Q: What will make intercourse less painful?

You say you’re past menopause, which is defined as a year without menstruating. Intercourse has become painful, and occasionally you have some bleeding afterwards.

The condition that leads to painful intercourse in menopause is vulvovaginal atrophy, now called genitourinary syndrome of menopause. The absence of estrogen leads to profound changes to the genitals. The vagina and vulva shrink, and the tissues are more dry, thin, and fragile. This leads to painful sex. Within five years of menopause, up to half of women have pain with intercourse.

Early in menopause, before the atrophy is advanced, vaginal moisturizers can be beneficial; they are considered part of prevention. But once the atrophy is more advanced, moisturizers are not enough.

You can restore health by adding a localized (vaginal) estrogen or using Osphena (an oral, non-estrogen treatment). Both of those options are prescription therapies that reverse the atrophy and restore health to the vagina, vulva, and lower urinary tract. A good lubricant is definitely important too, I recommend Pink, a silicone lubricant with aloe and vitamin E.

Occasionally, there can be an additional cause--beyond atrophy--for painful intercourse. A careful examination by a menopause care provider will help determine the exact cause and whether any additional treatment would be helpful.

Best of luck! With patience and persistence, most women can regain comfortable and satisfying intimacy!