5 Ways to Ease Painful Sex During and After Menopause

After you’ve officially made the transition into menopause, you may assume that your symptoms are behind you. And sure, hot flashes and night sweats can subside, but there’s one change that might linger for good: painful sex.

During menopause, your body loses estrogen, a hormone that helps keep the vaginal tissues healthy, says Mary Jane Minkin, MD, a clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale University School of Medicine, in New Haven, Connecticut. When your estrogen levels decline, you can also experience vaginal dryness, which can lead to painful sex.

Vaginal dryness and soreness or burning during penetration “often occur further out from menopause,” says Dr. Minkin. “Whereas a woman may experience hot flashes that get better, vaginal dryness tends to get worse over the years.”

Left untreated, the problem can become so severe that some women give up intercourse entirely because it’s too dry and uncomfortable to be pleasurable. Compounding the confusion, “since it occurs later, many women don’t associate this with menopause at all, and they think dryness is inevitable with aging,” says Minkin.

The good news is that there are many things you can do to improve vaginal lubrication, reduce pain, and make sex feel good again. Here are five options to try.

1. Get a Vaginal Moisturizer

Polycarbophil gel, which is available over the counter, is a good first remedy, says Minkin. The product works mainly by adding water to the tissues, she says, and because it’s applied two or three times per week, you don’t have to remember to use it every time you’re intimate. The gel can be applied with an applicator into the vagina.

You can also apply some vaginal moisturizers externally. The labia can become dry, too, explains Minkin, which can make intercourse uncomfortable.

2. Try a Lubricant During Sex

Intimacy can be even better if you combine polycarbophil gel with a lubricant during sex, says Minkin. There are plenty of lubricants available on the market, and finding the right one can take some trial and error.

“I tell patients not to go out and buy the giant, economy size bottle until you know it will agree with you,” says Minkin. Many contain fragrances, which can irritate especially sensitive vaginal and vulval tissues. Also, if you’re using condoms to protect against sexually transmitted infections, be aware that an oil-based lubricant can degrade the latex; in that case, choose a water-based or silicone lubricant.

3. Get Into Foreplay

A quickie might not work for you anymore. “The more foreplay the better, whether you’re pre- or postmenopausal,” says Minkin. “It gets the [vaginal] tissue revved up.”

Similarly, it may also help revamp your definition of sex. If intercourse is painful because of dryness, you might find that oral sex (which, yes, is still sex) is more pleasurable and allows you to be intimate with your partner.

4. Try a Toy

One word: vibrator. “I’m a big fan of recommending vibrators to my patients,” says Minkin. “Anything that will increase pelvic blood flow will increase moisture to the vagina.”

There are many styles and functions of vibrators on the market, ranging from base models with a few different intensities to those with multiple speeds, patterns, and extra features. Don’t know where to start? Try female-friendly online retailers like Babeland, Lelo, or Bellesa Boutique.

5. Ask About an Rx

For some women, all it takes to relieve dryness is a good vaginal moisturizer and some lifestyle changes. Others might need a prescription. If that’s the case for you, talk to your doctor about vaginal estrogen.

“Almost everyone can use vaginal estrogen,” says Minkin. “It’s really quite safe.” Vaginal estrogens work by increasing moisture to the tissue via vaginal suppositories, rings, or creams, based on personal preference, she says.

A vaginal suppository with the hormone DHEA, which is converted into estrogen and testosterone, may be another Rx option for you, she says. One study found that women using DHEA suppositories reported an improvement in vaginal dryness and pain during sex compared with those who used a placebo.

Finally, ospemifene tablets are a once-daily nonhormonal prescription medication that treats both vaginal dryness and painful intercourse due to menopause by increasing certain cells (and decreasing others) in the vaginal tissue.

Keep in mind that pain during sex can have other causes beyond vaginal dryness, such as a vaginal infection. It can also be a symptom of ovarian cancer — as can bloating, pelvic or abdominal pain, and feeling the urge to urinate more often, notes the American Cancer Society — or vulvodynia, a chronic pain condition.

The bottom line: Be up front with your doctor about your discomfort. A good sex life is one part of being in good health.