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“Nothing to be Done about Pain?” Not So.

by Dr. Barb DePree MD

I’ve talked about a couple of general topics prompted by reading the REVEAL research results: that lots of women aren’t aware of the effects of menopause on sexuality and that many of us aren’t talking about it. There’s one more topic that’s on my mind, because I hear about it every day in e-mails I receive from the “Ask Dr. Barb” link on our website.

It’s painful intercourse. In the study, 36 percent said that pain during sex made them stop having sex. That’s one issue. The other issue is that 59 percent of women who experience pain during sex still have intercourse on a regular basis. About three-quarters of those women have sex at least once a month, on average; a third have sex at least once a week.

The good news for the women among the 59 percent is that they recognize their sexuality as an important part of their selves and their relationships. The bad news, of course, is that it hurts. And more bad news is that not enough women realize that it doesn’t have to.

When midlife women talk about their sexuality, pain with sex is easily the most common physical complaint. This pain may feel superficial or deep. It may feel like burning or aching. It may happen only on initial penetration or only with deep thrusting.

The medical name for this is “dyspareunia" (dis-pu-ROO-nee-uh). It’s a tongue twister of a word, I know, but it comes from “dys” (as in dysfunctional) plus a Greek word that means “lying with”—so it’s as simple as “lying together doesn’t work.” It’s a general diagnosis that needs more investigation, because many things can cause the pain, and the pain can be experienced in a number of ways.

Another scary part of the research: A quarter of the women who experience painful intercourse thought that there was “nothing that could be done medically” to address their pain; I assure you that’s not true. There are solutions ranging from regular use of moisturizers and personal lubricants to overcome dryness to vaginal dilators to restore vaginal caliber (size and depth of the opening) to systemic or vaginal estrogen to maintain tissue health.

About a quarter also felt that their pain during sex was “an inappropriate conversation” to have with their health care provider; that’s not true, either.

Easy for me to say, I know, since I specialize in mid-life women’s health. Whoever your health care provider is, he or she will recognize the importance of sexuality to a full and healthy life. And if you don’t sense that, it’s worth it to find a sexually literate health care provider. Really.


  • Cheryl, you need a complete exam by a menopause-informed physician ( to determine exactly what the issue is. It may be vaginismus or another condition that’s complicating the atrophy, or it may be atrophy alone. An accurate diagnosis is really key to identifying next steps.

    Dr Barb on

  • I haven’t reordered in sometime. I still have pain so we don’t have intercourse. Try using the smallest dilator but that still was uncomfortable. Can you suggest where to go from here?

    Cheryl on

  • This is a great post for women who are experiencing these problems. Unfortunately, the pain with intercourse as we age can also coincide with a decrease in libido. I think that prevents women from addressing this issue unless it is impacting their relationship with their partner. It is important for us to know that there are options and solutions to these problems as we age.

    AnneV on

  • One of my most significant and lasting losses from menopause is exactly what you have discussed here. Vaginal dryness and pain during interourse. I am on vagifem – a prescription vaginal suppository – and i have found a lubrication product that works for me. The combination of the two has given me relief (and enjoyment!) I would encourage women to try different lubricants until you find one that works – they are not all created equal! and you WILL find one that works for you. Also, be liberal with applying it – that is a factor too.
    At the end of the day, another big factor is frequency of sex. I do know that the more we do it – the less i have pain! I have pain almost every time upon penetration, but with a lubricant that works for me and having sex at least once a week, and the vagifem, i have found the pain is a short lived – and we are on to good stuff!!
    My relationship with my husband has become more intimate because we talk about the changes i/we have experienced and because i have a great dr. who knows what she is talking about.
    there is life – and sex – after menopause!

    ruth on

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