Harvard Women's Health Watch

Ask the doctor: What can I do about painful sex?

Q. Since I went through menopause, sex has become very painful. I no longer enjoy it. Are there any treatments I can try?

A. Sexual intercourse should be a pleasurable part of your relationship, but for some women it becomes very uncomfortable after menopause. One common cause of painful sex (termed dyspareunia) is the drop in estrogen after menopause, which leads to vaginal dryness. Other reasons include conditions such as uterine prolapse, vaginal infections, tense vaginal muscles, endometriosis, lichen sclerosis (a skin condition that causes thinning of the genital skin), uterine fibroids, or pelvic surgery (for example, hysterectomy).

Although sex can sometimes be difficult to discuss with your doctor, it's important to make an appointment to detect physical causes of your problem and to consider available treatments. If vaginal dryness is an issue, you can try a water-soluble lubricant. Or, your doctor can prescribe a vaginal estrogen cream or ring to increase the resilience of the vaginal tissues. The FDA recently approved a new treatment for painful intercourse in postmenopausal women. Ospemifene (Osphena) is a pill that acts like estrogen to thicken vaginal tissues. Studies suggest Osphena can make sex less painful, but it does carry a "black box" warning (the FDA's strongest warning label for drugs) about an increased risk for endometrial cancer.

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