Sex painful after the menopause? Here’s what can help

Menopause is likely to be a time of great change for most women, and for many, these changes may bring on some anxiety. Not only might you experience physical changes, but mentally too it can be a taxing period. From hot flushes to joint pain, many women will go on HRT or source alternative supplements to lessen their symptoms.

One area which remains widely undiscussed when it comes to talk of menopause is sex. While recently we saw Zoe Ball talk publicly about how she intends to make it through menopause by having “HRT and more sex”, in reality, more sex might be the last thing many women feel like doing. In fact, some may even find themselves suddenly physically unable to have sex, or find it very painful when they do. But why is this, and what is the solution?

Why might sex become painful during menopause?

Around the time of menopause, a woman’s oestrogen levels will start declining. Unfortunately, oestrogen is an important hormone when it comes to sex. Oestrogen is the hormone that ensures the lining of the genital tissues stays thick. As oestrogen levels drop, the walls of the vulva and vagina will become fragile and drier. This can result in painful sex due to a lack of natural lubrication and thin skin which can become irritated due to friction. Increased risk of thrush or cystitis around this time can also prevent women from wishing to engage in sexual activity.

“Low oestrogen levels that occur during the perimenopause and menopause affect the lining of the vagina leading to soreness, irritation and discomfort,” says Dr. Louise Newson, a GP and menopause expert. “Vaginal dryness can cause painful sex, and can even make exercising and walking uncomfortable.”

Louise adds that psychologically, this can contribute to relationship problems, fear of intimacy, depression, and diminished confidence. “For these reasons, it really is important for women to talk about what is a very common and treatable medical condition,” she says.

Lubricants and hormones

Fortunately, there are plenty of solutions out there, and no women should resign herself to no longer having a sex life simply due to menopause. For those that are reluctant to use hormonal treatment, there are plenty of hormone-free vaginal moisturisers. “Regelle, YES, and Sylk can be really effective when they are used regularly,” says Louise. “These are available over-the-counter, and on prescription, and are simply squeezed into the vagina. Vaginal lubricants can be used during sexual intercourse.”

For those looking to go down the hormonal route, vaginal oestrogen comes in the form of pessaries, creams, or a ring, and these can all be very effective. Not only are they safe to use in the long term, they can also be used with vaginal moisturisers and lubricants, which should prove a great solution for even the driest vagina.

Finally, women can undergo hormone therapy, which includes the various forms of HRT. While HRT received some bad press several years ago, the concerns about it have largely since been disproven, or rather, there is lack of evidence supporting any claims that it is dangerous for everyone. Many  women will find that despite some very small increased risks of cancers such as breast cancer, the benefits, which include helping to prevent osteoporosis and cardiovascular disease, outweigh the risks. If you have concerns about going on HRT you can talk these through with your doctor, who will be able to advise you on whether or not you are a good candidate for the treatment.

“Hormone therapy, including the various forms of HRT, is a very effective treatment for vaginal atrophy, the dryness that comes as a menopausal symptom due to falling oestrogen levels,” says Louise. “There is also laser treatment for the area, promoting collagen production, which can be beneficial too.”

Lifestyle changes

There are plenty of lifestyle changes you can make too, in order to stay healthy and happy during menopause. This in turn should have a positive effect on your sex life, as you will feel more confident and have more energy. Around the time of menopause it is important to do plenty of exercise, to protect your bones and avoid weight gain. Strength training, particularly, will help prevent reduction in bone density, and low-impact cardiovascular exercise such as cycling will boost your mood and keep you fit.

There is some evidence that an active lifestyle can also help diminish night sweats, and sleeping in a cool airy room will also reduce these. Reducing processed foods, and avoiding alcohol and caffeine can also help reduce menopausal symptoms, meaning you have more energy to engage in sexual activity, and more confidence too.

If you are suffering from painful sex, vaginal dryness, or any other symptoms which mean you are no longer enjoying sexual activity, there is absolutely no reason for you to keep quiet about it. You can be sure it affects countless other people too, and there are plenty of solutions. You can go to your GP to discuss treatment options, and there are plenty of private doctors specialising in menopause who will also be happy to find some solutions tailored to your own situation. Menopause might signal the end of your reproductive years, but there is no reason at all why you shouldn’t keep enjoying an active and fulfilling sex life for many more years to come. 

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Last revised: 31 August 2017
Next review: 31 August 2020