Painful sex

• 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.

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

• 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.

• 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.

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.

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.

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.

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.

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.

Deep pain during sex may be a sign of:

In almost every case, treatment can help.

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?”

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.