What is Dyspareunia?

For many women, the lifestyle changes that accompany the menopausal transition can provide new opportunities for closeness and intimacy. Whether you’re rediscovering your partner after your children leave the nest, or are exploring new relationships, your menopausal years can be a time of emotional and physical reconnection.

Unfortunately, a condition that can occur during menopause, called dyspareunia, may put a strain on rekindled intimacy. The medical term for painful intercourse, dyspareunia affects up to 45% of postmenopausal women¹, many of whom may find themselves choosing between avoiding sex or living with the pain.

The good news? There are things you can do to manage painful intercourse after menopause and reduce the severity of any related dyspareunia symptoms.

Understanding this menopause symptom — including potential treatments for female dyspareunia— can help you reach a place where physical intimacy is not only just comfortable again, but it’s also enjoyable during menopause and beyond.

Female Dyspareunia: Understanding Painful Sex After Menopause

“Dyspareunia is the clinical term for painful intercourse, and it can be associated with pain with sex, in addition to burning, itchiness and pelvic discomfort,²” says Dr. Michael  Krychman, MDCM, and the Executive Director of the Southern California Center for Sexual Health and Survivorship Medicine.

While it can occur at any time during a woman’s life, dyspareunia is very common during and after menopause. Up to 45% of postmenopausal women say they find sex painful, according to The Menopause Society.³

“Painful intercourse may even develop during perimenopause, or the 7-10 years before a woman has her last menstrual period,” Dr. Krychman explains. “It may be episodic, meaning that sometimes painful intercourse will be experienced and at other times, sex is not painful.”

Painful sex after menopause often occurs because decreasing levels of estrogen can lead to the deterioration of vaginal tissues. Clinically known as vaginal atrophy, this set of symptoms is characterized by loss of elasticity and lubrication that can cause vaginal dryness, itchiness, and burning — all of which can contribute to painful sex after menopause.⁴

“The vaginal mucosa is highly dependent on estrogen for its ridges, folds, elasticity and pliability,” Dr. Krychman says. “With the loss of estrogen and decline in hormonal levels during menopause, the vaginal tissues can become pale, frail and inelastic, which can lead to painful and frustrating symptoms.”

Dyspareunia symptoms often include:⁵

• Sharp pain and burning during and after intercourse, upon penetration
• Deep pain during thrusting
• Throbbing or aching after intercourse
• Vaginal burning
• Cramps
• Muscle spasms or tightness
• Spotting or bleeding after intercourse

While physically painful, dyspareunia can also contribute to mental health issues that may negatively impact a woman’s intimate relationships and overall quality of life.⁶ One study of over 500,000 women found those with vaginal atrophy, and issues with painful sex, had significantly higher rates of depression and anxiety compared to those without the condition.⁷

How Long Do Dyspareunia Symptoms Last?

For women struggling with dyspareunia and its symptoms, the condition can become chronic and progressive, especially if left untreated.⁸ Even when a woman is postmenopausal and her hormone levels begin to stabilize, vaginal atrophy will unfortunately not go away, meaning painful sex and its associated symptoms may continue to be a problem even after menopause.⁹

“These vaginal symptoms are typically chronic and progressive,” Dr. Krychman advises. “They can last and be persistent throughout the menopausal years — especially if they are left untreated.”

Dyspareunia Treatment

Many dyspareunia treatment options, ranging from prescription medications to over-the-counter solutions, are available to help ease painful sex and related symptoms after menopause. They include¹⁰:

• Vaginal lubricants that are used before and during intercourse to provide short-term, in the moment relief
• Hormone-free vaginal moisturizers, such as Revaree® or Revaree® Plus, that are designed to relieve dryness in the longer term when used regularly (every 2-3 days before bed)
• Prescription, topical hormone creams/gels/vaginal tablets or rings that are used locally
• Systemic hormone replacement therapy (HRT) by prescription
• Other medications called selective estrogen receptor modulators (SERMs) which act like estrogen in the body are also available
• Vaginal laser therapy or any other energy-based therapies (i.e. radio frequency)

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“I personally start with conservative measures when treating painful sex after menopause, such as hormone-free vaginal moisturizers, as a front-line treatment,” Dr. Krychman says. “It’s always best to check with your healthcare provider to determine the best option for you.”

Painful Sex After Menopause – Can Your Healthcare Provider Help?

If you’re experiencing painful sex after menopause, don’t struggle in silence. A healthcare provider can provide a dyspareunia diagnosis and walk you through any next steps, helping to develop a treatment plan based on the specificity and severity of your symptoms.

Since mental wellbeing is as important as physical health, it may also be worthwhile reaching out to a sex therapist if you’re concerned about the toll painful sex after menopause is taking on your self-esteem and/or relationship. Painful intercourse after menopause may not be easy to talk about, but treatment options are available to help reduce the severity of your symptoms.

“There is no reason to suffer in silence,” Dr. Krychman advises. “Once a woman has symptoms, she should seek medical care from her primary care professional, gynecologist or menopausal specialist.”

Resources:

1. https://www.webmd.com/menopause/painful-sex-menopause
2. https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967#:~:text=The%20medical%20term%20for%20painful,or%20lessen%20this%20common%20problem.
3. https://www.menopause.org/for-women/sexual-health-menopause-online/sexual-problems-at-midlife/pain-with-penetration
4. https://www.health.harvard.edu/pain/when-sex-gives-more-pain-than-pleasure
5. https://my.clevelandclinic.org/health/diseases/12325-dyspareunia-painful-intercourse#symptoms-and-causes
6. https://www.aafp.org/afp/2021/0515/p597.html
7. https://pubmed.ncbi.nlm.nih.gov/31688416/
8. https://newsnetwork.mayoclinic.org/discussion/womens-wellness-painful-sex-after-menopause/
9. https://www.health.harvard.edu/womens-health/managing-postmenopausal-vaginal-atrophy
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074805/