4 Ways to Manage Painful Intercourse in Peri/Menopause

As women transition through perimenopause and menopause, many experience physical changes that can affect intimacy, including painful intercourse, or dyspareunia. These changes are primarily caused by declining levels of estrogen, which can lead to vaginal dryness, thinning tissues, and reduced elasticity. While this can feel isolating and overwhelming, it is important to know that there are effective ways to manage and overcome these challenges.

Here are four evidence-based methods to address painful intercourse during this stage of life:

1. Open Communication and Emotional Support

Painful intercourse is not just a physical challenge; it can also take a toll on emotional and relational health. Communicating openly with your partner is a crucial first step in addressing discomfort. Share your feelings and experiences to foster understanding and partnership in seeking solutions.

In addition, consider joining support groups or working with a therapist who specializes in sexual health or menopausal transitions. Knowing you are not alone and having a space to share your journey can alleviate emotional stress and provide access to helpful resources. A therapist can also guide couples in exploring alternative forms of intimacy, emphasizing emotional connection and physical closeness that go beyond penetrative sex.

2. Use of Vaginal Moisturizers and Lubricants

Vaginal dryness is one of the leading contributors to painful intercourse during perimenopause and menopause. Unlike hormonal therapies, vaginal moisturizers and lubricants offer a non-prescription option that provides immediate relief for dryness and discomfort.

• Vaginal Moisturizers: These products are designed for daily use to hydrate and improve the elasticity of vaginal tissues. They help maintain a healthy vaginal environment by mimicking natural lubrication
• Lubricants: Applied directly before sexual activity, lubricants reduce friction and make intercourse more comfortable. Opt for water-based or silicone-based lubricants that are free of irritating chemicals. Silicone-based lubricants tend to last longer, which may be beneficial for those with significant dryness

It may take some experimentation to find the products that work best for your needs. Look for ones that are pH-balanced and specifically designed for sensitive tissues.

3. Consider Hormone Therapy

Declining estrogen levels during menopause are a primary cause of vaginal atrophy and dryness. Discussing hormone therapy with your healthcare provider can be a transformative step in managing these symptoms if it’s a viable option for you

Localized Hormone Therapy: Vaginal estrogen creams, rings or tablets deliver small amounts of estrogen directly to the vaginal tissues. This localized approach can significantly improve vaginal elasticity, hydration, and comfort during intercourse, with minimal systemic absorption

Systemic Hormone Therapy: For women experiencing a range of menopausal symptoms, including hot flashes, mood swings, and sleep disturbances in addition to vaginal discomfort, systemic hormone therapy (via pills, patches, or gels) may be recommended

Hormone therapy is safe for most, but is not suitable for everyone, so it is essential to discuss your medical history and individual risk factors with your doctor. Together, you can weigh the potential benefits and risks to determine whether this approach aligns with your needs and goals.

4. Use of Vaginal Dilators

Vaginal dilators are another effective tool for managing painful intercourse. These devices are designed to gently stretch and relax vaginal tissues, improving comfort and function over time.

How They Work: Vaginal dilators are cylindrical tools of varying sizes that are inserted into the vagina. They help reduce pain by addressing tissue tightness, enhancing elasticity, and desensitizing nerves. Dilators can be an empowering solution for women experiencing painful intercourse due to vaginal atrophy, scarring, or muscle tension 

The Intimate Rose Difference: Intimate Rose vaginal dilators are FDA cleared, and crafted with soft, body-safe silicone, ensuring comfort during use. Their gradual sizing allow women to progress at their own pace, fostering a sense of control and confidence

Getting Started: Intimate Rose features easy-to-use guides included with each dilator set, and helpful free guides online as well. That said, it is helpful to use dilators under the guidance of a pelvic health physical therapist or healthcare provider. They can help you develop a tailored plan that aligns with your specific needs. Consistency is key; regular use can lead to meaningful improvements in comfort and ease during intimacy

Additional Considerations

Pelvic Floor Therapy: Working with a pelvic health physical therapist can address muscle tension, pelvic floor dysfunction, or scarring that may contribute to pain. Therapists use techniques such as manual therapy, biofeedback, and guided exercises to restore pelvic health

Healthy Lifestyle Habits: Staying hydrated, maintaining a balanced diet rich in omega-3 fatty acids, and engaging in regular exercise can support overall vaginal health and well-being. Weight-bearing exercises, in particular, promote healthy circulation and tissue repair

Patience and Self-Compassion: The journey to rediscovering comfort and intimacy takes time. Celebrate small milestones and be gentle with yourself as you navigate this phase of life

Closing Thoughts

Painful intercourse during perimenopause and menopause is a common challenge, but it does not have to be a permanent one. By addressing the underlying causes and exploring these four methods—open communication, vaginal moisturizers and lubricants, hormone therapy, and the use of vaginal dilators—you can take proactive steps toward restoring comfort, confidence, and connection in your intimate life.

Your body is constantly evolving, and so are the solutions available to support you. Seek guidance from trusted healthcare providers, embrace the tools you need, and remember that you deserve a fulfilling, pain-free intimate life. With the right resources and support, it is entirely possible to thrive during this transition and beyond.

Dr. Amanda Olson teaches internationally on various pelvic health topics and has written various articles on pelvic floor dysfunction and running. She authored the book: Restoring the Pelvic Floor For Women. Dr. Olson is the president and chief clinical officer of Intimate Rose where she develops pelvic health products and education. She is passionate about empowering women and men with pelvic health issues including pelvic pain, incontinence and postpartum issues.