Painful Sex: A Real Mid-life Crisis

It’s one of life’s cruel ironies: the kids are finally out of the house so you have more privacy and free time for sex but it’s not the same as it used to be. For women, bodies often don’t respond the way they did in younger years. Many experience decreased sensation, vaginal dryness and even pain with penetration.  In fact, painful intercourse is among women’s top three menopause complaints and often what drives women to finally seek treatment here at NDV. The culprit, of course, is changing hormones.

Throughout a woman’s reproductive years, estrogen contributes to effective vaginal lubrication and thickens the vaginal wall while increasing blood vessels in the skin. But levels of estrogen wildly fluctuate in women’s 40s and—without hormone therapy – remain low after menopause, causing vaginal atrophy – vaginal dryness and loss of elasticity. Not only can this cause pain during sex, but, over time, intercourse under these harsh conditions also can cause vaginal inflammation and even mild injury. It can become a vicious downward spiral; the less you have sex, the more atrophy will develop, so more discomfort and less sex. It’s a use-it-or-lose-it situation!

Luckily, there are treatments available for vaginal atrophy and dyspareunia (the medical term for painful sex), ranging from over-the-counter, water-soluble lubricants to hormone replacement therapy. But lubrication alone may not solve the problem of vaginal atrophy. The North American Menopause Society suggests the use of vibrators and dildos to help stimulate blood flow. And vaginal dilators – plastic or rubbery round-tipped cylinders, graduated in size – can be used to stretch and relax the vaginal muscles. (Go to, for more information.)

Be sure to talk to your GYN about pain that persists and don’t be shy about talking to a sex therapist. A hormone specialist can help you design a therapy course that meets your body’s specific needs.

It may take some extra work, a bit of adjustment, and a sense of humor certainly helps, but sex beyond your 40s can be fun and satisfying. Take advantage of that empty nest: say YES to sex!