Painful sex

Sexual health is an important part of your overall health. Talk to your doctor if you experience any amount of pain during sex, so you can get the care you need.

Causes of Painful Sex

Mild or moderate pain during sex can happen because of:

  • Bacterial infections, including urinary tract infections, which become more likely after menopause due to a higher vaginal pH
  • Falling estrogen levels during perimenopause and menopause, which can make your vagina feel dry or tight, a problem called genitourinary syndrome of menopause
  • Narrowed vagina due to lack of sexual activity after menopause
  • Muscle dysfunction

Lifestyle Tips

Take these steps to feel more comfortable during sex.

Behavior

  • Use a vaginal lubricant for temporary relief of dryness before and during sex. For longer-term relief, use a vaginal moisturizer on a regular basis, regardless of sexual activity. 
  • Tell your partner when you’re in pain, and be honest about what hurts and what helps. 
  • Engage in regular sexual activity or self-stimulation to promote vaginal health and blood flow. The vagina, like other parts of the body, can become stiff and sore when not exercised enough. 
  • Don’t smoke. This bad habit decreases circulation.

Diet

  • Limit alcohol, which weakens the body’s sexual response.

Exercise

  • Stay physically active to improve circulation, which is important for sexual arousal. Exercise also releases endorphins, which are the body’s natural pain relievers. 
  • Ask a physical therapist about strength training that can help improve muscle tone in the core, pelvis and upper thighs, making sex feel better. 
  • Do Kegel exercises, in which you squeeze and release pelvic floor muscles to promote healthy blood flow and muscle tone.

Stress Management

  • Relieve stress through daily meditation, deep breathing, progressive muscle relaxation or biofeedback, which shows when you’re tense so you can try to calm down. Chronic stress can throw your hormones off balance.
  • Talk to a counselor or your doctor if you have anxiety or depression. These problems can make sex less pleasurable.

Treatment Options

Ask your doctor about your best treatment option for pain during sex.

Medication

Vaginal estrogen can relieve vaginal skin thinning and dryness. Vaginal estrogen comes in many forms, including creams, pills (for the vagina), caplets, suppositories and a three-month slow-release vaginal ring. Used as directed, these therapies do not increase systemic levels of estrogen above the normal postmenopausal range.

Pelvic Floor Physical Therapy

If pain during sex is caused by tight, stiff pelvic muscles, a pelvic floor physical therapist can help train the muscles to loosen and relax.

Psychotherapy/Sex Counseling

Fear of sexual pain can prevent arousal or make your pelvic floor muscles tighten. That can make the problem worse over time. Talking to a qualified sex therapist can help identify behavioral or emotional triggers for pain during sex, and offer ways to address them.

Sexual Devices

If your pain is caused by a tight vagina, a vaginal dilator or vibrator can help to stretch and relax the muscles. The dilator provides a gentle stretch and comes either as a static device or one that expands while inserted. Vibrators can increase blood flow and help relax the muscles.

Frequently Asked Questions

How common is painful sex during menopause?

About 20% to 50% of U.S. women experience symptoms in the vulva or vaginal area sometime during menopause. The problems, including pain during sex, may occur early or not until after several years of reduced estrogen levels.

Why should I talk to my doctor about this?

Deep pain during sex may be a sign of:

  • Bowel or bladder disease
  • Endometriosis
  • Ovarian cysts
  • Pelvic inflammatory disease
  • Pelvic tumor
  • Scar tissue

In almost every case, treatment can help.

I’m embarrassed. How can I talk to my doctor about this?

There’s no shame in wanting a healthy and satisfying sex life. Your provider wants to be aware of all your health concerns so they can connect you with the care you need. At your next appointment, try saying something like, “Lately I’ve been having sex less often than I’d like, because when I do have sex, it’s uncomfortable for me. What do you recommend?”

What tests can I expect?

Your doctor may perform a physical exam to identify possible causes of sexual pain. Based on the results, you may get other tests, such as a bacterial culture, to determine the best course of treatment.

Contact us

Talk to a care navigator or schedule an appointment at the Women’s Health & Wellness Center.