Painful sex is far more common during and after menopause than most people realize. The medical term for painful sex is dyspareunia, and it’s usually a result of declining estrogen levels.

Many people delay getting the help they need. They might be reluctant to discuss sexual problems with their doctor, or they might not realize that painful sex is related to menopause.

Having an active sex life is important. A doctor will be able address your symptoms by treating the underlying cause.

Here are six signs it’s time to see a doctor about painful sex.

Lower estrogen levels during and after menopause can thin and dry the vaginal tissues. This makes it difficult to become naturally lubricated.

You can try an over-the-counter, water-based lubricant or vaginal moisturizer during sex when this happens, but for some people, that’s not enough.

If you’ve already tried several products and still find sex too painful, see your doctor to discuss treatment options. Your doctor may prescribe a vaginal cream, insert, or supplement to help reduce your symptoms.

After menopause, vaginal bleeding at any time should be evaluated by a doctor. This could be a sign of something serious. Your doctor will want to rule out any other conditions before you’re given a diagnosis of dyspareunia.

The thinning of the vaginal walls, also known as vaginal atrophy, can be caused by decreased estrogen levels. This commonly occurs after menopause. Vaginal atrophy increases your risk of vaginal infections, urinary function problems, and urinary tract infections (UTIs).

Symptoms include more frequent urination or a more urgent need to urinate, and a painful, burning sensation during urination.

Sexual pain can be worse if you’re also experiencing pain during urination. Your doctor will need to prescribe antibiotics to treat a UTI.

Your partner(s) might have a difficult time understanding what you’re going through. You might feel embarrassed or hesitant to talk about the pain with them, or you might find it hard to describe what type of pain you’re having.

Eventually, you might start losing interest in having sex at all. But avoiding sex and not being open about how you feel can breed negativity in your relationship(s).

Speak with your doctor about your physical symptoms, and ask them about seeing a therapist if you’re having trouble with communication.

Sex is a healthy part of a relationship, but constant pain can turn it into a source of anxiety. Your pelvic floor muscles may also tighten in response to stress and anxiety, making matters worse.

If you find that the fear of pain and anxiety about sex is making you avoid it, it’s time to see a doctor.

For some people, store-bought lubricants and vaginal creams help reduce the severity of pain during sex. For others, despite the use of lubricants, the pain gets worse.

You may even start having other problems related to vaginal dryness.

Make an appointment to see a doctor or gynecologist if the pain doesn’t go away or if you have any of these symptoms:

  • itching or burning around the vulva
  • frequent need to urinate
  • vaginal tightness
  • light bleeding after sex
  • frequent UTIs
  • urinary incontinence (involuntary leakage)
  • frequent vaginal infections

Visiting your doctor to talk about painful sex can be nerve-racking, but being prepared can help ease tension.

Your doctor is there to help you feel better, both mentally and physically, but you can’t always expect them to initiate the conversation.

In a 2014 study, only 13 percent of women said their healthcare provider started the conversation about postmenopausal vaginal changes.

Try to prepare beforehand by making a list of your symptoms and medical information, such as:

  • when your sexual problems began
  • what factors influence your symptoms
  • if you’ve already tried something to address your symptoms
  • any other vitamins, supplements, or medications you’re taking
  • when menopause began for you or when it ended
  • if you have symptoms other than pain, such as problems urinating or hot flashes

Your appointment is a good time to ask questions. Here’s a list of questions to get you started:

  • “What is causing painful sex?”
  • “Apart from medications and lube, are there any other lifestyle changes I can make to improve the situation?”
  • “Are there any websites, pamphlets, or books you recommend for more advice?”
  • “Will treatment help? How long will I need treatment?”

Of the 64 million postmenopausal women in the United States, as many as half may be experiencing symptoms of painful sex, vaginal dryness, and vaginal irritation. That’s 32 million women!

Painful sex doesn’t have to be something you learn to live with. Though doctors are becoming more aware of the need to bring up these topics with patients who’ve gone through menopause, this isn’t always the case. Talking about sex can be uncomfortable, but it’s important to be proactive and discuss your pain with your doctor.