Complete Symptom Guide to Painful Sex and Menopause - Stella

Menopause and painful sex


It can feel distressing and upsetting when what should be a pleasurable experience becomes painful. Painful sex can often wreak havoc on your libido, sense of self and relationships. It can often make you want to avoid being sexual. Thankfully, it isn’t all gloom and doom – there are several potential causes of painful sex during and after menopause and in nearly every case, it is treatable.


In medical terms, recurrent, or persistent genital pain that occurs before, during or after sex is referred to as dyspareunia. This pain widely varies and can be: 

  • Felt on entry or deep penetration 
  • Vary in intensity from mild to excruciating
  • Occur occasionally or every time 

Sexual pain that is associated with menopause is often due to genitourinary syndrome of menopause or GSM (the medical term for some of the vaginal and urinary changes that occur during menopause). 

GSM is thought to affect up to half during menopause, many of whom report their vagina feels dry, rough, or raw. The tissue in the vagina may also feel fragile and it may bleed more easily. Find out more about why your vagina looks and feels different after menopause.

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  • If you experience painful sex, you are not alone
  • Three-quarters report painful sex at some point and it is particularly common during and after menopause
  • Although painful sex is common, you don’t need to accept it as normal

Read more about the stages of menopause.


External pain on your vulva

Internal pain in your vagina, uterus or pelvis

Sharp pain, burning, stabbing, aching or throbbing

Painful sex during or after menopause may leave you with feelings of shame or that something is wrong. Have a read of our post on sexual self-esteem to find out how to address this.


Sexual pain associated with the changes of menopause can often be easily and successfully treated.

Tune in with your body

If something hurts or doesn’t feel good, don’t force it or try to push through the pain. You need to love and respect your body, not self inflict pain.

Try a vulvar or vaginal moisturiser

These can help to increase moisture and the tissue quality of the vulvar and vaginal tissues. You can buy them without prescription, and your pharmacist will be able to advise on which products to try.


Lube can help decrease pain during sex and can be applied as needed. Be aware that lubes and vaginal moisturisers work in different ways, so you may wish to try both.

Think outside the box

Sex can be so much more than just penetration. Try sexual activities such as touching, oral sex or mutual masturbation.

Increase foreplay

Although foreplay alone rarely cures painful sex in menopause, it may help you become more aroused and decrease your pain response.

Have sex with yourself

Just because you are having pain with sex does not mean that you don’t deserve to have pleasure. It is important to remind yourself that you can feel good in your body. Check out our sex toy guide here.

Communicate about sexual pain

 Sexual partners are not mind readers – so it is important to communicate about painful sex, particularly if some positions feel more painful and can be avoided. Avoiding positions that inflict pain can help teach your body not to anticipate pain with sex.

Improve your washing and grooming habits

Avoid soap, loofahs, douches or sprays to clean the vulva or vagina. These can actually dry out and irritate the tissues.

Take pain-relieving steps

To reduce pain on deep penetration, you can try something like the Ohnut rings to adjust the depth of penetration to what feels comfortable. Other preventative steps include taking a warm bath or painkiller prior to sex. After sex, apply an ice pack to the vulvar area.

See a doctor

If you have painful sex, you should always go to see a doctor for review. They will be able to help you work out what is causing the pain, and how best to treat it. Depending on the cause of your painful sex, seeing a sex therapist or pelvic floor physio may also be helpful. See your doctor urgently if you have any bleeding after sex, bleeding in between periods, sores on the vulva or vagina or any other symptoms which are worrying you.

Consider topical oestrogen

This comes in the form of creams, pessaries or rings and is applied directly to the vaginal area. This is an effective, low-risk form of HRT and is used to treat menopausal changes in the vagina and surrounding tissues which could be causing your pain. Speak to your doctor for further advice about this and other forms of HRT.

Quit smoking

Smoking can worsen dryness and contribute to painful sex.


Experiencing painful sex often results in a fear cycle around sex. Your body has a good memory and if it expects to experience pain then it sets up an involuntary reaction of tensing up which can actually worsen the pain. You may start to fear or feel anxious about sex and even avoid it altogether. 


The best way to break this cycle is to find sexual activities that don’t hurt and to create clear boundaries with your partner so that when you do have sex, you know that it won’t hurt.

If you experience sexual pain from intercourse or any other activity, stop doing it…today. Many often believe that if they could just push through the pain that it will get better. However, doing this is actually counterproductive. 


Continuing to have painful sex can actually exacerbate the pain and you are also creating a link in your head between pain and sex. Stopping doing anything sexual that hurts you might mean that you need to explore new ways to have sex for a while. There are so many types of sex that you can have that don’t involve penetration.

During perimenopause and menopause, painful sex often is associated with changes in hormone levels which can cause:

  • Less moisture and lubrication in the vagina
  • Thinner and less elastic vaginal tissues 
  • Changes to the vagina including narrowing and tightness

You may experience vaginal irritation, dryness, itching and burning. Over time, sex without sufficient lubrication can result in inflammation and a greater risk of tearing or bleeding – and of course painful sex. 

Your sexual pain may be related to other causes, such as:

  • Vaginismus
  • Pelvic floor dysfunction
  • Gynaecological conditions (such as endometriosis or ovarian cysts)
  • Vaginal infections or STIs
  • Partner techniques
  • Psychological causes (such as stress or anxiety) 
  • Past injury
  • Genital washing practices
  • Skin conditions
  • Many other reasons 

Due to the wide range of causes of sexual pain, we always recommend that you see your doctor for a physical exam and investigations.

Some go from doctor to doctor without getting help or gaining an understanding of why they might be experiencing sexual pain. Some even report being told ‘just to relax’ or simply have a glass of wine. But this advice can add to the feeling that there is something wrong with you or that things are all in your head – which it is not. 

The reality is that sexual pain can often be both psychological and physical. If someone tells you that the pain is imagined or doesn’t take your concerns seriously, it might indicate that your doctor doesn’t know how to handle this problem. There are plenty of other health professionals out there – find someone else!


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