Pain during intercourse after menopause: what to know

Lower oestrogen levels can make vaginal tissue drier, thinner and more easily irritated. Pain may feel like stinging at the opening, soreness afterwards or deeper pelvic discomfort. Vaginal dryness can occur alongside other menopause symptoms such as hot flushes, night sweats, mood changes, low sex drive and periods stopped.

A pelvic organ prolapse can also cause pressure, a dragging sensation or discomfort with penetration. These symptoms do not identify one cause by themselves, so the pattern, examination and any discharge, bleeding or urinary changes matter.

Pause when pain starts and choose activities that do not hurt. Allow more time for arousal, use a generous water-based or silicone-based lubricant, and consider a vaginal moisturiser used regularly. Avoid perfumed washes and products that sting. A clinician can discuss local vaginal treatment, pelvic floor physiotherapy or treatment for another condition when appropriate.

Arrange a medical review if pain keeps returning, limits intimacy or does not improve with lubrication. Seek prompt care for bleeding after sex, unusual discharge or odour, sores, fever, severe pelvic pain, or pain with urinary symptoms. Bleeding after menopause should be assessed even when it is light.

Ask what the pain pattern suggests, whether the vaginal or pelvic tissues need examination, and which moisturiser or lubricant is suitable. You can also ask about local hormonal options, pelvic floor therapy, and whether prolapse or infection needs checking.