8 Ways to Treat Painful Sex During Menopause

Painful sex can be one of the many symptoms of menopause, but the good news is that it’s not something you have to live with forever. With the right strategies and treatments, intimacy can feel enjoyable again.

Pain before, during, or after intercourse is called dyspareunia. While dyspareunia can happen at any age, it’s particularly common during and after menopause because of the hormonal changes that affect vaginal tissues, lubrication, and pelvic floor function.

If sex is giving you more pain than pleasure, keep reading. We’ll explore why menopause can make sex painful, the science behind those changes, and eight evidence-based ways to make intimacy more comfortable.

Painful sex after menopause: Why does it happen?

One word: estrogen — or more accurately, the lack of it. Estrogen plays a critical role in keeping the tissues in and around the vagina and vulva thick, lubricated, and elastic. As estrogen levels decline in the lead-up to menopause, the vagina and vulva become thinner and drier. This condition, often called vaginal atrophy or atrophic vaginitis, means the tissues lose their natural flexibility and moisture, making any type of penetration uncomfortable or painful.

This collection of changes is referred to as genitourinary syndrome of menopause (GSM), which also includes urinary tract symptoms like urgency or recurrent infections. Urinary tract issues can contribute to discomfort and pain during sexual activity. This is the main driver of dyspareunia in menopausal women or people assigned female at birth (AFAB).

In some cases, the natural decline in estrogen can also contribute to pelvic floor dysfunction or pelvic organ prolapse. When pelvic muscles can’t properly support the bladder, uterus, or rectum, those organs may shift and press into the vaginal space, creating discomfort or pain during sex. Many women report that sex hurts or that sex is painful due to these changes.

Other factors and medical problems, such as infections, skin conditions, or medications, can also cause sexual pain. Experiencing pain or sexual pain during or after menopause is common, and many women experience pain during sexual activity.

How to treat painful sex during menopause

Menopause is an inevitable part of life for women and people assigned female at birth, but that doesn’t mean your sex life has to suffer. Sexual pain during or after menopause can often be effectively treated with a range of medical and prescription therapies. Some treatments specifically target the vaginal opening to relieve discomfort during intercourse. The following treatments can help reduce pain, restore comfort, and make intimacy enjoyable again.

Hormone replacement therapy

Hormone replacement therapy (HRT) replenishes the estrogen your body no longer produces naturally. This can restore the thickness, elasticity, and natural lubrication of vaginal tissues, reducing pain during sex and addressing other systemic symptoms like hot flashes or night sweats.

HRT can be prescribed in pills, gels, or patches depending on your needs and lifestyle. However, systemic estrogen therapy isn’t for everyone. It may not be safe if you have a history of stroke, blood clots, breast cancer, ovarian cancer, or certain heart conditions.

If you’re considering HRT, especially if you have a history of breast cancer, talk to your healthcare provider about your personal risk factors and whether systemic therapy is right for you.

Vaginal estrogen

If your primary symptoms are vaginal dryness, discomfort, or pain, vaginal estrogen (also called local or topical estrogen) can be a safer and highly effective alternative.

Applied via a low-dose cream, vaginal ring, vaginal tablet, or small insert (pessary), this treatment delivers estrogen directly to the vaginal tissues without significantly entering the bloodstream. This makes it a safer option for people who may not be candidates for systemic HRT.

In many cases, vaginal estrogen works even better than systemic estrogen at restoring vaginal comfort because it targets the tissues directly.

Vaginal moisturizers

For a hormone-free alternative, vaginal moisturizers can be a great first step. These products hydrate the vaginal lining and help restore the tissue barrier, reducing irritation and dryness.

Unlike lubricants, which are used only during sex, vaginal moisturizers are applied regularly (daily or every few days) to keep tissues hydrated and more comfortable throughout the day.

Many people find that pairing moisturizers with lubricants during intimacy provides the best relief.

Lubricants

Never underestimate the power of lube! Whether you’re 25 or 65, lubricants reduce friction, prevent micro-tears, and make sex more pleasurable.

There are three main types: water-based, silicone-based, and oil-based lubricants. Water-based lubes are versatile and condom-safe, silicone-based formulas last longer and are great for severe dryness, and oil-based lubricants can feel silky and provide extra slipperiness, but should not be used with latex condoms as they can cause the condom to break. For vaginal health, look for a pH-balanced, body-safe lubricant to avoid increasing your risk of irritation or infections.

Prioritize foreplay

Arousal increases natural vaginal lubrication, which can make penetration easier and more comfortable. Rather than rushing straight into intercourse, spend time on foreplay — kissing, touching, or oral sex — to help your body naturally prepare.

This isn’t just about physical readiness. Prioritizing foreplay also builds intimacy and reduces the anxiety that often comes with painful sex, helping break the cycle of fear and discomfort.

Pelvic floor physical therapy

If pelvic organ prolapse or pelvic floor tightness is contributing to pain, pelvic floor therapy can be transformative.

Kegel exercises and guided physiotherapy help strengthen and relax the muscles of the pelvic floor, improving blood flow, supporting vaginal tissues, and reducing discomfort during sex. Vaginal dilators can also be used under professional guidance to help stretch tight muscles and improve comfort.

If you’re unsure where to start, consult an OB-GYN or pelvic floor physical therapist. They can design a tailored program to meet your specific needs.

Ospemifene and prasterone

For people seeking prescription options beyond estrogen, two FDA-approved medications can help:

• Ospemifene is an oral selective estrogen receptor modulator (SERM) that acts like estrogen in vaginal tissues, thickening the vaginal lining and reducing pain.
• Prasterone (DHEA) is a daily vaginal insert that converts into estrogen and androgen locally, improving hydration and elasticity.

These therapies may be suitable for those who can’t or prefer not to use traditional estrogen therapies, but they do require a doctor’s prescription.

Masturbate and explore non-penetrative pleasure

Penetration isn’t the only path to intimacy. Solo or mutual masturbation, oral sex, or external stimulation can all help you maintain intimacy while avoiding discomfort during penetration.

Masturbation also increases blood flow to vaginal tissues, which can promote elasticity and lubrication over time, making other forms of intimacy more comfortable down the line.

Recommended products for painful sex after menopause

Evvy Hyaluronic Acid Suppositories

Evvy’s Hyaluronic Acid Suppositories provide deep hydration to vaginal tissues, reducing dryness and friction during sex. Regular use can restore moisture balance and support more comfortable intimacy without introducing hormones.

Evvy Anti-Itch Vulva Cream

For external irritation or itching that often accompanies GSM, Evvy’s Anti-Itch ulva Cream is a soothing, external-use-only cream that calms inflammation and supports the skin barrier of the vulva.

Evvy Soothing Vulva Cream

Designed for external dryness and irritation, Evvy’s Soothing Vulva Cream provides gentle hydration to improve everyday comfort and make intimacy feel more natural and less painful.

These products can be used alone or in combination with other treatments like lubricants, moisturizers, or even local estrogen therapies, depending on your needs and preferences.

Seeking medical help

If you’re experiencing painful sex or other symptoms related to menopause, seeking medical help is an important step toward relief. A knowledgeable healthcare provider can assess your symptoms, perform a physical exam, and recommend treatment options tailored to your needs.

In some cases, working with a sex therapist can help address sexual problems and improve sexual function, while pelvic floor physical therapy can be highly effective for treating pelvic floor dysfunction and relieving pain during sex.

Remember, you don’t have to navigate these changes alone. There are many treatment options available, and the right treatment can make a significant difference in your comfort and quality of life.

The importance of communication

Open communication is essential for addressing sexual problems and maintaining sexual health during and after menopause. Postmenopausal women should feel empowered to discuss symptoms like painful sex, vaginal dryness, or changes in their sex life with both their healthcare provider and their partner.

Honest conversations can help identify the underlying cause of discomfort and lead to effective treatments that restore intimacy and confidence. Painful sex isn't an inevitable part of menopause, and seeking help is the first step toward finding relief. By communicating openly, you can advocate for your needs, explore treatment options, and maintain a fulfilling sex life throughout menopause and beyond.

FAQs about painful sex during menopause

What exercises reduce pain during sex?

Exercises that strengthen and relax the pelvic floor muscles, such as Kegels or guided pelvic floor physiotherapy, can reduce pain during sex. Strengthening these muscles improves blood flow and tissue support, while learning to relax them helps decrease tightness that can make penetration painful.

How to make sex less painful during menopause

Keeping vaginal tissues hydrated and elastic is key. Regular use of vaginal moisturizers, good-quality lubricants during sex, and, if appropriate, vaginal estrogen can help significantly. Pairing these with longer foreplay can boost natural lubrication. If pain persists despite these changes, consult a healthcare provider. Advanced treatments like vaginal estrogen, DHEA inserts, or pelvic floor therapy may be needed to fully restore comfort.

What is painful sex during menopause called?

Painful sex during menopause is called dyspareunia. It’s most often caused by the changes associated with genitourinary syndrome of menopause, including vaginal dryness, loss of elasticity, and thinning tissues. These changes can make penetration uncomfortable or painful and sometimes cause burning or irritation.

What is the best cream for painful sex after menopause?

The best cream depends on your specific symptoms and whether you prefer hormonal or hormone-free treatments. For a hormone-free option, Evvy’s Hyaluronic Acid Suppositories and Soothing Vulva Cream provide hydration that restores moisture and reduces friction. For people with more advanced GSM symptoms, prescription vaginal estrogen creams can restore tissue thickness and elasticity, offering longer-lasting relief. Always consult a healthcare provider to find the approach that fits your needs and medical history.