As you go through menopause, falling estrogen levels cause many changes in your body. Changes in the vaginal tissues caused by lack of estrogen can make sex painful and uncomfortable. Many women report a feeling of dryness or tightness during sex, leading to pain that ranges from mild to severe.

Painful sex is a medical condition referred to as dyspareunia. What most women don’t realize is that dyspareunia is fairly common. Between 17 and 45 percent of postmenopausal women say they experience it.

Without treatment, dyspareunia can lead to inflammation and tearing of the vaginal tissues. Plus, the pain, or the fear of pain, can cause anxiety when it comes to having sex. But sex doesn’t have to be a source of anxiety and pain.

Dyspareunia is a real medical condition, and you don’t have to hesitate to see a doctor for treatment. Here’s a deeper look into the link between menopause and dyspareunia.

Common side effects of menopause

Menopause can cause a laundry list of uncomfortable symptoms. Every woman is different, though, so the set of symptoms you experience may differ from others.

The most common symptoms that women experience during menopause include:

  • hot flashes, night sweats, and flushing
  • weight gain and muscle loss
  • insomnia
  • vaginal dryness
  • depression
  • anxiety
  • reduced libido (sex drive)
  • dry skin
  • increased urination
  • sore or tender breasts
  • headaches
  • less full breasts
  • hair thinning or loss

Why sex becomes painful

The symptoms that women experience during menopause are primarily related to lowered levels of the female sex hormones estrogen and progesterone.

Lower levels of these hormones can cause a reduction in the thin layer of moisture that coats the vaginal walls. This can cause the vaginal lining to become dry, irritated, and inflamed. The inflammation can cause a condition called vaginal atrophy (atrophic vaginitis).

Changes in estrogen may also reduce your overall libido, and make it more difficult to become sexually stimulated. This can make it difficult for the vagina to become naturally lubricated.

When vaginal tissue becomes drier and thinner, it also becomes less elastic and more easily injured. During sex, the friction can cause small tears in the vagina, which leads to pain during penetration.

Other symptoms associated with vaginal dryness include:

  • itching, stinging, and burning around the vulva
  • feeling the need to urinate frequently
  • vaginal tightness
  • light bleeding after intercourse
  • soreness
  • frequent urinary tract infections
  • urinary incontinence (involuntary leakage)
  • increased risk of vaginal infections

For many women, painful sex can be a source of embarrassment and anxiety. Eventually, you may lose interest in having sex at all. This can have a profound effect on your relationship with your partner.

Getting help

If your symptoms are severe and affect your quality of life, don’t be afraid to see a doctor to learn about available medications.

Your doctor will first likely recommend using an over-the-counter (OTC) water-based lubricant or a vaginal moisturizer during sex. The lubricant should be free of perfumes, herbal extracts, or artificial colors, as these can be irritating. You might need to try several products to find the one that works for you.

If you still experience pain, your doctor may prescribe localized estrogen therapy. Estrogen therapy is available in several forms:

  • Vaginal creams, such as conjugated estrogens (Premarin). These release estrogen directly to the vagina. They’re applied two to three times per week. You shouldn’t use them right before sex as a lubricant because they can penetrate your partner’s skin.
  • Vaginal rings, such as the estradiol vaginal ring (Estring). These are inserted into the vagina and release a low-dose of estrogen directly to the vaginal tissues. They need to be replaced every three months.
  • Oral estrogen tablets, like estradiol (Vagifem). These are placed into the vagina once or twice per week using an applicator.
  • Oral estrogen pill, which can treat vaginal dryness along with other menopause symptoms, such as hot flashes. But prolonged use heightens the risk of certain cancers. Oral estrogen isn’t prescribed to women who’ve had cancer.

To maintain the benefits of estrogen therapy, it’s important to continue having regular sex. Doing so helps keep the vaginal tissues healthy by increasing blood flow to the vagina.

Other treatment options include ospemifene (Osphena) and prasterone (Intrarosa). Osphena is an oral tablet, while Intrarosa is a vaginal insert. Osphena acts like estrogen, but is hormone-free. Intrarosa is a steroid that replaces hormones that are normally made in the body.

The bottom line

Painful sex during or after menopause is a problem for many women, and is nothing to be ashamed about.

If vaginal dryness is affecting your sex life or your relationship with your partner, it’s time to get the help you need. The longer you wait to treat dyspareunia, the more damage you can do to your body. If left untreated, vaginal dryness can cause sores or tears in the vaginal tissues, which can make things worse.

A doctor or gynecologist can recommend treatments to stay on top of your symptoms and help you return to a healthy sex life.