Why Sex Can Hurt After Menopause, and How to Make It Comfortable Again
I’m now in my 50s and over the years, I’ve noticed modern life loves to blame stress for everything. Yes, stress can be a big factor, but it also papers over many of the scenarios driving stress in the first place. As you age, the body changes. A great example is the menopause. Symptoms for this can be very physical, to the point where some days your entire body feels unfamiliar.
With that said, one of the big questions around menopause is sex. I’ve had very detailed conversations about this with my friends. The conversation is often around how the menopause is linked to hormonal shifts that stop a woman wanting to be intimate with their partner. However, that’s not always true. A friend of mine, in her mid-50s said the turning point for her was the soreness of intercourse. It made her start avoiding sex because she didn’t want the pain or discomfort. It was the avoidance that made her stressed.
The fact is, menopause often shifts sex in two big ways. These are in your levels of comfort and desire. Lower hormone levels can change vaginal tissue, sleep, mood, and how easily your body responds. That’s whether you still love your partner and your life is otherwise steady or not.
According to the Mayo Clinic, vaginal dryness after menopause is common, and the go-to options usually start lubricants, then move to low-dose vaginal estrogen if symptoms stick around.
The E word (estrogen)
Let’s get one thing straight, estrogen does not disappear, but it drops. When it dips, vaginal tissue can get thinner and drier, which can make sex feel irritating or painful.
This whole cluster of changes is often called genitourinary syndrome of menopause (GSM). It’s a medical umbrella term for dryness, burning, urinary symptoms, and pain with sex that can show up as estrogen declines.
The North American Menopause Society notes that lubricants and moisturizers can help with dryness-related pain, and low-dose vaginal estrogen is another option for some women.
The truth is that dryness can sneak up fast.
ACOG notes a simple split that helps a lot of women. The first step is to use moisturizers on a schedule and lubricants right before sex. If dryness is the main issue, those over-the-counter steps are often the first try (and pretty successful).
Desire
Another area where people get it wrong is when it comes to desire. This is not driven by hormones, so they stop being blamed. Desire can be driven by so many factors, sleep, pain in your joints, blood sugars, a healthy circulation, and even general mood. For example, if arthritis is flaring up, you’re not going to have any desire to get into any awkward positions.
Desire can be harder to build if you’re on various medications, suffer from diabetes, or many other chronic illnesses. When one partner is feeling it and the other is not, this is where stress can build over time. For example, Harvard Health Publishing reported that SSRIs can lower interest in sex and make arousal and orgasm more difficult for some people.
This part is frustrating because you can be doing everything “right,” taking care of your mental health, staying on top of doctor visits, and still feel like your body changed the rules overnight. Sadly, this is part of getting older.
A great way to look at desiree is via Dr. Rosemary Basson’s explanation. Desire is often “responsive,” meaning it can show up after touching and closeness begins, not always as a lightning bolt beforehand.
A PubMed summary of Basson’s work describes a model that focuses less on spontaneous drive and more on a cycle where arousal and desire can build during the experience.
Another way to work around dryness and desire is to focus more on foreplay. Lubrication and other steps can be part of this build-up, and can often be the difference between “let’s not” and “actually, yes.”
If you want one practical mindset shift, stop treating desire like a test you either pass or fail. Treat it like an oven that needs preheating.
Check health, then self
An interesting report on this topic mentioned that first steps should include ruling out health issues that interfere with sexual function, like diabetes and high blood pressure, plus reviewing medications and supplements. So call your clinician if you have:
- New pelvic pain
- Bleeding after sex
- Burning or urinary symptoms that keep coming back
These symptoms need a real evaluation, rather than guesswork.
Once you know your health status, the rest is about keeping it simple and consistent.
Start with your comfort
- Use a vaginal moisturizer on a routine if dryness is daily.
- Add lubricant right before sex to cut friction.
- If pain continues, ask about low-dose vaginal estrogen options and whether they are appropriate for you.
The Mayo Clinic notes creams, tablets, or rings are commonly used for vaginal symptoms, with guidance tailored to your history.
Put time and effort into your body
- Get regular movement to help with mood and circulation.
- Consider doing pelvic floor exercises as they can improve sensation and comfort over time.
Talk to your partner and avoid adding stress to the situation
- Talk earlier than you think you need to.
- This means don’t let it linger in your head. You’ll find that your partner will be willing to do anything to help, especially if they want intimacy.
Give yourself the freedom to change your mindset
- Some women want frequent sex. Some don’t. Either can be healthy.
- The pressure makes everything worse. A piece carried by MedicalXpress echoed psychologist Leonore Tiefer’s point that cultural expectations can push women to chase a “standard” that may not match their real lives. So give yourself the freedom to do what’s right for you.
The key to all of this is to remember that your body is changing, not quitting.
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