Why is Sex Painful After Menopause?
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Having pain with vaginal sex after menopause? You’re not alone!
Up to 45% of post-menopausal people experience painful vaginal intercourse., but pain-free sex is absolutely still possible after menopause.
All people with ovaries go through menopause. It’s a fact of life. Many people go through medical or induced menopause, which is when your menstrual cycle stops due to medical treatment. This could mean surgical removal of the ovaries, chemotherapy or radiation damage to the ovaries, or medications used specifically for inducing menopause. Regardless of whether you go through natural or induced menopause, hormonal levels of estrogen, progesterone, and testosterone dramatically decrease.
Genitourinary syndrome of menopause (GSM) is a group of symptoms experienced due to the decreased estrogen effects on the vulvar and vaginal tissues as well as the bladder and urethra. Tissue changes and symptoms of GSM typically progress and include:
Vulvar and vaginal dryness, burning, and irritation
Less elastic vaginal tissues which makes them prone to tearing and bleeding
Vaginal tissues become thin
The vagina itself becomes shorter and more narrow
Pain with vaginal sex
Bladder symptoms like urgency, painful urination, and recurrent urinary tract infections (UTIs).
Most post-menopausal people who have pain with vaginal intercourse will experience pain with superficial penetration (more on the outside) due to the vaginal and vulvar tissue changes. Some people can experience pain with deeper penetration or thrusting, or even have pain with both superficial and deeper penetration. Regardless of the type of pain you’re having, getting assessed by your medical provider is the first step in figuring out what is causing your pain and how to best treat it.
Tips for pain-free vaginal sex after menopause
Work with a physical therapist! Pelvic health physical therapists will assess your tissues and symptoms to provide you with an individualized program. Want to learn more about what to expect? Read my blog post, “Pelvic Health Physical Therapy 101”.
Keep up your water intake! The tissues that line your bladder and vagina will thank you for it.
Always use lubricant with sexual activity. Check those ingredients! Avoid parabens, glycerin, petroleum, baby oil, propylene glycol, and any products that are tingling or warming. These can all irritate the tissues more. Some of my favorite lubricants are Sliquid, Good Clean Love, and Aloe Cadabra.
Spend more time on foreplay. Not only is it enjoyable, but foreplay will increase your arousal, increase your natural lubricant, and help lengthen then vagina for comfortable penetration, all of which will help you have less pain.
Get creative and try different positions. If you have pain with deeper penetration, you may want to find positions that limit the depth of thrusting from your partner. You can also try the Oh Nut, which is a soft, wearable device that acts like a bumper for your partner.
Use vaginal moisturizers like coconut oil, vitamin E, Good Clean Love, or Revaree to help with vaginal dryness. Just massage a little bit of the moisturizer on the vulvar and vaginal tissues several times per week. I always recommend doing this before bed when you’re lying down.
Try trainers (also called dilators). Soft silicone dilators like the ones from Intimate Rose and Soul Source are perfect to work on more comfortable penetration. Make sure to work with a pelvic health physical therapist for the best results. Use code ALEXANDRA for $5 off at Intimate Rose.
Use a prescribed vaginal estrogen cream, ring, or tablet medication. This locally acting medication will help reverse the tissue changes brought on by menopause. Estrogen medication isn’t appropriate for everybody, so talk to your medical provider.
Work with a sex therapist. They can talk with you about your concerns and any other stressors that may be impacting your sex life and guide you through different strategies to address your problems. Find one through American Association of Sexuality Educators, Counselors, and Therapists (AASECT).
Just because you have gone through menopause, that doesn’t mean you can’t enjoy intimacy! If you’re having discomfort, then talk to your medical provider and work with a pelvic health physical therapist.
