Menopause brings about a number of physical changes. Ovaries stop releasing eggs, periods cease, hot flashes begin, and vaginal dryness becomes more common. Along with the dryness, vaginal pain may also increase during and after menopause.

Most pain after menopause can be traced to one issue: A drop in estrogen. This hormone is responsible for lubricating the skin in and around the vagina, making the tissues more flexible, and maintaining the vagina’s pH balance. (This helps keep infections at bay.)

The greater the drop in estrogen, the higher the likelihood of issues like vaginal dryness, tightness, and pain.

Learn more about what causes vaginal pain after menopause and what can help relieve the pain. This article will also look at other issues not related to menopause that could be responsible for vaginal pain or discomfort.

In most cases, vaginal discomfort and pain after menopause is related to sex. In fact, according to the North American Menopause Society, 17 to 45 percent of postmenopausal women say they find sex painful.

As estrogen levels drop, the vagina makes less of its own natural lubrication and moisture. The tissues become thinner and more fragile.

As a result, penetrative sex may cause tearing and irritation. Discomfort and pain after sex are more likely, too. In fact, it‘s not uncommon for postmenopausal women to experience soreness, burning, and irritation in the vagina or vulva after sex.

Pain after menopause may also be the result of vaginal tightness during sex. Without estrogen, your vagina can shorten and narrow at the opening. Penetration may be painful.

This dry, thin vaginal tissue and the resulting inflammation and irritation is a condition called vaginal atrophy or atrophic vaginitis. Other symptoms can include:

Without treatment, you may experience tearing and bleeding after sex. You may also be less inclined to have sex because of vaginal discomfort and pain.

Vaginal atrophy can also lead to chronic vaginal infections like yeast infections after menopause. Because of the changes in the vagina‘s pH, bacteria, yeast, and other organisms can grow and thrive more easily. This can also lead to vaginal discomfort.

Urinary function issues are common in people with vaginal atrophy, too. This includes urinary tract infections (UTIs) and bladder infections. These conditions cause pain and discomfort.

Vaginal pain after menopause is often easily treated. Your doctor will want to pinpoint the underlying cause of any pain or discomfort. This will help ensure you‘re receiving the proper treatment. Some of these treatments include:

  • Vaginal moisturizer. You can use over-the-counter vaginal moisturizers during sex or at other times to increase the vagina‘s moisture level. During sex, moisturizers can also help reduce friction.
  • Water-based lubricants. Lube can help reduce friction during sex, which may make sex less painful.
  • Estrogen. Supplementing estrogen levels may help increase the vagina‘s flexibility and lubrication. Some estrogen products can be applied topically to the vagina. A low dose estrogen supplement may help ease minor symptoms. Systemic hormone therapy, or hormone replacement therapy, provides larger doses of the hormone.

Hormonal changes aren‘t the only reason for vaginal pain after menopause. The following issues may also cause vaginal pain and discomfort:

  • Vulvodynia. Vulvodynia is a condition that causes chronic pain in the vulva, the outer part of the female genitals. It‘s unclear in most cases what causes it.
  • Vaginismus. This involuntary muscle spasm clamps off the opening to the vagina. That makes penetrative sex difficult, and penetration is often painful as a result. These contractions may be caused by any number of underlying issues, from psychological trauma to injury.
  • Urinary tract conditions. You may be familiar with a UTI, but other urinary issues can cause vaginal pain. These include bladder infections, bladder inflammation or irritation, and urethritis.
  • Sensitivity to condoms. Some people with an allergy to latex experience pain, discomfort, and itching if their partner uses a latex condom during sex.
  • Yeast infection. A yeast infection can cause pain, burning, and itching. Yeast infections are more common after menopause because of the changes to the natural environment of the vagina.

You don‘t have to live with vaginal pain after menopause. Lower estrogen levels do cause many changes to the body, including vaginal pain and discomfort. However, most of the underlying causes of this pain can be treated and corrected with your doctor‘s help.

Pain during sex after menopause is a common issue. Many of the other issues that can cause vaginal pain after menopause are common, too. Despite that, many people simply do not talk about it with their doctors or clinicians.

It may be a fear of embarrassment. It could also be simply not knowing how to bring up the topic. But if you don‘t discuss this issue, you won‘t have the opportunity to get help and treatment.

Tips for talking with your doctor

  • Speak about your quality of life. It may be easier to broach the subject of sex by talking about other issues first. For example, are you having a hard time sleeping through the night because of itchiness or burning? Is exercise more difficult because of the discomfort? Start with the symptoms. Then, as you feel more comfortable, explain other issues you’re experiencing.
  • Be honest. Your doctor can‘t treat what they don‘t know about. These issues are deeply personal to you, but remember that what you discuss with your doctor is private. It‘s also something they likely have helped other people treat many times.
  • Ask questions. During the visit, your doctor will ask you questions about your health and activities. You should be asking questions back to them. For example, you can ask about over-the-counter treatments that might help. You can also ask about sex practices that may be more comfortable.
  • Talk about lifestyle factors. Some issues may not have to do with menopause at all. They could be the result of lifestyle factors like irritating products — soaps, detergents, perfumes, or cleaning products can upset the vagina‘s pH balance and cause pain and vaginal burning. Wearing tight pants or exercise clothes too long could cause issues, too.
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After menopause, vaginal pain is typically the result of changes to the vagina caused by low estrogen levels. Less estrogen in the body leads to thinner, drier, and less elastic vaginal tissues. Penetrative sex may be more painful as a result of these changes, especially if you do not use lubrication.

Typically, vaginal pain after menopause is easily treatable. Over-the-counter lubrication or moisturizers can help during sex. In some cases, you may need a prescription from your doctor for estrogen supplements or creams. These treatments can help boost your estrogen levels and restore the vagina‘s natural moisture and flexibility.

If you‘re experiencing vaginal pain after menopause, talk with your doctor, who will be able to help you find the right treatment.