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Q: What do I do about pain during intercourse?

by Dr. Barb DePree MD

If you have pain during intercourse, you need a good, thorough physical exam to start, to make sure there is no obvious cause for the pain with penetration (for example, vulvodynia/vestibulodynia). If the exam doesn't identify any apparent physical cause, you might spend some time on MiddlesexMD's recipe for sexual health, walking through each component to see what makes a difference:
  • Understand the physiology of menopause so you understand what you're compensating for.
  • Learn to care for your vulvo-vaginal tissues, including considering moisturizers or lubricants.
  • Compensate for less sensitivity in genital tissues with more stimulation -- and more patience!
  • Maintain pelvic floor muscles to encourage circulation and maintain orgasms.
  • Attend to emotional intimacy -- because the brain is a vital part of arousal for women.
Our website is structured to help you learn about and address each of these topics; just follow the tabs across the top. You'll need patience to figure out what combination of strategies will work for you, but continued use of the vagina is recommended for continued sexual activity. Avoidance because of pain only makes matters worse. Be in touch if you have questions as you explore possible approaches to get past this pain. It's worth the time you spend!


  • Unfortunately, in menopause without regular use, and/or vaginal moisturizers or vaginal estrogen, the typical woman will lose some vaginal function. The result is pain with attempted intercourse. This doesn’t mean it can’t become comfortable again, but it will take some effort.

    The vagina as it ‘ages’ becomes more thin, fragile and narrow; all of these can result in discomfort. Partner size may be one factor as well. You should begin with a vaginal moisturizer, a vaginal product used on a regular basis to restore some moisture to those tissues. You may also benefit from vaginal dilators, they are designed to regain vaginal capacity or caliber.

    The website can give you some additional information about solutions to this issue. Please visit, if you haven’t already, @

    barbdepree on

  • I haven’t had sex in ten years. My husband passed away three years ago. It wasn’t a good marriage. We weren’t close. Now after all this time I find myself wanting sex and wanting to be wanted. Last week I went to have sex with a man I have known for a couple of months. It hurt. And we didn’t continue. He seamed to be very thick much thicker than my late.
    Is it because I haven’t done it in so long or are there different sizes and we can only do it with a certain size or can you ease into it and get use to someome that is much thicker? Does the vulva stretch to allow for the differnce.
    I am in my sixties and haven’t had much experience in this field. I had been married for forty years

    Donna on

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