If sex has become uncomfortable or even painful during perimenpause or menopause, you’re not imagining it—and you’re not alone. Around 60% of postmenopausal women experience discomfort during intercourse, yet it’s rarely talked about. The pain can be either superficial (for example a burning or rubbing sensation) or deeper pain with penetration, or a combination of both.
It can be frustrating, isolating, and impact relationships, sleep and general enjoyment of life. Understanding why it is happening is the first step to addressing the problem.
You deserve to feel heard, and this conversation matters
Why does it happen?
Lower estrogen levels lead to vaginal dryness, thinning tissues, and decreased elasticity : a recipe for irritation. Irritation during sex can cause microtears which may present as bleeding or spotting during or after sex. In addition, pelvic floor muscles often become overactive during perimenopause/menopause which contributes to pain on intercourse.
Once the brain starts to associate sex with pain, a vicious cycle can start: pain leads to reduced sexual desire and arousal, which in turn further reduces natural lubrication, increasing irritation and pain. Loss of libido can occur for other reasons as well but pain is a very common driver.
Many women are ashamed or embarrassed about their sexual pain and or loss of libido, but there are proven solutions.
Management:
- Vaginal estrogen is extremely effective in treating vaginal symptoms.
- DHEA suppositories
- Vaginal moisturisers and or lubricants
- Pelvic floor therapy (+/- vaginal dilators and wands) can address overactive/tight pelvic floor muscles
- Sex therapy and Education- it may be time to discover what works for you in this stage of life
