Why Does Menopause Make Sex Hurt?

5 minute read

By: Alloy Staff|Last updated: March 23, 2023|Medically reviewed by: Sharon Malone
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Hot flashes. Mood Swings. Night Sweats. Irritability. You expected these, or may have at least heard about them through the grapevine. How about painful sex, though? No one ever mentioned that symptom! 

Dyspareunia, or pain during sex, is actually one of the more commonly reported problems in postmenopausal women. Research suggests that anywhere from 27-84% of post-menopausal women suffer from the genitourinary syndrome of menopause (GSM), of which painful sex is a key component. 

If you’re experiencing painful sex after menopause, Alloy can help. Speak to a menopause-trained doctor who can discuss what treatment is best for you, including vaginal estradiol cream.

As with many of the symptoms already mentioned, this painful symptom actually can arise anywhere during the transition to menopause and thereafter, and is attributed to the thinning of the vaginal tissue and decreased lubrication caused by lowered estrogen levels.

If you are wondering if you will ever be able to enjoy your intimate life again, rest assured that there are safe and effective treatments for painful sex and the myriad of menopause symptoms that you may be facing. 

How Menopause Can Cause Painful Sex

Estrogen plays a vital role in your sexual health. Along with regulating ovulation and menstruation, this hormone is responsible for maintaining your vaginal health. During the menopause transition, estrogen levels fluctuate and, over time. This results in inevitable consequences for your sex life.

Vaginal Dryness and Menopause

Estrogen is responsible, in part, for keeping your vaginal tissue plump, lubricated, and elastic. The downward shift in your estrogen during menopause leads to a condition known as the genitourinary syndrome of menopause (GSM) formerly known as vaginal atrophy. 

Aside from the negative connotations that the term atrophy implies, vaginal dryness and painful intercourse are just a few of the symptoms of GSM. Characterized by vaginal dryness and thinning, vulvar itching and burning, and decreased lubrication, GSM can cause you to experience vaginal irritation and inflammation with friction, and subsequent pain with intercourse. Unlike other symptoms of menopause such as hot flashes which may resolve over time, vaginal dryness and painful sex typically get worse over time.

Menopause and Reduced Blood Supply to Clitoris and Lower Vagina

Decreased estrogen levels lead to reduced blood circulation to the clitoris and vagina. This can make arousal and genital health in general more challenging. 

Can Menopause Reduce Sex Drive?

As you advance through menopause you may notice a decrease in your sex drive. You are not alone. 40-55% of menopausal women complain of decreased sexual desire, and yet very few women raise the issue with their healthcare providers. 

How Age Can Affect Sexual Desire

Sexual desire and drive are multifactorial phenomena. Hormones certainly play a role, as do psychological, social, and other physical factors. If you are in good physical and mental health, there is no reason that you cannot enjoy a fulfilling sex life as you get older.

However, if you are suffering from hot flashes and sleep disturbances brought on by perimenopause and menopause, it is possible that you will be less likely to be “in the mood.” Also, weight gain later in life can affect your self-image and lower your self esteem, making you feel less desirable and in turn making you less inclined towards intimacy.

How Poor Health Can Affect Sexual Drive

Conditions such as diabetes, high blood pressure, heart disease, arthritis, and obesity can all adversely affect your sexual drive. Medications, including those commonly prescribed as treatments for depression and high blood pressure, can also lower your libido. 

Lower Estrogen Levels Affect Sex Drive

Research has shown that lower estrogen levels in women are associated with decreases in libido. As already discussed, declining estrogen levels lead to vaginal changes and subsequent pain which alone can decrease your sex drive. Additionally, it is believed that declining estrogen affects your neurological systems to decrease your sex drive.

Other Causes of Painful Sex After Menopause

There are several other causes of painful sex, aside from vaginal changes associated with menopause-related changes, that can arise after menopause.

Painful Intercourse and Polycystic Ovarian Disease

Polycystic ovarian syndrome (PCOS) is a condition that affects 6 to 12% of women of reproductive age and is characterized by excess androgen hormone production and insulin resistance. These hormonal derangements lead to a range of symptoms, including irregular menstruation and infertility, pelvic pain and inflammation with associated dyspareunia, acne, and excessive facial hair.  

Pelvic Inflammatory Disease and Painful Sex

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs. PID typically develops when a sexually transmitted bacteria spreads from your vagina to your uterus, fallopian tubes, or ovaries. The symptoms of PID can be mild, and the infection can even go completely unnoticed. However, in some women, PID can cause deep pelvic pain with intercourse.  Approximately 11.5% of postmenopausal women are diagnosed with PID. 

Yes! You Can Still Have An Orgasm After Menopause

And, yes, you can still have an orgasm after menopause. Having a fulfilling intimate life as you enter menopause, and thereafter, is definitely achievable.  

Many Older Adults Enjoy Sex

You are never too old to enjoy a happy and healthy sex life. Studies show that while less than half of women between 57-73 stay sexually active, sexual intimacy is important to the vast majority of people even into their older years. 

Being aware of how your body is changing during menopause and how these changes affect your sex life will help you to realize your intimate life is “normal.” It will also help you think about steps you can take to improve your sexual experiences as you age.

Tips for Improving Sex After Menopause

Menopause-related changes in your body can certainly decrease your libido, make it harder to become aroused, render sex painful, and even make climaxing more challenging. With that being said, there are several approaches you can take to help you enjoy yourself with your new body. 

Use Lubrication

Vaginal dryness can put a damper on your sex life. Vaginal tears, irritation, burning, and bruising can occur with any type of friction. Using sufficient lubrication can help. Vaginal moisturizers and lubricants are available at your local pharmacy and do not require a prescription. Moisturizers (Vagisil, Replens) can mimic vaginal secretion as they retain and accumulate water and then release them locally.  You will need to apply moisturizers every 2-3 days.

Whereas moisturizers are intended for chronic maintenance to replace vaginal secretions, lubricants (KY Jelly) are specifically designed to reduce friction during intercourse thus increasing comfort and reducing pain. Lubricants have either oil, glycerin or silicone bases and are usually used in addition to other local or systemic treatments. You will apply lubricants as needed each time you choose to be intimate.

Use a Vibrator

Because of the decreased blood flow to the vagina and clitoris, the stimulation required to reach orgasm may be increased.  Direct stimulation to the clitoris or to the tissue around the clitoris with a vibrator can not only increase arousal but also help achieve orgasm (with or without a partner).

Try Direct Stimulation and Oral Sex

Direct clitoral stimulation and oral sex can increase genital blood flow and improve your ability to be sexually aroused. Clitoral Stimulation Device, such as the EROS Clitoral Therapy Device, increases genital blood flow by applying a gentle vacuum to the clitoris. The device costs around $300 dollars and is FDA-approved. A small study showed that the use of the device resulted in 100% of study participants experiencing improved genital sensation and the majority of participants reported more sexual satisfaction and genital lubrication.    

Emphasize Affection-Centered Sex

While orgasms can feel like the end goal for sexual intimacy, many women feel fully if not more satisfied with affection-centered sex. Emphasizing kissing, hugging, and heavy petting with your partner will allow you both to show and receive affection. 

Practice Open Communication with Your Partner

As your body is changing, you will want to communicate how the menopause transition is affecting your physical and emotional well-being with your partner. Open communication is the foundation of a healthy sex life and is comprised of honesty and a willingness to work with your partner. Do not fake arousal or desire, be willing to compromise and to be open when it comes to the changing landscape of your sexual relationship, and cultivate excitement over experimentation. 

Consider Menopause Hormone Therapy

Pain with sexual intercourse and decreased libido are common in menopausal women. For some women, these symptoms can be significant and prevent you from feeling your best. For these women, MHT may be a good option.

For the vast majority of healthy women, supplementing the body’s natural hormones with menopause hormone therapy is safe and improves their quality of life. Research shows that estrogen-based MHT can improve sexual desire by eliminating vaginal dryness and decreasing clitoral and vulvar sensation.

Alloy can provide you with high-quality MHT products including topical estradiol vaginal cream, oral estradiol pills, and estradiol patches. We also have creams with sildenafil to enhance sexual arousal.

Estradiol Vaginal Cream 

Estradiol vaginal cream is an FDA-approved, plant-based form of estrogen that is available by prescription. The cream is absorbed directly into the vaginal wall and remains local to the area of application. Topical estradiol is very effective in treating vaginal dryness and in relieving dyspareunia. Very little of the topical estradiol will get into your bloodstream, so you will not experience relief of other menopausal symptoms you may be experiencing such as hot flashes. If your menopausal symptoms are limited to vaginal dryness and pain or bleeding with sexual intercourse, estradiol vaginal cream may be the right choice for you. 

Estradiol Pill 

Estradiol is a plant-based, bioidentical form of the hormone estrogen that can be taken orally in pill form or applied topically as a vaginal cream. Estradiol pills are taken once daily and have been found to be effective in relieving vaginal dryness and pain with sexual intercourse. As oral estradiol increases the amount of estrogen circulating in your bloodstream, your entire body will benefit from this increase. Estradiol pills will help provide relief from hot flashes, night sweats, sleep disturbances, and mood swings, and can boost your sex drive.

Estradiol Patch

Estradiol patches are a good option if you prefer the convenience of a twice-weekly patch to daily oral estrogen pills. 

Alloy Can Help Treat Painful Sex During Menopause

If you are experiencing painful sex during menopause, Alloy can help. Alloy’s menopause experts will evaluate your concerns and advise you regarding your best treatment options. Start by filling out your free assessment and getting the treatment you need.

For enhanced sexual arousal and satisfaction, learn more about our O-mazing Cream.


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