Painful sex after menopause: what to know

Lower oestrogen after menopause can make vaginal tissue drier, less elastic and more easily irritated. This may cause burning at the entrance, friction during penetration, soreness afterwards or light bleeding. Symptoms may occur even when desire is unchanged.

Pain deeper in the pelvis can have another cause, such as pelvic organ prolapse, infection, skin irritation or a pelvic muscle problem. Menopause can also involve hot flushes, night sweats, mood changes, stopped periods or low sex drive, but those symptoms do not explain every episode of painful sex.

Allow more arousal time, communicate about depth and pressure, and use a generous water-based or silicone-based lubricant. A regular vaginal moisturiser may help dryness between sexual activity. Stop if pain increases rather than trying to push through it.

Book a clinician visit if discomfort continues. They may check the vulva and vagina, discuss local treatment for tissue changes, test for infection, or assess pelvic floor muscles and prolapse. Do not use perfumed washes or insert household products into the vagina.

Arrange prompt medical assessment for bleeding after sex, a new vaginal lump or bulge, unusual discharge or odour, sores, fever, burning urine, pelvic pain, or pain that is worsening. Seek urgent care for severe pain, heavy bleeding, fainting or feeling seriously unwell.

Ask whether vaginal tissue changes explain the pain, whether local treatment is suitable, how to use lubricants and moisturisers, and whether examination or infection testing is needed.