Painful Sex After Menopause: Causes and How to Find Relief

Why Is Sex Painful After Menopause?

You have always had a satisfying and comfortable intimate life, but soon after menopause, sex becomes uncomfortable and sometimes painful, making you lose interest. What is behind this change? Is it all in your mind, or are your hormones to blame?

Various factors are responsible for discomfort and pain during sex post-menopause. Let us look at the causes:

1. Hormonal Changes and Sexual Discomfort:

• During menopause, the declining levels of your sex hormones, especially that of oestrogen, cause thinning of your vaginal walls, leading to a loss of elasticity and dryness. This makes sexual intercourse painful.

2. Decreased Lubrication:

• Oestrogen stimulates the production of natural lubrication in the vagina, keeping it thick, elastic and healthy. When oestrogen levels fall during menopause, production of natural lubrication reduces, resulting in vaginal dryness, causing friction, pain and discomfort during sex.

3. Weak Pelvic Muscles:

• Post-menopause, your pelvic floor muscles begin to weaken, leading to tightness of the vagina, making sex painful. Weak pelvic muscles may also make it harder to maintain bowel and bladder control.

4. Emotional and Psychological Factors:

• Menopause can also cause anxiety, stress, low mood or body image issues, which contribute to difficulties in arousal and make sex uncomfortable or painful. Experiences of past sexual trauma can also negatively impact your sexual health.

Common Causes of Painful Sex After Menopause

Have you ever wondered what might be making sex painful after you reach menopause? Here are some common conditions that cause painful sex after menopause: 

1. Vaginal Atrophy:

• Vaginal atrophy is a condition directly related to low oestrogen levels where thinning of the vaginal walls leads to inflammation. It causes pain along with itching and a burning sensation during sex.

2. Decreased Vaginal Elasticity:

• Low oestrogen levels in the bloodstream make your vaginal walls thin and less elastic, leading to vaginal dryness post-menopause. This makes penetration uncomfortable and even painful for women.

3. Pelvic Floor Dysfunction:

• During menopause, the natural decline in oestrogen, along with less physical activity and the natural ageing process, can make your pelvic floor muscles weak and tight, making intercourse painful or uncomfortable.

4. Urinary Tract Infections (UTIs):

• Urinary infections can affect your vaginal area, making it sore and tender. UTIs can also worsen vaginal dryness, leading to vaginal discomfort and painful sex.

5. Chronic Conditions and Medications:

• Long-standing health issues like diabetes, high blood pressure, obesity, arthritis, and thyroid disorders, and some medications like antidepressants can cause poor blood circulation, stiffness of the body, and hormonal imbalances, which can affect sexual function and contribute to painful sex post-menopause.

6. Psychological Factors:

• Menopause can bring with it psychological symptoms like low mood, anxiety, stress and depression. It can affect the way you perceive yourself, leading to body image issues and low self-confidence. This can also be a factor for painful and uncomfortable sex after menopause.

How to Find Relief from Painful Sex After Menopause?

There are several effective ways to restore comfort and intimacy in your postmenopausal life. Here are some proven methods that can relieve dyspareunia:

1. Vaginal Moisturisers and Lubricants:

• To reduce vaginal dryness, you can make use of over-the-counter vaginal lubricants or moisturisers. Water-based and silicone-based lubricants are the best, as it is easy to clean and has reduced chances of causing vaginal irritation.

2. Topical Oestrogen:

• Topical means something that is applied directly to your body. To replace declining levels of oestrogen after menopause, use topical oestrogen therapies like oestrogen creams, gels or patches. Small, flexible devices called oestrogen rings are placed in the vagina to relieve vaginal dryness, irritation and painful sex.

3. Pelvic Floor Exercises for Sexual Health (Kegels):

• Practising Kegel exercises can strengthen your pelvic floor muscles by improving blood circulation to the tissues. It can also help improve vaginal lubrication and reduce discomfort during sex.

4. Vaginal Dilators:

• For women experiencing postmenopausal vaginal atrophy, medical devices called vaginal dilators can be useful in reducing pain and discomfort during vaginal penetration. Vaginal dilators can help you gradually stretch your vaginal tissues and reduce tightness, making sex more comfortable.

5. Hormone Replacement Therapy (HRT):

• HRT involves administration of oestrogen alone or combined with progesterone in the form of pills, gels, patches or injections to reduce postmenopausal symptoms like vaginal dryness, restore hormonal balance and thereby reduce discomfort during intercourse.

Non-hormonal Treatments for Painful Sex

Some women prefer non-hormonal treatments for vaginal dryness and painful sex either due to concerns about the side effects of hormonal therapy, history of other diseases or simply because of their personal preferences. Here are some effective non-hormonal treatments to manage painful sex:

1. Vaginal Lubricants:

• Water-based and silicone-based lubricants are recommended to reduce vaginal dryness.

2. Antidepressants:

• Antidepressant medications or cannabidiol (CBD) products reduce anxiety and stress associated with menopause. When used as a topical application, CBD oils and lubricants can reduce vaginal dryness and pain perception.

3. Herbal Supplements:

• Herbal supplements can balance hormone levels, heal and soothe vaginal irritations and reduce stress and anxiety accompanying menopause. Ayurvedic herbs like asparagus (Shatavari) and Indian ginseng (Ashwagandha) balance your hormones, aloe vera and Triphala soothes and heals the vaginal walls and spikenard (Jatamansi), and Indian pennywort (Brahmi) improves mental health by reducing stress and anxiety.

4. Acupuncture:

• According to a study, Acupuncture is an effective, simple and easily available alternative treatment that can improve sexual arousal and vaginal lubrication and reduce dyspareunia.

Emotional and Psychological Support 

Anxiety and depression associated with menopause can lower your self-esteem and confidence and negatively impact your sexual health and intimacy. Let us look at some methods to improve your sexual well-being. 

1. Talk to your Partner: 

• Your partner might feel confused and not able to understand what you are going through. It is important to share your feelings and communicate openly with your partner about the pain you experience during sex. Understanding and patience can make your sexual experience more comfortable. 

2. Manage Anxiety and Stress: 

• Methods like yoga, meditation, and deep breathing exercises reduce stress and anxiety levels and improve sexual well-being. 

3. Therapy for Sexual Health Issues: 

Therapy can be beneficial in addressing both the physical and emotional problems you are facing after menopause. Some common therapies are: 

4. Cognitive Behavioural Therapy (CBT):

• This therapy helps you solve the issues you are facing by changing the way you think and approach it. It is used to treat anxiety and depression leading to painful sex or lack of interest in sex. 

5. Sex Therapy for Menopause:

• A trained sex therapist will help you identify the cause of pain during sex and teach you methods to cope, communicate better with your partner and improve intimacy. 

7. Couples Therapy:

• If painful sex is affecting the relationship with your partner, couples therapy can help. It helps you understand each other’s needs, reduce misunderstandings and improve relationships and intimacy.

Lifestyle Changes to Support Sexual Health

Simple changes in your lifestyle can go a long way in supporting your overall as well as sexual health.

Here’s a list of expert-recommended diet and lifestyle tips that address both physical and emotional challenges of menopause to improve your sexual health:

1. Regular Exercise:

• Staying physically active by doing exercises like brisk walking, jogging, swimming, or cycling improves your mood, increases blood circulation, and strengthens your muscles. Pelvic exercises can strengthen the pelvic floor muscles, thereby reducing pain and discomfort during sex.

2. Healthy Diet:

• Consuming a balanced and nutritious diet, including omega-3 fatty acid-rich fish and nuts, foods rich in antioxidants, and staying hydrated throughout the day by drinking plenty of water is essential for your overall and sexual well-being.

3. Balance the Hormones:

• Include phytoestrogen-rich foods (phytoestrogens are substances found in plant sources that produce effects like oestrogen in the body) like soybeans, flaxseeds and legumes. Balanced hormones improve sexual health and relieve painful sex after menopause. Read more about how to manage your hormones naturally.

4. Sleep Well:

• Ensure you get at least 7 to 9 hours of sleep every night. Good sleep naturally balances your hormones and improves mood.

5. Quit Unhealthy Habits:

• Limit smoking and consumption of alcohol, and reduce intake of fatty and processed foods as these may lead to hormonal imbalances and worsen your symptoms.

When to Seek Professional Help

In most cases, simple techniques and lifestyle changes can help manage postmenopausal painful sex. However, there are certain conditions where professional medical help becomes necessary. You should consult a doctor for the following conditions:

1. Persistent Pain:

• If you experience pain during sex even after using vaginal lubricants or if you notice other symptoms accompanying pain like bleeding or abnormal vaginal discharge, it is important to consult a healthcare provider for the right treatment and to rule out other potential conditions.

2. Hormonal Imbalance or Vaginal Atrophy:

• If the hormonal imbalances happening during menopause leads to vaginal atrophy and pain during sex, specific hormonal or non-hormonal treatments can relieve your symptoms and give you lasting relief from sexual discomfort.

3. Other Underlying Health Issues:

• Other health conditions, such as vaginal or urinary infections, weak pelvic floor muscles, endometriosis and so on, can cause pain during sex. Long-standing health problems like diabetes, high blood pressure or arthritis can affect your nerves, muscles and blood flow, leading to reduced sexual health.

4. Medications:

• Certain medications like antidepressants or cancer treatments like chemotherapy can cause a lack of interest in sex and vaginal dryness, making sex painful and uncomfortable.

Preventing Painful Sex in the Future

Is painful sex post-menopause preventable? Yes, with the right interventions, this problem that most women face after menopause can be prevented.

• Prevent vaginal dryness by regular use of vaginal moisturisers and lubricants during sex.
• Keep your pelvic muscles strong by practising Kegel exercises regularly.
• Get regular gynaecological check-ups done.
• Get treatments, if necessary, to enjoy a comfortable and pain-free sexual life post-menopause.

Wrapping Up

Many women experience painful or uncomfortable sex, which may be due to hormonal imbalances, weakness of the pelvic floor muscles, other underlying health issues or even the stress, anxiety and emotional challenges they face after menopause.

Don’t be disheartened! There are many treatment options which can help you manage and relieve discomfort, help you regain confidence, and improve intimacy.

Remember, menopause is not the end of your sexual life – it is a new phase which can be a satisfying and enjoyable intimate journey with the right support and care!

Are postmenopausal changes giving you a tough time? Face these challenges hand-in-hand with our expert Ayurveda and Yoga practitioners at Nirva Health. We’re here for you every step of your journey to wellness!