“It feels like he’s banging into my cervix.”
That is how one of my patients described sex with her partner. She wasn’t wondering whether this was something she was expected to tolerate, she was already tolerating it, and each time it happened, she found herself dreading the next time her partner might want to have sex.
By the time pain enters the bedroom, it rarely stays only physical because it begins affecting anticipation, desire and connection. It is difficult to look forward to sex when your body is preparing to be hurt.
Her partner wasn’t trying to hurt her, and she wasn’t trying to reject him, but their bodies were no longer having the same experience. He was experiencing sex, while she was enduring it.
Menopause does not send every woman the same memo. One woman may notice a change in desire, another may struggle to become aroused, while someone else may suddenly discover that penetration, which once felt comfortable, now burns, pulls, stings or hurts deep inside.
Pain during sex is common during perimenopause and menopause, but that does not mean you should continue having sex that hurts.
What Does Menopause Have to Do With It?
As estrogen levels decrease, the skin and tissue inside the vagina can become thinner, drier and less stretchy. Doctors call this genitourinary syndrome of menopause, or GSM, which is quite a name for something many women experience without ever being told what is happening.
In plain English, menopause can change the vagina, vulva, bladder and urinary tract.
These changes may cause dryness, irritation, urinary symptoms or pain during penetration. Some women feel discomfort near the vaginal opening, while others experience pain much deeper inside, where penetration can feel as though a penis or toy is repeatedly striking the cervix.
If this happens once because of a particular position or unusually deep thrusting, changing the depth, pace or angle may solve the problem. If it continues happening, repeatedly testing whether it still hurts is not the answer, so make an appointment with a gynecologist.
Your Body May Need More Time
When you become physically aroused, your vagina does more than produce lubrication, it also becomes longer and wider, creating more room for penetration.
During menopause, this process may take longer, natural lubrication may decrease, and the vagina may not stretch or expand as easily as it once did.
This means that moving quickly into penetration, especially deep penetration, can feel very different from how it felt several years ago. Your body may need more time, more stimulation, additional lubrication, a different position or less depth.
None of this means you are no longer attracted to your partner, and it does not mean you have suddenly become “bad at sex.” It means your body has changed, and the way you have sex may need to change with it.
There is also another part of this that couples do not always recognize. Once sex has hurt several times, your body may begin preparing for pain before penetration even starts.
The muscles around the vagina can tighten because your body remembers what happened last time, and that tightening can make penetration hurt even more. Now you have a cycle in which sex hurts, the body expects pain, the muscles tighten, and sex hurts again.
This response is not imaginary or “all in your head,” it is your body trying to protect you.
Where Does It Hurt?
Not all sexual pain feels the same, and where you feel it matters. The location can help your doctor understand what may be causing it.
Pain near the vaginal opening may feel like burning, stinging, tearing or extreme tightness, and it can be caused by dryness, irritation, hormonal changes, infection or muscles that tighten without your control.
Deep pain may feel like pressure, cramping, aching or a sharp pain inside the pelvis, and it may become worse in positions that allow deeper penetration.
Although menopause may be part of the reason, it should not automatically be blamed for everything. Ovarian cysts, fibroids, endometriosis, infections, scar tissue and tight pelvic muscles can also cause pain during sex, which is why ongoing or severe pain should be evaluated by a gynecologist.
Lube Can Help, but It Isn’t Magic
When a woman says sex hurts, one of the first things she is often told is, “Use more lube.”
Sometimes that is excellent advice because lubricant can make an enormous difference when dryness or rubbing is causing discomfort. A water-based lubricant may be a good place to start, while a silicone-based lubricant usually lasts longer and provides more glide.
However, some women experience vaginal dryness and irritation even when they are not having sex, which is where a vaginal moisturizer may help.
Lubricant and vaginal moisturizer serve different purposes. Lubricant is applied during sexual activity to reduce rubbing and make penetration more comfortable, while a vaginal moisturizer is used regularly to help the vaginal tissue remain moist and comfortable over time.
If dryness is part of the problem, a woman may benefit from lubricant during sex, a vaginal moisturizer between sexual experiences or both.
Neither one, however, can make deep thrusting comfortable when a penis or toy repeatedly hits an area that hurts, and neither can treat an infection, cyst, fibroid or another underlying medical condition.
Sometimes the right lubricant or moisturizer can make an enormous difference, while other times the pain is the body’s way of saying that something more needs to be evaluated.
When “Not So Deep” Isn’t Being Heard
Painful sex can become a relationship issue even when the relationship itself is not the cause.
Some women move their hips away, change positions or repeatedly say, “Not so deep,” hoping their partners will understand without feeling rejected. Others say nothing because they do not want to interrupt the moment or make their partners feel unwanted, while inside, they are counting the minutes until it is over.
A caring partner does not need to understand every detail of female anatomy to understand the words, “That hurts, please stop.”
Stopping penetration does not mean the sexual experience has failed. Penetration can become slower or shallower, pause for a while or stop completely, and a couple can move toward touching, oral sex, mutual masturbation, vibrators, massage or anything else that feels pleasurable and safe.
Penetration is one form of sex; it is not the price you have to pay for intimacy.
What Actually Helps?
Most causes of painful sex can be treated or improved once the cause is understood.
A gynecologist or healthcare professional who specializes in menopause and hormone therapy may discuss vaginal estrogen or another treatment for vaginal changes caused by menopause. These treatments are not right for everyone, so the decision should be made with a professional who knows your medical history.
Other things that may help include using a vaginal moisturizer regularly, adding plenty of lubricant during sex, allowing more time for arousal or working with a physical therapist who specializes in the muscles inside and around the pelvis.
If those muscles remain too tight, a specially trained physical therapist can help you learn how to relax them. Many women assume that pelvic-floor therapy means doing Kegel exercises, but the pelvic floor does not always need to become stronger, sometimes it needs to learn how to release.
Kegels involve repeatedly tightening the same pelvic muscles you would use to stop the flow of urine, and they are often recommended to improve bladder control. However, if those muscles are already too tight, repeatedly tightening them may increase pain instead of relieving it.
Position also matters. Lying side by side can limit how deeply a penis or toy enters the vagina, while being on top may allow the receiving partner to control the depth, speed and angle.
Positions that allow very deep thrusting may need to be avoided, at least until the cause of the pain is understood.
The goal is not to find a way to tolerate the same painful sex, the goal is to discover what feels comfortable and pleasurable now.
When Should You Call a Doctor?
Make an appointment with your gynecologist if the pain is severe, happens frequently, continues to get worse or suddenly begins after years of comfortable sex.
Contact your gynecologist promptly, visit urgent care or go to an emergency room if you experience sudden, intense pelvic pain along with fever, heavy bleeding, vomiting, fainting, unusual discharge or severe pain outside of sex. If the pain is extreme, or you are fainting or bleeding heavily, go directly to the emergency room.
When you speak with your doctor, explain where the pain occurs, what it feels like, which positions make it worse and whether you experience dryness, bleeding or pain afterward, because those details can help identify what is causing it.
Menopause can change how sex feels, how long arousal takes and what your body needs to experience pleasure, which may require patience, communication, medical care and a willingness to rethink what satisfying sex looks like.
You deserve more than being told to relax.
Your body is not being difficult, it is communicating.
Sex should not hurt, and pleasure should never require you to ignore your own body.
Sources
American College of Obstetricians and Gynecologists. “When Sex Is Painful.”
American College of Obstetricians and Gynecologists. “Your Sexual Health.”
Mayo Clinic. “Painful Intercourse: Symptoms and Causes.”
The Menopause Society. “Sexual Health.”
The Menopause Society. “Menopause Symptoms.”
