Journal / Menopause

Painful Sex and Menopause - It Isn’t Acceptable

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

Painful Sex and Menopause - It Isn’t Acceptable

You officially hit menopause when you have gone one year without a period, but you have likely been noticing symptoms of menopause long before that. In the US, the average age that women reach menopause is 51. Perimenopause (the phase before menopause) can start in your late 30s and early 40s and lasts 10 years. Peri- and menopause can also bring some unwelcome physical menopausal symptoms like painful sex. Painful sex and menopause often go hand in hand. The good news is that there are ways to manage the symptoms that occur during menopause 1

Painful sex is one menopause symptom that doesn’t get a lot of attention. Sex is supposed to be fun, and women have every right to have satisfying sex with their romantic partners. However, as we age and enter perimenopause, sex is sometimes painful and the desire for sex drops.

Menopause can last more than a decade and depending on the severity of your sexual discomfort, untreated vaginal pain with sex can have a negative impact on the quality of your life and your relationships. This article will discuss the options for preventing and treating painful sex, and ways to get you back to wanting and enjoying sex again.

Painful Sex with Menopause

Even if you don’t expect menopause to be simple, one symptom that might catch you off guard is painful sex (dyspareunia). During menopause, it’s not uncommon to have pain with sex. How painful it is varies from woman to woman. The pain can also vary from pain only at penetration, to a burning or throbbing sensation that lasts long after penetration.

In peri- or menopause the hormone levels estrogen, progesterone, and testosterone drop. With the drop in these hormones, women can start to develop what is called Genitourinary Syndrome of Menopause (GSM). GSM brings a wide array of symptoms that can impact a woman’s vagina, labia, urethra, and bladder. 

One symptom of the decreased hormones with menopause is Vulvovaginal Atrophy (VVA) which can make sex painful. Other symptoms of VVA are vaginal drying, burning, painful urination, thinning, and narrowing of the vagina which can add to the pain felt during sex.

Unlike other menopause symptoms (like hot flashes which usually improve over time), GSM and VVA get worse with time when not treated. Regardless of the degree of VVA, women can get treatment for their symptoms and enjoy a pain-free sex life.

Ways to Avoid Painful Sex

You don’t have to put the brakes on your sex life. There are a variety of ways to enjoy sex again like:

  1. Using over-the-counter vaginal lubrication which can make penetration more comfortable. 

  2. Hormone replacement therapy (HRT) can relieve symptoms of VVA and vaginal dryness/thinning.

  3. Adjust your sex life to include more foreplay to stimulate natural lubrication for less pain.

  4. Try topical ‘female viagra’ - not to be confused with a tablet men take - which Winona provides as a cream.

  5. “Use it or lose it.” Women who have not been sexually active for years are often surprised when sex is painful. So, staying sexually active and keeping the vagina healthy is critical to sexual health. 

  6. Vaginal estrogens and dehydroepiandrosterone (DHEA), are fast, safe, and effective treatments for VVA and other GSM symptoms.

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Prescription menopause relief. Delivered.

Men’s Viagra vs. Women’s

The best-known sexuopharmaceutical is Viagra, which focuses on enhancing sex for men. Viagra includes the chemical sildenafil citrate which increases the blood flow to the penis so a man can enjoy a harder, longer-lasting, erect penis. This was a breakthrough for aging men, but women have not been so lucky. Often because of VVA symptoms, women cannot, or do not want to, keep up with their male partner's new interest in sex. 

When a man arrives with a cure to his erectile dysfunction (ED) this can be a major change in the dynamics of a relationship. The average couple seeking help for ED haven’t engaged in penile-vaginal sex for 2–5 years. This change can potentially be incredibly harmful to a woman and their relationship, especially when the man is suddenly able to perform and wants sex again, but his female partner isn’t prepared.

Penetrative sex, even with lubrication, can be painful for many peri- and menopausal women. Because women’s levels of testosterone, progesterone, and estrogen drop off with age, their vaginal skin becomes drier and thinner. With sex, women may experience pelvic pain, irritation, and even tearing of the vaginal wall. 

Winona offers a sildenafil topical cream treatment called “Blossom” that can help increase blood flow, sensitivity, arousal, wetness, and orgasmic function for women. Because Blossom contains Sildenafil (which is the same ingredient in Viagra), when it is applied topically on the clitoris (instead of taken as a pill) it is safe and effective for women when prescribed by your Winona physician.

Available Solutions and Treatment Options

The good news is that menopausal women can resolve many painful sex and menopause, genitourinary symptoms,  improve their sexual health and their quality of life by appropriately treating GSM. The choice of therapy depends on a woman’s medical history, severity of symptoms, and patient preferences. 

Because of the complexity of a woman’s anatomy, they may need a combination of treatments. Painful sex after menopause is common, but treatment may include hormone replacement therapy, lubricants, and their own type of ‘Viagra’ so their libido is increased and their vaginas are prepared to enjoy sex once again.

While you can’t cure menopause, you can certainly manage its unpleasant symptoms. The sooner you meet with your Winona doctor, the sooner you can get relief from symptoms like painful sex. Options for relief can include hormone replacement therapy (HRT), lubricants, and vasodilators (Blossom for women). Check out Winona today to learn more.