Does Sex Have to Hurt As I Age?
Reviewed by Dr. Lisa Czanko MD, MPH
With all the changes happening to your body during perimenopause and menopause, painful sex can be one of the more challenging. While it’s totally normal to experience discomfort during sex during this time, it doesn’t mean you have to simply suffer through it. There are treatments that can help.
Sex has been associated with numerous health benefits including improved mood, decreased anxiety, decreased pain, and improved cardiovascular health. Let’s get you the pleasure you deserve.
In this article, we discuss why sex may become uncomfortable and what you can do to have a pleasurable sex life through perimenopause and beyond.
Why Does Vaginal Discomfort Occur During Perimenopause and Menopause?
During perimenopause, the body’s natural estrogen levels begin to decrease. After menopause, estrogen levels decrease even more profoundly. These hormonal changes affect the bladder, pelvic muscles, and vagina. Read on to understand the main ways decreased estrogen levels can impact ones sex life and what can be done about it.
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What Symptoms Might Someone Experience?
- Vaginal Dryness and Pain
Less estrogen can cause the vagina to lose some of its natural fluid lubrication (wetness). This loss of lubrication means that penetrative sex can become a lot more uncomfortable, and even painful.
- Vaginal Fragility and Bleeding
The decrease in estrogen during perimenopause and menopause causes the walls of the vagina to become thinner and less flexible, which makes the vagina more fragile and more prone to injury. People may experience vaginal bleeding or inflammation with sex or when they get their pap test at the doctor’s office.
Keep in mind, however, that bleeding can also be a symptom of a more serious medical condition, so be sure to see your medical provider if this occurs.
- Increased Chance of Vaginal and Urinary Tract Infections
A decrease in estrogen also impacts the vagina’s natural bacteria that protect the body from infections. That means the vagina’s self-cleaning system can become weaker, making it more susceptible to infections, such as urinary tract infection, yeast infections, or bacterial vaginal infections.
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How Can I Make Sex More Comfortable?
The good news is there are several medically-proven remedies for vaginal discomfort during menopause.
Vaginal Moisturizers and Lubricants
For pain with sex due to these age-related changes, many people start with vaginal moisturizers and lubricants, which are found in most pharmacies.
Vaginal moisturizers are used regularly, generally 2-3 times per week and often contain hyaluronic acid. You can think of them as a sort of lotion for your vagina, keeping it well moisturized on a day-to-day basis.
Lubricants, on the other hand, are used right before sex to help make it more comfortable.
Lubricants can be either water or oil-based. For people using latex condoms (for pregnancy and sexually-transmitted disease prevention), oil-based lubricants are not recommended as these lubricants can cause condom breakdown.
These products do not reverse the age-related changes brought about by decreasing estrogen, but can make sex more comfortable and improve symptoms of vaginal dryness.
Vaginal Estrogen Therapy
If moisturizers and lubricants do not work to improve symptoms, a doctor may prescribe vaginal estrogen therapy.
Vaginal estrogen therapy can help restore natural vaginal lubrication, protect against vaginal thinning, and help support good vaginal bacteria, making sex more comfortable.
Vaginal estrogen medications come in many forms including creams, tablets, capsules, and rings. One review of 19 studies including over 4,000 people showed that all of these forms of vaginal estrogen therapy were equally effective at treating symptoms.
We’re often told to do cardio to keep our heart healthy, but what about sex to keep our vagina healthy? Think of sex (partnered or solo) like exercise.
Having frequent sex (while using some of the remedies we discussed) can help to improve vaginal discomfort by increasing the flexibility of the vagina and leading to increased blood flow and vaginal fluid production.
Pelvic physical therapy can also strengthen or relax the muscles of the pelvic floor to help improve core stability and control over sexual function.
Other non-estrogen-containing therapies are also available. A vaginal preparation of the hormone dehydroepiandrosterone (DHEA) has been approved for the treatment of painful sex due to vaginal changes during menopause.
Another drug, called ospemifene, can be taken by mouth and may be an option for people who cannot use or prefer not to use a vaginal medication.
For people in menopause who have multiple symptoms beyond vaginal discomfort, broader hormone therapy can be used.
Smoking can make vaginal discomfort worse by further decreasing estrogen and by affecting how well blood flows to the vagina. Over-the-counter and prescribed medications are available to help people quit smoking. The CDC has many free resources including a toll-free quitline at 1-800-QUIT-NOW.
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During perimenopause and post-menopause, the body’s natural estrogen levels decrease. This hormonal shift can lead to painful sex due to the effects on the vagina. However, there are good treatment options out there, including over-the-counter lubricants and moisturizers as well as prescription hormonal medications.
Our Simple Note
Still feeling a little meh about it all? Studies show that most women believe the symptoms of pain with sex and vaginal irritation are a normal part of aging that people just have to cope with.
In one study, people reported hesitancy to discuss these symptoms with their healthcare provider. Some people feel that they have to stop having sex altogether to be able to deal with the symptoms!
This doesn’t have to be the case. We’re here to empower you so you don’t have to suffer! Take control of your pleasure with these remedies or reach out to your healthcare provider for more information.
1. Mollaioli D, Sansone A, Ciocca G, Limoncin E, Colonnello E, Di Lorenzo G, Jannini EA. Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout. J Sex Med. 2021 Jan;18(1):35-49. doi: 10.1016/j.jsxm.2020.10.008. Epub 2020 Oct 23. PMID: 33234430; PMCID: PMC7584428
2. Castelo-Branco C, Cancelo MJ, Villero J, Nohales F, Juliá MD. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas. 2005;52 Suppl 1:S46. Epub 2005 Sep 1.
3. Pandit L, Ouslander JG. Postmenopausal vaginal atrophy and atrophic vaginitis. Am J Med Sci. 1997;314(4):228.
4. Krychman M, Graham S, Bernick B, Mirkin S, Kingsberg SA. The Women's EMPOWER Survey: Women's Knowledge and Awareness of Treatment Options for Vulvar and Vaginal Atrophy Remains Inadequate. J Sex Med. 2017;14(3):425. Epub 2017 Feb 12.
5. Huang AJ, Gregorich SE, Kuppermann M, Nakagawa S, Van Den Eeden SK, Brown JS, Richter HE, Walter LC, Thom D, Stewart AL. Day-to-Day Impact of Vaginal Aging questionnaire: a multidimensional measure of the impact of vaginal symptoms on functioning and well-being in postmenopausal women. Menopause. 2015;22(2):144.
6. Portman DJ, Gass ML, Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014 Oct;21(10):1063-8.
7. Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician. 2000;61(10):3090