When to worry about pain during sex with genitourinary syndrome of menopause

Lower oestrogen levels can make vulval and vaginal tissues thinner, drier, and less flexible. This may cause burning or pain at entry, deeper discomfort, small tears, urinary irritation, or symptoms that continue after sex.

Similar symptoms can be caused by infection, skin conditions, pelvic floor muscle tension, or medication effects. A new symptom should not automatically be attributed to menopause, especially when it differs from your usual pattern.

Stop if sex becomes painful and consider a water-based lubricant or regular vaginal moisturiser if suitable for you. Avoid perfumed washes and products that sting. Note dryness, burning, urinary symptoms, discharge, bleeding, and how long discomfort lasts.

Arrange a clinical review when pain keeps returning, causes tears, affects intimacy, or does not improve with simple measures. Treatment may include local options, pelvic floor support, or care for another cause.

Seek prompt medical care for bleeding after sex, bleeding after menopause, sores, a new lump, unusual discharge, fever, severe pelvic pain, or symptoms that are rapidly worsening. Urgent help is needed for heavy bleeding, fainting, or severe pain.

Ask whether the tissues show dryness, inflammation, infection, or a skin condition, and which moisturiser or lubricant is appropriate. Ask about local treatment choices, pelvic floor therapy, and how any bleeding should be investigated.