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Pain with Penetration

As estrogen levels fall as women approach and pass menopause, the resulting dryness and thinning of vaginal tissues can cause penetration and intercourse to be uncomfortable for many women. The discomfort can range from a feeling of dryness to a feeling of vaginal “tightness” to severe pain during sex. After sex, some women feel soreness in their vagina or burning in their vulva or vagina. Over time, and without treatment, the inflammation that may result from infrequent sex without sufficient vaginal lubrication can lead to tearing and bleeding of vaginal tissues during sex.

Between 17% and 45% of postmenopausal women say they find sex painful.

This is one of the main reasons why between 17% and 45% of postmenopausal women say they find sex painful,5-8 a condition referred to medically as "dyspareunia." Vaginal thinning and dryness are the most common cause of dyspareunia in women over age 50. Be aware, however, that pain during sex can also result from vulvodynia (chronic pain in the vulva, or external genitals) and a number of other causes not specifically associated with menopause or aging (see the “Vaginal Discomfort” and “Pain in the Vulva or Pelvis”) portions of this program.

Beyond the immediate effects of the pain itself, pain during sex (or simply fear or anticipation of pain during sex) can trigger performance anxiety or future arousal problems in some women. Worry over whether pain will come back can diminish lubrication or cause involuntary—and painful—tightening of the vaginal muscles, called vaginismus. The result can be a vicious circle, again highlighting how intertwined sexual problems can become.

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