Sex and gender terminology
Sex and gender exist on spectrums. This article uses the terms “female” and “women” when discussing people who are assigned female at birth to reflect language that appears in source materials.
Read more about sex and gender in this Healthline article.
The loss of estrogen and testosterone during menopause causes changes in your body and sex drive. Declining estrogen levels can lead to vaginal dryness, hot flashes and night sweats, and mood changes. It can affect female arousal, drive, and physical pleasure.
Sexual intercourse can be painful due to a loss of estrogen in the vaginal tissues. There is a decreased blood supply to the vagina, which can reduce vaginal lubrication. Thinning of the vaginal walls can lead to atrophy, which causes the vagina to become less elastic and dry. This leads to pain during intercourse.
It’s a common problem, but not all people experience vaginal dryness. Regular intercourse and vaginal activity can keep the vaginal muscles toned, stimulate blood flow, and help preserve elasticity.
Yes. According to a 2022 study, painful sexual intercourse may occur in anywhere from 20% to 59% of women experiencing perimenopause or postmenopause.
Potentially. Loss of hormones can affect other body organs.
Estrogen loss
Various methods are available to help manage painful intercourse.
Regular sexual activity helps maintain a healthy vaginal environment and elasticity by increasing blood flow. Lubricants and moisturizers like K-Y and Replens may provide relief during intercourse.
Prescription treatments include vaginal estrogen, which is available as a cream, vaginal ring, or tablet. This form of estrogen is local, meaning you apply it only to the vaginal area. It
Oral forms of estrogen include conjugated estrogens (Premarin) and estradiol (Estrace). They provide systemic relief from menopausal symptoms. You should discuss the risks of this form of therapy with your doctor. You could also ask about estrogen therapy in the form of a skin patch.
Non-estrogen medications that improve vaginal thickness include ospemifene (Osphena), which is a daily pill, and prasterone (Intrarosa), which is a steroid insert that goes in your vagina.
Soy estrogens, natural herbs, and creams may help, but talk with your doctor first. Other modalities that may improve your sex life include regular physical activity, getting adequate sleep each night, and eating a balanced diet.
Sex therapy and mindfulness may also help some people.
Have a candid discussion with your partner about the ways menopause is affecting you. If you’re experiencing fatigue, vaginal dryness, or a lack of desire, communicating with your partner may help decrease your anxiety about performance.
Tell your partner what’s comfortable and what’s painful. You could also discuss it with your primary care physician or OB-GYN.
Libido decline and painful intercourse are common. Many times a healthcare professional can help guide you to treatment. Medications and alternative therapies may help.