Why menopause can make sex painful – and what can help when pleasure turns to pain...

It’s hard to think of any aspect of women’s lives that menopause doesn’t affect but one of the most difficult to come to terms with – or to discuss – is how to cope when sex becomes painful. If you have always had an enjoyable sex life, it’s easy to assume that it will continue. So, when any sort of penetrative sex, and even foreplay, starts to become uncomfortable and then painful, it’s distressing - and likely to have an enormous impact on your ability to enjoy intimacy. This is true, whether you have a long-term partner, an occasional partner, or you’re embarking on a new relationship.

We’re taking a look at why sex can become painful during and after menopause, and at medical conditions such as vaginal atrophy and lichen sclerosus that can make sex painful, in some cases so painful that the sort of sex you once enjoyed becomes impossible. The good news is that, as well as medication, there are products and exercise techniques that could help, so we wanted to tell you about these too – and share some useful tips!

Why can sex become painful during menopause?

As you move through perimenopause, you may notice that you start to experience vulval and vaginal dryness. As our oestrogen levels drop, the vagina becomes less moist and the vulval and vaginal skin becomes thinner. You might also notice some physical changes – loss of tissue means that your labia and vulva start to loss their plumpness, so you’re more sensitive to friction, and sex can leave you feeling sore and uncomfortable.

As one Live Better With community member described it: ‘The discomfort during and after intimacy is so bad sitting down is uncomfortable, it’s like sandpaper has been used - awful - and I've never felt more isolated and unfeminine.’

What else can make sex painful during menopause?

Conditions like vulvodynia (vulval pain or burning), lichen sclerosus (an auto-immune condition that can cause severe itching, inflammation, splitting, bleeding, loss of the labia and other physical changes) and vaginal atrophy (thinning, drying and inflammation of the vaginal walls) endometriosis and uterine fibroids, can all make sex painful, as can frequent bouts of cystitis.

If you have any of the above symptoms, especially bleeding or splitting, do see your GP as soon as possible. You may need tests or a biopsy to find out what is causing the problem and the sooner you start appropriate treatment the better. Unfortunately, some GPs are better informed and more understanding and helpful than others but don’t be fobbed off. If you’re not happy, get a second opinion.  It can be a struggle to get not only the right diagnosis but the right treatment, as Jane Lewis, author of My Menopausal Vagina found, so be prepared to be determined. Whatever you do, don’t let embarrassment stand in the way of getting the medical treatment you need – and deserve.

The first step – talk to your partner

In our expert guide, we stress the importance of talking to your partner how you feel about the physical changes you are going through and how this is affecting you. It may be difficult at first but it’s important that they know what’s happening and – hopefully – can be supportive, although we know from what some of our members tell us that this doesn’t always happen. Always remember, however, that’s it’s your body and you should never feel pressurised into having sex, especially if it’s painful. There are, after all, many ways to be intimate with someone…

If you are struggling to find the right words, why not let a good book, ldo the talking?  One Live Better With customer gave her husband a copy of Sex, Intimacy and Menopause, which was written specifically for men, by gynaecologist Philip Dubois. ‘At last - a book that talks about menopause from a man's perspective! This is so helpful for partners whose wives are experiencing the menopause, and it's full of helpful examples… Good information with lots of detail.’

Can anything help to make sex less painful during menopause?

Your GP or gynaecologist may prescribe conventional treatment, such as HRT and topical oestrogen cream, and using vaginal dilators regularly can help if you have vaginal atrophy or if you haven’t had sex for a while. There are also some excellent products that could make a difference to your physical symptoms, helping you to relax and enjoy intimacy and sex again.


Moisturisers and lubricants

A good vaginal moisturiser, such as Yes Water-Based Organic Vaginal Moisturising Gel is your first step towards tackling vaginal dryness. It’s hormone free and hypoallergenic, can ease vaginal and vulval dryness, and comes with easy- to-use applicators - ideal if you have vaginal atrophy. Being more comfortable will enable you to relax and feel more confident about being intimate.

Once you feel ready to explore having sex, use a recommended lubricant. Yes Water-Based Intimate Lubricant is the ideal partner to its moisturing gel – they’re part of the world’s first certified organic range of intimacy products. Like the moisturising gel, Yes lubricant helps to relieve dryness and discomfort, by replenishing the body’s natural moisture. It’s pH balanced and free from any hormones, perfumes, parabens and ingredients that could irritate sensitive vaginal mucous.

Sea buckthorn could help restore your sex life during menopause – and beyond

If you’d like to try something that is backed up by clinical trials, menopause expert Maryon Stewart recommends Pharma Nord Omega-7 SBA24 Sea Buckthorn Oil capsules. These have been shown to be effective in helping to combat vaginal dryness, one of the main causes of painful sex during menopause, and dry skin generally.  

Omega-7 SBA24 is made from the seed and berry of the rich, vibrant sea buckthorn plant and contains vital nutrients that contribute to the normal functioning of the mucous membrane of the vagina, responsible for our natural lubrication.  The capsules get to work very quickly and many women going through menopause and others who are post-menopausal often report seeing rapid improvements once they start taking a sea buckthorn oil supplement.

Products to help you relax and feel confident about having sex again

If you’ve had to stop or avoid having sex because it was too painful, it can take time to rebuild your confidence, even if you’re using intimacy products like those mentioned above. Creating the right mood and being relaxed can be the key and that’s where the Live Better With Essential Sexual Intimacy Kit can help, physically and psychologically. The kit includes five specially selected products: vaginal moisturiser, lubricant and applicators; a lavender blossom candle, and a massage oil for the neck, shoulders and back.

Keep those pelvic floor muscles toned

If you practise yoga or Pilates, you’ll know how important your pelvic floor muscles are and, hopefully, how to exercise them correctly. But many of us, even if we know we should be doing our pelvic floor exercises, either don’t do them as often as we should – or don’t bother at all - or we don’t do the exercises correctly.  That’s why we recommend the Elvie Pelvic Floor Trainer, which combines the latest technology with an individual exercise programme.

Weakened pelvic floor muscles can lead to bladder control problems, and can affect your ability to enjoy sex and achieve an orgasm.  It’s a particular problem for women during menopause and - if neglected - can cause more serious problems, such as bladder incontinence, after menopause.

Jane Lewis also recommends consulting a physiotherapist who specialises in women’s pelvic floor health, as they can give you personalised advice and information, and teach you the correct way to do your pelvic floor exercises.

Will it work for me?

While many women find some or all of the above helpful, they won’t necessarily work for everyone. Penetrative sex may no longer be possible and this can have a profound psychological effect on you and on your partner, so that’s why it’s important to explore different ways of being intimate.

If this is the case for you but you are finding it difficult or challenging, it may be helpful for you and your partner to consult a sex therapist. They can offer a safe and private environment where you can discuss your feelings in confidence and learn new ways to share intimate time together. Your GP can refer you to a sex therapist, although NHS availability differs from one area to another.

What about painful sex after menopause?

Everything that applies to painful sex during menopause applies after menopause too. Less oestrogen means that your vaginal tissues continue to become more fragile and you may be more likely to experience bleeding, tearing or pain during and after sex, especially if you have sex only occasionally. Do not suffer in silence. Make sure that you consult your GP or gynaecologist for advice, information and any appropriate treatment.

All of the Live Better With recommended products listed above can safely be used after menopause.

Do read:

The Live Better With interview with Jane Lewis, author of My Menopausal Vagina.

Live Better With article on vaginal dryness and low libido.

The Live Better With Expert Guide to the Menopause and Your Sex Life – How to live better and enjoy intimacy.

Are you struggling to enjoy intimacy during or after menopause because sex has become painful? Have you found anything that helped? Visit the Live Better With Menopause Community Forum for information, advice, and tips, and to share your own questions and suggestions.