Hormonal changes are the number one cause of painful sex after menopause. During menopause, some women have no symptoms, but most experience changes such as vaginal dryness, hot flashes, trouble sleeping, and decreased libido.
We talk about hot flashes and night sweats. We know our periods won’t come back. But many of us aren’t prepared for the changes in our sex lives after menopause. Primarily how much sex can hurt.
According to the American College of Obstetricians and Gynecologists (ACOG), around 75% of menopausal women experience painful sex.
Due to hormonal changes that happen during menopause, vaginal tissues can become dry. Anxiety and worry can worsen the situation. If you have previously experienced pain, you may dread engaging in any form of sexual activity again.
First, let’s go over what causes painful sex after menopause, and then dive into ways to ease your discomfort and restore your intimate health.
What causes painful sex after menopause?
Dyspareunia is the clinical term for painful sex, and it’s a lot more common than you might think.
During the menopausal transition, each woman's body will respond differently. However, the below are common causes behind painful sex after menopause.
Estrogen and hormonal Changes
Higher levels of estrogen promote natural vaginal lubrication, which could increase sexual desire or libido. However, low estrogen levels can have the opposite effect.
When estrogen levels drop, vaginal wall tissues thin out and become more elastic. This change increases tissue fragility, leading to tearing, bleeding, and pain during vaginal sex. As a result, you may feel irritation and lose interest in sex.
Changes in estrogen levels can also affect your urinary tract. Because of this, you may feel pain during penetration.
Sexual activity and menopause
Believe it or not, a lack of sexual activity can also cause pain when you become sexually active again. Women who return to an active sex life after considerable time off may find sex to be uncomfortable.
On the other hand, regular sexual activity has been shown to stimulate blood flow and encourage natural lubrication. If you have experienced a drop in sexual function or desire, you’re not alone either. One study estimated that between 68% and 86% of women experienced some type of sexual dysfunction after menopause.
Other causes of painful sex
Although these are the most common causes of dyspareunia, it’s important to rule out issues that are not associated with menopause. Other causes of painful sex include:
- Injury or trauma to the vaginal tissue
- Surgery or an accident
- Skin conditions
- Infections or STIs
- Certain medications
- Stress, fear of intimacy, or relationship difficulties
How to improve sex after menopause
The pain may have you running for the hills when you think about intimacy, but you don’t have to forego a healthy sex life. It’s important to talk with your healthcare provider about your symptoms. They can help you pinpoint any causes related to painful sex. This may include a pelvic exam to check for any underlying physical conditions.
Your healthcare provider can also talk to you about support for low estrogen levels and refer you to the right provider for any emotional support you may need.
Sex after menopause tips
In the meantime, there are a few steps you can take to ease back into sex. Remember that just because painful sex after menopause is common, it doesn’t mean that you have to live with it.
First, it’s important to rethink what sex means to you and your partner. Sex isn’t just intercourse. It’s about connection, and pleasure can extend beyond a vaginal orgasm. We encourage you to try extended foreplay and introduce new ways of connecting with your partner outside of vaginal intercourse. Often when the pressure is off to perform, you find many new ways to enjoy pleasure with your partner.
When vaginal play is introduced, we recommend using vaginal lubrication during intercourse. Introduce it early during intimacy and use it liberally.
Vaginal lubricants can enhance your body's lost natural lubrication. When having sex, lubricants reduce friction, resulting in a decreased risk of getting vaginal injuries like tearing.
However, it is important to choose the right type of vaginal lubricant for you. Choosing the wrong one could cause irritation and do more harm than good.
There are various types of vaginal lubricants, but the most common include:
- Oil-based lubricant
- Water-based lubricant
- Silicone-based lubricant
When physicians conduct pap smears and pelvic exams, they typically use water-based lubricants.
If you use condoms, you can also apply lube to make them less likely to break. Water or silicone-based lubricants are usually compatible with latex condoms. Oil-based lubricants and natural options like coconut oil can cause condoms to break.
It’s also a good idea to use a daily vaginal moisture serum, like our pH-balanced revitalizHER made from soothing, supple ingredients that support healthy vaginal skin. Keep in mind that it is safe to use in the vaginal area. However, because it includes coconut oil in the ingredients, it should not be used as a lubricant with condoms.
Hormone therapy focuses on replenishing and maintaining your estrogen levels. In addition to increasing estrogen levels, hormone therapy can prevent bone loss and reduce fracture risks. There are two primary types of estrogen therapy:
- Low-dose vaginal products. These usually come in the form of vaginal creams, tablets, or rings, and release small doses of estrogen directly to the vaginal tissue.
- Systemic hormone therapy - This form of therapy contains a higher dose of estrogen and can provide relief to the common symptoms of menopause. They come in pills, rings, gel, or skin patches.
Pelvic floor therapy
A healthy, functioning pelvic floor is also key to better intimate health. The vagina and other supportive muscles in the pelvic floor may weaken over time, which can increase pain and decrease pleasure during sex. You can improve your pelvic floor function and strength with a solid pelvic floor and core workout routine.
Before you start your morning Kegels, it’s essential to understand how your pelvic floor works. Some exercises may not be effective, and there are considerations when you try any new exercise or therapy. For instance, Kegels may not be beneficial for you if you find yourself frequently leaking urine when doing them.
Get your gynecologist's or urologist's advice before performing any pelvic floor exercise. To maximize results, you can include the vFit device in your pelvic floor exercise routine. Instead of just focusing on strengthening the vaginal muscles, you can target the tissues with red light therapy.
The most common misconception that menopausal women deal with is that there is a decrease in sexual activity as they age. Contrary to the belief, sex can be enjoyable and frequent, but it shouldn’t be painful. If you experience pain try these tips and talk to your gynecologist for personalized care.