Depressed Middle-Aged Woman Sitting on the Floor at Home

Life is filled with many pleasures that are meant to be enjoyed. Whether they are physical or mental, when something that should be a positive experience turns into a burden or negative experience, it can really take its toll on you. This is especially true as we age.

One such aspect of life that can take a turn for the worse as we age is sexual intercourse. This natural act between two individuals serves several purposes that range from procreation to physical and mental bliss. Whether it’s to start a family, connect with a significant other, or engage for pure enjoyment, sexual intercourse is meant to be a positive and pain-free act.

However, our bodies go through some drastic changes over time and as women, menopause is one of the biggest (behind pregnancy and childbirth). The effects on a woman’s body from menopause can range from mild to drastic and impact daily life. For this article, we’re going to discuss the situation in which women experience painful intercourse after menopause. 

What Is Menopause?

What Is Menopause

This natural process involves the steady decline in reproductive hormones when a woman reaches around the age of 40. Over the adult life of a woman, the levels of estrogen and progesterone regulate menstruation (periods) and ovulation (the release of the egg from the ovary). Menopause is when these processes stop and are diagnosed roughly 12 months from a woman’s last period.

During the years leading up to menopause (the phase is called perimenopause), the natural levels of the estrogen and progesterone will start to decline, which can cause the same symptoms and side effects that are experienced during menopause. After menopause, called post-menopause, the symptoms will subside for most women. Although,  there can be lingering symptoms that can be troublesome to deal with.

The decreased levels of hormones are to blame, but thanks to modern medicine, there are ways to combat the body’s difficulties. As mentioned above, some women experience painful sex after menopause, along with other symptoms as well. Some women experience very few or mild symptoms, while others experience them all and can even be severe. The most common symptoms and side effects that perimenopause, menopause, and postmenopause can produce include:

  • Uneven or missed periods
  • Sleep difficulties
  • Mood swings & depression
  • Excessive tiredness
  • Irritableness
  • Headaches/migraines
  • Bone density loss
  • Elevated heart rate
  • Aches and pains in muscles and joints
  • Urinary incontinence issues
  • Vaginal dryness
  • Sex drive changes

Based on this topic of discussion, vaginal dryness and changes in sex drive are the most related symptoms to why some women struggle with their sex lives after menopause. As stated before, menopause involves much more than just the ceasing of the menstruation and ovulation processes.

The female reproductive parts can have significant changes to them as well. Genitourinary syndrome of menopause (GSM) is the collective name for the symptoms associated with the female genitalia that women can suffer after menopause. Recent studies show that approximately 50 percent of women experience some degree of GSM. The lower genitourinary tract, which is made up of the bladder, urethra, vagina, and vulva, are all overly sensitive to any fluctuation in hormone levels.

When the hormone levels drop due to menopause, they can bring about changes in how these parts look, feel and function. Below, we’re going to discuss how each part is affected by the menopausal process. 


This is the external part of the female genitalia that covers and protects the rest, such as the sexual organs, urinary opening, and vagina. Much of a woman’s arousal is centered around the vulva because it contains the clitoris, labia majora and minora (which are the inner and outer lips). The clitoris contains approximately 8,000 nerve endings and many women require clitoral stimulation for sexual satisfaction.

When menopause occurs, the vulva undergoes some significant changes. First, the drop in estrogen levels causes fat loss in the labia majora, which decreases the physical size of the outer lips. The labia minora also can experience shrinkage and reduced production of protective secretions. When the lips shrink in size and the secretions stop, the underlying clitoris and vaginal opening become more sensitive and exposed to chaffing, irritation or trauma. In extreme cases, the clitoris can also shrink in size or fuse together with the lips.

These changes are not only noticeable but also impactful on the day-to-day function of your vagina but also for the purposes of sex. Sex can become painful and women lose interest or desire to engage in sex. 


A woman’s vagina is made up of three very unique layers of tissue that promote specific functions. The top or exposed layer is extremely sensitive to estrogen levels and when these levels start to drop, the once thick and lubricating layer of tissue begins to atrophy.

When this happens, the tissues begin to thin, dry out and loses its elasticity. As a result, the vagina may become itch or burn, and the tissues can easily tear from sexual intercourse or even a pelvic exam. Extreme vaginal atrophy can lead to the overall narrowing of the vaginal opening or entire vagina itself. 


There is much debate revolving around whether changes in the urinary tract are menopause or age-related, but there is evidence that shows lower estrogen levels can contribute to urinary issues. The urethra and bladder tissues are also hyper-sensitive to estrogen, so when the estrogen levels drop, the tissues will lose their elasticity, volume and create menopause dryness.

Also, the vaginal and urethral changes can alter the pH levels and environment that allow harmful bacteria to grow that can cause UTI’s.

Treatment Options

Treatment Options

There are several different options of treatment for painful intercourse after menopause that can be tired and many of them are simple and easy. 

  • Healthy sex life
    Yes, this may sound silly, but an active and healthy sex life during the years of menopause and after can actually keep your vagina healthy. Sexual activity increases the blood flow to the organs and tissues, which helps stimulate healthy tissue function, maintain elasticity and promote natural lubrication. This is the best of the natural remedies for painful intercourse after menopause.
  • Lubrications
    Vaginal dryness after menopause can be helped with lubricants found at your local drug store prior to having sex. There are three main types of lubricants that each have their pros and cons and they include:

    • Water-based
    • Silicone-based
    • Oil-based
  • Estrogen Replacements
    Another very effective treatment for GSM are using topical applications of estrogen products. Creams, rings or even tablets that introduce estrogen into the body to stimulate the natural function of the vagina can be very successful at alleviating painful sex during menopause.
  • Mona Lisa Touch
    This relatively new MonaLisa Touch laser treatment was specifically designed to help women who experience vaginal atrophy that is related to estrogen levels impacted by childbirth. This also serves for other medical conditions/treatments and the phases of menopause. Without surgery or hormones, the results of these treatments help restore the natural functioning of the vagina by promoting the healing process within the tissues. The CO2 laser energy safely penetrates the tissues and jumpstarts that healing process for the body to increase the natural collagen production and blood flow to the tissue. Increased hydration and lubrication, healthier tissue and improved vaginal cell function are all benefits that women experience. Ultimately, everyday life improves and normal, pain-free sex life can be enjoyed once again.

Dr. Andrew Krinsky of Tamarac, FL, has been helping patients of south Florida for decades with exceptional patient care and the latest treatments available. If you find your daily or sex life suffering because of the symptoms of menopause, contact us or visit our site today to learn more about your options and to schedule an appointment!