Painful Intercourse After Menopause: Causes and Help

It might sting or burn as soon as things start. It might feel tight, sore or raw, or ache for hours afterwards. Sex that used to feel fine now hurts, and you may have started to dread it, or to quietly avoid it.

Painful intercourse after menopause is common, and it isn't something you just have to put up with. The NHS says dryness, burning, irritation and itching in and around the vagina are symptoms of perimenopause and menopause, and that these can make sex feel painful. So painful sex during menopause, not only after it, is common too.

Falling oestrogen is the usual reason. But it isn't the only one, and a few causes need checking. The good news is that a lot can help. Doctors call painful sex dyspareunia, so you may hear that word.

See your GP if you have:

bleeding after sex
any bleeding from the vagina after your menopause, even a small amount or a one-off (read our page on bleeding after menopause)
a lump, a sore or an ulcer on your vulva that does not go away
unusual discharge
an itchy white patch on the skin of your vulva

These are common and usually have other causes. But they need checking (NHS vaginal dryness, NHS lichen sclerosus, NHS menopause symptoms).

About this page: it's based on NHS guidance, including the NHS page on vaginal dryness and the NHS page on menopause symptoms. It hasn't been reviewed by a doctor, and it can't tell you what's causing your symptoms. If you're worried, speak to your GP or call NHS 111. In an emergency, call 999.

Painful intercourse after menopause: why does it happen?

It's mainly about oestrogen. Women's Health Concern, the patient arm of the British Menopause Society, explains that without oestrogen from the ovaries, the skin of the vulva (the outer lips) and vagina becomes thinner and less stretchy. Dryness is often the first thing women notice.

Thin skin is more easily hurt. Women's Health Concern says this is most likely during sex, especially if there's not much natural wetness. Even quite gentle rubbing can cause pain.

Doctors may call these changes vaginal atrophy, or genitourinary syndrome of menopause (GSM). We explain more on our page about vaginal dryness in menopause.

Is painful sex during menopause normal?

It's very common. Women's Health Concern says up to half of women after the menopause have vaginal dryness. Yet only about a fifth to a quarter of women with symptoms ask for help.

A 2020 review found that painful sex is one of the most common and most bothersome symptoms of GSM. It also found that GSM is often missed. Women can feel embarrassed, or think it's just part of getting older. And some health professionals are slow to ask.

Other causes of painful sex

It isn't always the menopause. It's worth knowing what else it could be, so you can get the right help.

Infections. The NHS lists thrush and sexually transmitted infections (STIs) among the causes of pain during sex. Brook, the sexual health charity, adds urine infections such as cystitis. See our page on UTIs in menopause.
A reaction to products. The NHS also lists reactions to condoms or soaps.
Vaginismus. The NHS says this is when the vagina suddenly tightens up as you try to put something in. It's a reflex you can't control. It can start even if you've had sex without pain before.
Lichen sclerosus. This skin condition is much more common in women over 50. It causes itchy white patches, and the NHS says sex can become painful because the vulva may shrink or tighten. A prescription steroid ointment usually helps.
Vulvodynia. The NHS describes this as long-lasting pain in the vulva with no clear cause. The vulva usually looks normal. The pain may burn, throb or sting, and touch or sex can set it off. Lower oestrogen is one possible factor.
Bladder pain syndrome. This long-term bladder condition can make sex painful during penetration. The NHS says it usually affects people aged 40 or over.
Deeper pelvic conditions. The NHS vaginismus page also lists pelvic inflammatory disease and endometriosis as causes of pain during sex.
Medicines and treatments. The NHS says some medicines, such as antidepressants, can cause dryness. So can cancer treatments, and a hysterectomy where the ovaries were also removed.
Not feeling aroused. The NHS lists this as a cause of dryness. Brook explains that without arousal there's less wetness, so touch can feel uncomfortable.

If you're tired, stressed or just not in the mood more often than before, our page on low libido in menopause may help.

What can help with painful sex after menopause

Things you can try yourself

These come from the NHS and Brook. The NHS says you can get most of these products without a prescription.

Use a lubricant before sex. The NHS suggests a water-based one, used inside and outside the vagina, or on your partner or a sex toy. Brook says water-based and silicone-based lubricants are safe with condoms.
Use a vaginal moisturiser. This is for regular use, to keep the vagina moist whether or not you have sex.
Wash gently. Use unperfumed soaps and washes around the vagina. Avoid perfumed soaps, washes and douches.
Only use products made for the vagina. The NHS warns that other creams and lotions can cause irritation or infection.
Take your time. Brook suggests waiting until you feel aroused before any penetration. The NHS suggests trying different types of foreplay.
Try different positions. The NHS vulvodynia page suggests this, along with lubricant.
Keep a note. Brook suggests writing down what seems to set the pain off, so you can share it with a doctor or nurse.

Treatments to talk to your GP or pharmacist about

Vaginal oestrogen. This is a low-dose hormone treatment that goes inside the vagina. NICE, which writes guidance for the NHS, says it should be offered to women with these menopause symptoms, including women already on HRT. NICE says serious side effects are very rare. Only a tiny amount gets into the bloodstream.

The NHS says it comes as a tablet, pessary, cream, gel or ring. It can take up to 3 months to work fully. Most types need a prescription, but the NHS says a few can be bought from a pharmacy. Women's Health Concern says it can help greatly with pain during sex.

NICE adds that symptoms often come back when vaginal oestrogen is stopped, but it can be started again. You can also use it alongside a moisturiser or lubricant.

HRT. If hormone changes are the cause, the NHS says a GP may suggest HRT. It isn't right for everyone, so talk it through.

If you've had breast cancer. NICE says to offer moisturisers and lubricants first. If symptoms carry on, vaginal oestrogen may be considered. If you're taking certain breast cancer medicines, your GP should work with your breast cancer team.

Other prescription options. NICE lists a hormone pessary called prasterone if other treatments haven't helped. It also lists a tablet called ospemifene for women who find it hard to use treatments inside the vagina.

Treating the cause. If it's an infection, lichen sclerosus or something else, the right treatment for that comes first.

Pelvic health physiotherapy and other support

A specialist physiotherapist can help with pain during sex. The NHS vulvodynia page says a physiotherapist can teach pelvic floor exercises to help you control the muscles around the vagina. Women's Health Concern says your GP or practice nurse should be able to refer you to a specialist pelvic floor physiotherapist.

The NHS also mentions:

vaginal trainers: tampon-shaped objects in different sizes, used to build up slowly
psychosexual therapy: a talking therapy about how you feel about your body and sex
sensate focus: exercises to help you feel more at ease during sex

Talking to your partner about painful sex

Pain during sex can affect a relationship. Women's Health Concern says vaginal dryness may affect sex and cause relationship difficulties. Saying it out loud is often the hardest part.

Brook suggests:

saying when something hurts
asking your partner to go slower, be gentler, or touch somewhere less sensitive
checking in with each other about what feels good

Intimacy doesn't have to mean penetration while you're sorting this out. The NHS says you can choose whether to involve a partner in treatment for vaginismus.

And there is some hope in the facts. Women's Health Concern points out that some women have better sex after the menopause, free from worries about pregnancy.

Talking to your GP about it

It can feel awkward. Women's Health Concern suggests:

making a list and starting with the hardest question
taking information with you, like this page, to help explain
writing it down and handing it over if you can't face saying it

The NHS says you can ask for a female doctor and bring someone you trust. You can also go to a sexual health clinic instead of your GP.

When to see a GP about painful sex

See your GP or a sexual health clinic if:

sex is often painful
dryness has lasted a few weeks and things you've tried aren't helping
it's affecting your daily life or your relationship
you have pain in your vulva that doesn't go away or keeps coming back
it also hurts when you pee
you have any of the signs in the box near the top of this page

Painful sex often goes with vaginal dryness in menopause, menopause vaginal itching and low libido in menopause. You can see them all in our list of perimenopause symptoms.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms

Painful sex after menopause: why it happens and what can help