Why is it hurting to have sex?

Dr Alison Vickers, a Sydney GP with a special interest in the care of women during perimenopause and menopause, answers a question that women often don’t ask their doctors.

The short answer

A decrease in hormones during perimenopause and menopause causes changes to the vagina that may lead to pain during sex. The good news is that there is treatment available that is very effective.

The long answer

I wish more women over the years had told me it was hurting to have sex and not just put up with it. As doctors, we often forget to ask the question. It’s important as studies show that more than 50% of women after menopause get vaginal dryness and pain with intercourse, but less than 10% of women ask their doctors and are offered any help.

Hormones like estrogen play an important role in maintaining the tissues of the vagina. Low estrogen levels after menopause lead to vaginal dryness, inflammation and a thinning of the vaginal walls. Unlike many menopause symptoms that settle with time, this is a symptom that unfortunately does not go away and can get worse. This can mean that sex can become more uncomfortable and even painful. This doesn’t help if a woman’s libido is already decreased.

What treatments are available to help if it hurts to have sex?

• Menopause Hormone Therapy (MHT) restores estrogen levels. Even women who cannot take MHT, including women who have had breast cancer, are usually able to safely use an estrogen vaginal cream.
• A vaginal moisturiser like Replense. The same as a moisturiser you put on your skin keeps your skin from feeling dry, a vaginal moisturiser can help with vaginal dryness.
• A lubricant is a must if sex is painful. There are a variety of different lubricants. Silicone-based lubricants have the advantage of lasting longer.