Painful Sex After Menopause

The medical term for painful sex after menopause is menopausal dyspareunia. It’s not a matter of either you have it or you don’t. It’s a matter of what degree of pain you may have. Between 20 and 40 percent of menopausal women have some level of pain with intercourse. 

If you are having pain with intercourse, you should make an appointment with your doctor for a pelvic exam. Your physician may recommend an ultrasound. Conditions such as cancer of the vulva, vagina, uterus, ovary, or bowel may be associated with painful sex after menopause. These conditions are less common causes for the pain, but more dangerous.  These cancers are often hard to diagnose but are serious and treatment should not be ignored or overlooked. 

Cancer of the vulva begins with few symptoms except for the possible presence of itching or burning. As the vulva shrinks, a benign but troublesome disease called lichen sclerosis can develop. However, a small area as little as less than half an inch in diameter could be vulvar cancer. So I recommend you see your doctor for any itching or burning of your vulva. 

The value of pap smears has been downplayed in recent years, but although pap smears are no longer done routinely in the yearly physical exam for women, the rate of cervical cancer in increasing. The pap smear also can detect vaginal cancer.   

Once your doctor has ruled out cancer, your physician can move on to a common cause of painful sex after menopause, vaginal dryness.  In menopause, the outside layer of your ovaries stops making eggs—and estrogen. The estrogen is responsible for keeping your vagina soft and stretchy.  

The thinning and shrinking of your vagina which occurs when estrogen levels fall can be diagnosed with a pelvic exam. The American College of Obstetricians and Gynecologists (ACOG) recommends topical, vaginal Premarin cream. ACOG recommends against oral estrogen and an estrogen skin patch (transdermal) because it produces estrogen circulating in the blood stream. This ACOG recommendation is based on the results of the Women’s Health Initiative (WHI) study of about 20 years ago which associated oral estrogen treatment with increased risk of heart attacks.  

The big problem with vaginal estrogen cream is the expense. A tube may cost as much as $300. There are over-the-counter alternatives made from yams, plants which contain estrogens. These creams will be weaker than the prescription vaginal creams, but they can be effective, especially if you start treatment early before the dryness has a chance to become more severe. 


Dr. Alan Lindemann

Obstetrician-Gynecologist (OB/GYN)​

He is an obstetrician and maternal mortality expert with 4 decades of medical practice beginning in Minnesota and presently in North Dakota. He has delivered around 6,000 babies with zero maternal deaths.

Why should you support Rural Doc Alan?

Dr. Lindemann delivered 6000 babies for over 40 years with no maternal mortalities, no eclampsia, and no babies with cerebral palsy. He tells his story here of how he did this in a medical environment that really doesn’t do well with deliveries. He openly admits that much he learned about safe pregnancy came from his patients, not medical books. Donating here will help spread the word to women everywhere so they can learn about safe pregnancy.