Why painful sex is common during menopause, what your vagina is trying to tell you, why lube isn’t the solution, and how to get your pleasure back.
Ladies, we need to talk about something that makes me want to scream into a pillow.
Women having painful sex because they believe it’s their responsibility to keep their partners sexually satisfied.
HELL NO.
If intercourse hurts, stop. Not because your sex life is over, but because your pleasure and comfort matter just as much as your partner’s.
As an AASECT Certified Sex Therapist, I regularly work with women who have been tolerating painful intercourse for months, sometimes years.
And here’s what I want every woman to understand: Painful sex during menopause is common. But that doesn’t mean it’s something you should accept. Or something that’s untreatable.
What the Hell Is Happening to My Vagina?
Remember when your vagina was cooperative? Comfortable? Perhaps even enthusiastic about penetration?
Then perimenopause or menopause arrives, estrogen levels decline, and suddenly your vagina seems really pissed off and not working like it used to.
There’s an actual medical explanation.
It was previously referred to as Vaginal Atrophy but has more recently and accurately been renamed Genitourinary Syndrome of Menopause (GSM).
According to The Menopause Society, declining estrogen can affect the vulva, vagina, and urinary tract. Estrogen helps maintain healthy vaginal tissue. When levels decline:
- Vaginal tissues can become thinner, drier, and more fragile.
- The vagina loses some of its elasticity and natural lubrication.
- The vaginal opening may become narrower.
- Penetration can cause burning, irritation, tiny tears, or bleeding.
Imagine rubbing two pieces of delicate tissue paper together when they’re supposed to glide smoothly.
Not exactly a recipe for pleasure.
And here’s something REALLY important: Unlike hot flashes, which may eventually decrease or end, these vaginal changes usually worsen without treatment.
So waiting for your vagina to magically get its shit together isn’t a winning strategy.
Why You Should NEVER Push Through Painful Sex
Here’s a question I frequently ask women:
“Would you want your partner to experience physical pain so you could have an orgasm?”
Of course not! So why the hell are we expecting women to do exactly that?
Some women continue having painful intercourse because they don’t want to disappoint their partners, fear losing intimacy, or believe sex is something they owe their relationship. I’ve written about this in my blog before, for women who have struggled with painful sex for different reasons. But clearly you ladies didn’t get the memo, so this time, I’m using ALL CAPS!
But repeatedly experiencing pain can teach your brain to associate sex with discomfort, fear, and dread.
Your body starts anticipating pain, your pelvic floor muscles may tighten, ultimately making intercourse more painful, and your desire can disappear.
And then women wonder why their libido has gone missing.
Well, no shit! Who wants more of something that hurts?
I’ve written about this in my blog, It Makes Sense to Not Desire Bad Sex.
Your body isn’t betraying you. It’s trying to protect you.
First Things First: Get Medical Treatment
I cannot emphasize this enough.
If you’re experiencing painful intercourse during menopause, please see a knowledgeable gynecologist or menopause specialist.
You may need medical treatment to address the underlying tissue changes—not just another bottle of lube.
Vaginal Estrogen: A Game Changer for Many Women
One of the most effective treatments for GSM is low-dose vaginal estrogen.
Available as creams, tablets, inserts, or rings, it delivers estrogen directly to vaginal tissues.
It can help restore tissue thickness, elasticity, moisture, and comfort.
Unlike systemic hormone therapy, low-dose vaginal estrogen has minimal absorption into the bloodstream. Your doctor can help determine whether it’s appropriate for you.
And yes, women already using systemic hormone therapy experiencing pain with intercourse often still need vaginal estrogen.
Other treatment options include:
- Vaginal moisturizers: Used regularly to help manage dryness.
- Lubricants: Water-based or silicone-based products to reduce friction during sexual activity.
- Vaginal DHEA or prescription alternatives: Options for women who need additional treatment.
- Pelvic floor physical therapy: Particularly helpful when muscle tension contributes to pain.
These treatments aren’t interchangeable. Lubricant reduces friction, but it doesn’t reverse estrogen-related tissue changes.
If your clinician dismisses your concerns with “It’s just menopause,” find someone who understands menopausal sexual health at the menopause society.
You deserve better.
Outercourse: Because Penetration Isn’t the Main Event
Now for the fun part.
Sex doesn’t have to mean intercourse.
Somewhere along the way, we decided that kissing, touching, oral sex, massage, and mutual masturbation were merely appetizers before the main course.
Bullshit.
I prefer calling these activities outercourse rather than foreplay because they’re legitimate sexual experiences all by themselves and they shouldn’t be considered just an appetizer to the main entry. Can we say patriarchy?
While you’re getting appropriate medical treatment, take painful penetration completely off the menu.
Explore what feels pleasurable instead.
Try extended kissing, sensual massage, mutual masturbation, external clitoral stimulation, or simply enjoying naked cuddling.
Experiment with sex toys if they’re comfortable.
And here’s a revolutionary idea: You can have an incredibly satisfying sexual experience without putting anything inside your vagina.
Imagine that!
For more ideas, explore my sex education resources and books, When Sex Hurts or Come As You Are, or others on my Book Recommendations page.
How to Talk to Your Partner Without Killing the Mood
Try saying:
“I love being intimate with you, but intercourse has become painful because of the physical changes I’m experiencing. I’m getting medical help, and in the meantime, I want us to explore other ways to enjoy each other.”
That’s not rejection.
That’s an invitation to create a better sexual relationship.
And if your partner feels disappointed? They can have those feelings without you having to sacrifice your physical comfort.
Your partner’s pleasure should never come at the expense of your pain.
Menopause Doesn’t Mean the End of Great Sex
Menopause changes our bodies, but it doesn’t mean we have to retire our sexuality.
With appropriate medical care, better communication, and a willingness to redefine what sex looks like, pleasure can absolutely remain part of your life.
Read more on my Menopause & Sex resource page.
And remember: Sex should be pleasurable, not something you endure.
Your vagina deserves better. And so do you.
Struggling with painful sex, changing desire, or intimacy during menopause? Learn how sex therapy can help.
Now, go have outercourse aka sex!