Painful sex after menopause: remedies and next steps

Lower oestrogen can make vaginal tissue thinner, drier and less flexible. Pain may feel burning at the entrance, deeper pelvic aching, or soreness afterwards. Reduced arousal, irritation from scented products, infection, pelvic floor muscle tension or pelvic organ prolapse can also contribute. Pain does not mean you must stop intimacy, but continuing through sharp pain can worsen irritation.

Allow more time for arousal and use a generous water-based or silicone-based lubricant; a vaginal moisturiser used regularly may help ongoing dryness. Avoid perfumed washes and douching. Choose positions where you control depth, communicate when discomfort starts, and pause if pain increases. A clinician can discuss local vaginal oestrogen or other options, check for infection, and refer for pelvic floor therapy when muscle tension is involved.

Arrange an appointment if pain persists, returns, causes bleeding, or affects closeness or daily life. Seek prompt care for new bleeding after menopause, unusual discharge, sores, fever, severe pelvic pain, or pain with difficulty passing urine. Assessment may include an examination and targeted tests; these help identify a treatable cause rather than relying on symptoms alone.

Ask whether the pain is more consistent with dryness, infection, pelvic floor tension or prolapse; whether local treatment is suitable for you; and what to do if symptoms or bleeding continue.