Causes, Treatments, And Hope
Pain During Or After Sex

Dr Ioannis Liakas

Adviser: Dr Ioannis Liakas

Pain During Or After Sex Image

Pain during or after sex in menopause is more common than most women realise - yet it often goes unspoken. If intimacy feels different, difficult, or even impossible, you’re far from alone. This guide explores the real reasons behind the discomfort and the solutions that can help.

  • Why changes in hormones can make intimacy painful - and why it’s not “just in your head”

  • The hidden emotional toll many women never talk about with their partners

  • Proven medical and lifestyle treatments that restore comfort and confidence

Introduction

For many women, menopause arrives with changes you half expect — hot flushes, erratic cycles, maybe a shift in sleep. But what often takes people by surprise is how intimacy itself begins to feel different. Sex, which might once have been effortless, can suddenly feel dry, sore, or even impossible. And here’s the thing: it isn’t just about the body. Pain in the bedroom has a way of spilling over, quietly reshaping confidence, self-image, and relationships.

The difficulty is that this subject is rarely spoken about openly. Even in GP consultations, women admit to dodging the topic, worried it will sound trivial or embarrassing. Yet the reality is stark: up to half of postmenopausal women experience painful sex, and only a fraction seek help. The result? Too many women learn to endure, putting closeness on hold and accepting discomfort as their “new normal.” It doesn’t have to be that way.

There are reasons behind these changes — falling oestrogen, tissue thinning, muscle tension, and the psychological loop of anticipating pain. But there are also proven, effective treatments that can make intimacy comfortable again. From local hormone therapies and pelvic floor physiotherapy, to simple at-home solutions and fresh approaches to intimacy, relief is possible. This isn’t about “fixing” you; it’s about understanding what’s happening and reclaiming confidence in your own skin.

So, what exactly happens during menopause that makes sex painful, and why is it so common?

Understanding Pain During or After Sex in Menopause

Many women are surprised to discover that painful sex during menopause is not only common, but also highly treatable. The medical term often used is dyspareunia, and it usually stems from changes in hormone levels that affect vaginal tissue and natural lubrication. Knowing what’s happening in your body is the first step towards finding relief.

How Hormonal Changes Affect Your Body

  • As oestrogen levels fall, the vaginal lining becomes thinner, less elastic, and produces less natural lubrication.

  • This shift can make intercourse feel dry, tight, or even burning.

  • It’s not simply a sign of ageing – it’s a direct hormonal effect that can be managed.

Symptoms Beyond Pain

  • Vaginal dryness, itching, or irritation can appear long before you notice discomfort during sex.

  • Some women also experience urinary frequency or urgency, part of what doctors call genitourinary syndrome of menopause (GSM).

  • These symptoms may come and go, but often worsen without treatment.

In short, painful sex during menopause is common, but not inevitable. Understanding the biology behind it helps take away some of the worry and opens the door to effective solutions.

Why Sex Can Become Painful After Menopause?

While hormonal shifts are at the root, the reasons sex can become painful after menopause are rarely one-dimensional. For most women it’s a combination of physical changes, muscle tension, and the mind’s natural response to discomfort. Once you see how these pieces fit together, it’s easier to understand why pain shows up — and more importantly, what can be done about it.

Vaginal Dryness and Tissue Changes

  • Lower oestrogen reduces natural moisture and flexibility of vaginal tissues.

  • Thin, fragile tissue is more prone to small tears or inflammation during penetration.

  • This is why what once felt comfortable may now feel sharp, stinging, or tight.

Pelvic Floor Muscle Tension

  • Menopause, past childbirth, or even stress can lead to tight pelvic muscles.

  • When muscles contract instead of relax, penetration may feel like “hitting a wall.”

  • Many women describe burning or pressure sensations linked to this tension.

The Psychological Layer

  • Anticipating pain often causes anxiety, which tightens muscles further — a cycle that feeds itself.

  • Worries about body image, libido, or intimacy can amplify physical discomfort.

  • It’s not “all in your head,” but the mind and body do interact strongly here.

Pain after menopause is usually a mix of physical changes and emotional responses. The good news is, once identified, each factor can be addressed.

The Emotional Toll of Painful Sex

Physical discomfort is only part of the story. For many women, the harder impact of painful sex is emotional – a quiet sense of loss, a dip in confidence, or even tension in relationships. It’s not just about intimacy in the bedroom; it can ripple into self-esteem and daily life in ways that often go unspoken.

When Relationships Feel the Strain

  • Partners may misinterpret withdrawal as rejection rather than pain avoidance.

  • Some women avoid intimacy altogether, creating distance where there was once closeness.

  • A common story: a partner who says “I don’t want to hurt you,” leading to both sides stepping back and silence replacing conversation.

How Self-Esteem Gets Caught Up

  • Menopause already brings body image changes – from weight shifts to skin texture – and painful sex can amplify the sense of “something is wrong with me.”

  • The fear of pain can make women feel less feminine, less spontaneous, and less connected to their identity as a sexual being.

  • Even everyday things, like walking past lingerie in a shop window, can sting differently when confidence has dipped.

The emotional side of painful sex deserves as much care as the physical. Acknowledging it is often the first step to breaking isolation and seeking support.

Evidence-Based Treatment Options

The encouraging truth is that painful sex after menopause does not have to be a permanent reality. There are well-researched, clinically approved options that can restore comfort and rebuild confidence. Treatments range from simple over-the-counter solutions to prescription therapies and holistic approaches, so the right path depends on individual needs and medical history.

Everyday Relief with Over-the-Counter Products

  • Vaginal moisturisers can be used regularly to improve hydration and tissue comfort.

  • Lubricants provide immediate ease during intercourse, reducing friction and discomfort.

  • Look for products free from perfumes and irritants – a pharmacy shelf scan will show dozens, but pH-balanced formulas are usually gentler.

Prescription Hormonal Therapies

  • Local vaginal oestrogen (creams, pessaries, rings) helps replenish tissue strength and elasticity.

  • Hormone replacement therapy (HRT) may also be considered for broader menopausal symptoms, not just vaginal health.

  • Evidence shows localised treatment delivers minimal systemic absorption, which many women find reassuring.

Non-Hormonal Medical Innovations

  • Vaginal laser therapy and radiofrequency treatments are gaining attention – early studies suggest tissue regeneration benefits.

  • These are not first-line options but may be considered when traditional therapies fall short.

The Role of Pelvic Floor Physiotherapy

  • Specialist physiotherapists can help retrain and relax pelvic floor muscles.

  • Techniques may include guided exercises, dilator therapy, and biofeedback to reduce tension and improve comfort.

Lifestyle and Holistic Approaches

  • Staying sexually active, even with gentle touch, helps maintain blood flow and tissue health.

  • Exercise, balanced diet, and stress management support overall hormonal balance and wellbeing.

  • Some women find mindfulness or cognitive therapy beneficial in reducing the anxiety–pain cycle.

Effective treatment often combines more than one approach – for example, using a vaginal moisturiser alongside local oestrogen and pelvic floor support. The key is to know that options exist, and many women experience profound improvement once they seek help.

Talking Openly About Painful Sex

For many women, the hardest part isn’t the discomfort itself – it’s finding the words to talk about it. Painful sex can feel like an intensely private issue, yet starting a conversation is often what unlocks solutions. Whether it’s with your GP or your partner, honesty and clarity can transform silence into understanding and progress.

How to Speak to Your GP or Specialist

  • Be direct: describe when the pain happens (before, during, or after sex), what it feels like (burning, tightness, stinging), and how long it has lasted.

  • Mention any other symptoms, like dryness or urinary changes, to give a full picture.

  • It can help to write notes in advance – one woman described scribbling reminders on the back of a shopping list just so she wouldn’t lose courage in the consultation room.

  • Ask about guidelines (NICE, British Menopause Society) to ensure treatment discussions are evidence-based.

Conversations with Your Partner

  • Frame intimacy as more than penetration – emphasise closeness, touch, and other ways of connecting.

  • Explain that avoiding sex is about pain, not rejection, and invite them to be part of the solution.

  • Simple phrases like, “I want to enjoy this with you, but I need your patience while I figure it out,” can keep intimacy alive while exploring treatment.

Silence can make painful sex feel heavier than it is. Speaking openly, even if the first words come awkwardly, often brings relief and new options.

When to Seek Professional Help Urgently

Most of the time, painful sex during menopause is linked to hormonal or muscular changes that can be treated safely. But there are situations where seeking medical help promptly is essential. Knowing the difference can give peace of mind and ensure that nothing more serious is overlooked.

Red Flags Not to Ignore

  • Bleeding after sex: always requires medical review, even if it happens just once.

  • Persistent pelvic pain: especially if it occurs outside of intercourse or worsens over time.

  • Sudden changes in symptoms: such as new discharge, pain on one side, or unexplained spotting.

  • Unexplained weight loss or fatigue: when combined with gynaecological symptoms, warrants prompt investigation.

How to Find Specialist Menopause Care in the UK

  • Start with your GP, who can refer you to a gynaecologist or menopause clinic if needed.

  • The British Menopause Society has a directory of accredited specialists, available privately and within some NHS trusts.

  • Some clinics offer combined medical and physiotherapy support, which can be especially helpful for complex cases.

  • If appointments feel rushed, consider bringing a partner or friend to help note down advice and next steps.

Most cases of painful sex during menopause can be treated, but ignoring certain warning signs may delay vital care. A timely consultation can make all the difference.

Living Well: Reclaiming Pleasure and Intimacy

Once symptoms are managed, the focus can shift from “how do I stop the pain?” to “how can I enjoy intimacy again?” For many women, menopause becomes an opportunity to redefine what pleasure means, rebuild confidence, and even discover new dimensions of their sexual wellbeing.

Redefining Intimacy Beyond Penetration

  • Intimacy does not have to centre on penetrative sex – touch, closeness, massage, and shared experiences all sustain connection.

  • Couples often find that experimenting with different types of physical affection reduces pressure and brings back playfulness.

  • One woman described how simply lying together after work with a glass of wine and no distractions rekindled a sense of closeness she thought had been lost.

Support Networks and Resources

  • Menopause support groups (online and local) offer shared stories that remind women they are far from alone.

  • The British Menopause Society and Women’s Health Concern provide trusted, evidence-based resources.

  • Private and NHS clinics specialising in menopause can guide tailored treatment plans and lifestyle advice.

  • Professional counselling or sex therapy can help couples navigate emotional and physical changes together.

Reclaiming intimacy after menopause is not just possible – for many, it becomes more fulfilling once pain is addressed and new ways of connecting are embraced. Menopause can close one chapter but open another, marked by deeper self-knowledge and shared understanding.

Conclusion

Menopause can change the way intimacy feels, but it does not have to mean living with pain or silence. What often begins as an uncomfortable secret – a moment of wincing during sex or quietly avoiding closeness – is in fact a common, treatable condition that many women share. The most powerful step is recognising that your body deserves care, and that solutions exist far beyond simply putting up with discomfort.

From medical treatments like local oestrogen and pelvic floor therapy, to practical adjustments such as moisturisers, lubricants, and open conversations, relief is possible. Just as importantly, there is space to reimagine intimacy itself – shifting from pressure and performance towards connection and pleasure in its many forms.

If you recognise yourself in these experiences, consider speaking with a qualified menopause specialist or your GP. Exploring evidence-based options, or even starting with a trusted resource, can be the turning point. The aim is not just to reduce pain but to reclaim confidence, comfort, and a more fulfilling relationship with your body.

FAQ's

A GP may carry out: - A pelvic examination to check tissue health. - Tests for infections or abnormal cells if symptoms suggest. - A review of your medical history, medications, and overall health.

If symptoms persist despite first-line treatments, or if you have additional concerns such as bleeding after sex, sudden changes in symptoms, or ongoing pelvic pain, it’s best to see a menopause specialist or gynaecologist.

Relief can vary depending on the treatment. Lubricants and moisturisers may help immediately, while local oestrogen or physiotherapy can take several weeks to show results.

Yes. Stress increases muscle tension and reduces natural lubrication, which can intensify discomfort. Stress management techniques, such as breathing exercises or mindfulness, may help reduce pain.

Not necessarily. Vaginismus involves involuntary tightening of vaginal muscles, while menopause-related pain is often linked to dryness or thinning tissue. However, the two can overlap.

A balanced diet supports overall hormone and tissue health. Staying hydrated and eating foods rich in omega-3 fatty acids, phytoestrogens, and antioxidants may support vaginal comfort.

Yes. Conditions such as endometriosis, fibroids, or urinary tract problems can contribute to pain during or after sex. This is why a professional assessment is important.

Not at all. Redefining intimacy to include touch, closeness, and non-penetrative activities helps maintain connection. Avoiding all intimacy can increase tension and distance in relationships.

Yes. Regular physical activity supports blood flow, hormone balance, and pelvic floor health. Specific pelvic floor exercises, guided by a physiotherapist, can make a noticeable difference.

Yes, it is common due to hormonal changes that cause vaginal dryness and thinning of the tissues. However, you don’t have to suffer in silence—treatments are available to help reduce pain and make sex more comfortable.

Certain medications, such as antidepressants, antihistamines, or some cancer treatments, can reduce natural lubrication or impact sexual function. Discuss any concerns with your GP or pharmacist.

Yes, water-based and silicone-based lubricants are designed for regular use. Avoid products with fragrances or glycerin, as these can irritate sensitive tissues.

Yes. Ongoing pain can lead to disrupted sleep, either from discomfort at night or from the stress and anxiety surrounding intimacy. Over time this may affect energy, mood, and overall wellbeing.

Low oestrogen is the most frequent cause, but not the only one. Pelvic floor tension, vaginal infections, or other health issues can also contribute. A proper assessment helps identify the underlying reason.

Research suggests that up to half of postmenopausal women experience pain during or after sex. Despite being so common, many do not talk about it or seek medical advice.

For some women, mild discomfort may improve with time or lifestyle changes, but most cases persist or worsen without support. Seeking treatment early usually leads to faster, longer-lasting relief.

Yes, vaginal oestrogen therapy or systemic hormone replacement therapy can help restore vaginal health and improve symptoms. Always discuss the risks and benefits with your healthcare provider to determine the best option for you.

Yes, water-based lubricants can be very effective in reducing friction and discomfort during intercourse. Avoid oil-based or scented lubricants, as they can irritate sensitive tissues.