to healthcare provider without getting help or gaining an understanding of why they might be experiencing sexual pain.

The reality is that sexual pain can often be both psychological and physical. If someone tells you that the pain is imagined or doesn’t take your concerns seriously, it might indicate that your healthcare provider doesn’t know how to handle this problem. There are plenty of other health professionals out there – find someone else!


railway split

The conversations needed for intimacy during menopause. Read more

Non-penetrative sex options during menopause. Read more

Menopause and contraception: your questions answered. Read more

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