What to Do About Painful Sex After Menopause

There are several other factors that can also contribute to dyspareunia among menopausal women. The hormonal changes alter acidity levels of the vagina, Dr. Streicher said, which can lead to recurrent urinary tract infections among menopausal women, creating discomfort in the area whether or not they are having sex. And some common health conditions among older people, like diabetes or cardiovascular disease, can also dry out the vagina, she added.

So what is the solution?

It all depends on the degree of changes to the vaginal area, Dr. Streicher said, and the safest way to determine what treatment you need is by seeking out an expert who will do a thorough exam. “There’s a big difference between ‘Oh, you know, I’m not as wet as I usually am’ versus it is so dry, so tight and so thin that the tissue literally splits.”

Here are a few of the treatment options:

Lubricants: This is a quick and easy solution for women who suffer only from dryness. Dr. Streicher recommends warming the lubricant because “cold is a vasoconstrictor, which will make you have even less natural lubrication, whereas heat is a vasodilator and will help the muscles relax,” she said. One option is placing a bottle of lubricant in a bowl of hot water for a few minutes before use.

Vaginal moisturizers: These creams and gels can be found over the counter. “What they actually do is increase water content in vaginal mucosal cells — the ones that are lining the wall,” Dr. Streicher said, helping restore their elasticity and lubrication, though they can also be helpful for those who have pain in the vestibule. Some moisturizers can also help lower vaginal pH levels, she said. Beware that many lubricants market themselves as moisturizers; the difference is that a moisturizer will have instructions to apply it inside the vagina on a regular basis, Dr. Streicher said, whereas a lubricant should be used during sex.

Estrogen creams: Studies have repeatedly found that this prescription option is highly effective at reducing pain, including in the vestibule area. They are generally low-dose, localized and come in different formulations that your doctor can help you choose among.

Lidocaine: This is an unconventional prescription option that Dr. Goetsch has recommended for many of her patients, particularly those who can’t use hormones, like breast cancer survivors. Liquid lidocaine is an anesthetic that numbs the nerve endings of the vestibule. In a small randomized trial in women with dyspareunia, lidocaine reduced pain substantially during intimacy for most participants, Dr. Goetsch said, and women who had sex while using lidocaine rarely reported residual pain after the anesthetic wore off. And, Dr. Goetsch added, application of liquid lidocaine didn’t numb the partner.