Why does sex hurt?

As a doctor, I get asked a million questions by my patients. Oftentimes, I get asked the same questions over and over again, which is why I decided to outline the top 5 questions I get asked right here!

Why does sex hurt?

At Amazing over 40, we want to educate you to help you live your best life – in and out of the bedroom!

There may be many reasons why sex might hurt – vaginal infections, uterine fibroids, endometriosis, as well as many others.  As we approach our 40’s, 50’s and beyond, pain with intercourse is a very common complaint.   One of the primary reasons for this pain is lack of sufficient vaginal lubrication.


It’s a fact. Approximately 40% of post-menopausal women experience vaginal dryness and pain with intercourse— yet only 20-30% of those discuss it with their physician! (1, 2)

Many peri-menopausal women have the same complaint. Sex hurts! Given the fact that the average age of menopause is 51 and the average lifespan for a woman in US is 82 years, wouldn’t you like to learn how to solve this problem so you can keep sex fun and pleasurable for 30-plus years?

So, what causes vaginal dryness? 
In general, it occurs with the onset of menopause when a rapid decline in estrogen production leads to many symptoms, including vaginal dryness and pain with intercourse. Another medically used term for this is “vaginal atrophy” and although it is technically correct it doesn’t sound like a condition that many women would like to have.

What are the symptoms?
Many of my patients describe it as “sharp knives cutting into the vagina” or a “rough sand-paper” sensation. Occasionally there also may be some vaginal bleeding associated with sexual activity. Due to these symptoms it’s easy to see why many women would avoid sexual relations at all, which we all know can lead to strained relationships or worse. 

It doesn’t have to hurt!
That’s right, there are many ways to reduce these symptoms. Below are my top recommendations for relieving the pain and getting your sex life back on track: 

1) Stay hydrated: Drinking six to eight glasses of water a day (and more if you exercise vigorously) will help keep your tissues moist, both above and below the belt.

2) Use water-based lubricants: You should look for natural, water-based lubricants to avoid developing sensitivities in your delicate areas.  At Just Pure Essentials, they have a fantastic line of water-based organic products that ‘ticks all the boxes’ if you’re looking for something that’s paraben and glycerin-free (which you should be) as well as organic. Read more about them here. www.justpurelife.com 

3) Use a long-lasting vaginal moisturizer: The one I recommend most to my patients is Replens. It lasts for 48-72 hrs. and can be used 2-3 times a week, even without sex so you’ll be ready anytime. Usually it will take at least 3 months before a significant difference is noticed and your vaginal tissues regain their elasticity and moisture.

4) Avoid personal hygiene sprays: These contain irritating chemicals which will only further the pain and sensitivity to thin vaginal tissues.

5) Don’t douche!: Marketing companies were smart in trying to convince women that our bodies were dirty and smelly. Well, Mother Nature was smarter! She built a self-cleansing system which regulates and maintains a healthy vaginal environment. By douching, you’re washing away the healthy vaginal bacteria, lactobacilli, and acidic vagina chemical balance (pH = 4.5) is disrupted leading to dryness and inflammation.

6) Use It or Lose It: Yes, this is true —- the more sexual activity you have, the more blood flow to all areas in your body, especially your vaginal tissues.

What if these don’t work?

For many patients, these remedies don’t completely knock out their pain and dryness. Fortunately, we have many options now which include:

  • low-dose intravaginal estrogen therapy (tablets - Vagifem, creams- Estrace and Premarin, ring - Estring and suppositories- Imvexxy)

  • DHEA vaginal suppositories (Intrarosa)

  • Oral therapy (Osphena)

If you are experiencing hot flashes, night sweats, mood swings, and any other common menopausal symptoms, systemic (oral or transdermal) therapy might be needed.

Discuss these with your physician to see which one would work best for you given your lifestyle and comfort level with applicators, etc.

Openly discussing this topic and addressing these concerns is incredibly satisfying for me and my patients! I know that I have helped them regain this important intimate part of their health and they are excited to have it back!

Remember – sexual health concerns are important, no matter what age!

Be honest with your physician.

Talking about sex and sexual issues should no longer be considered taboo. It is an astounding (and saddening) fact that 7 out of 10 women with this condition do not speak to their gynecologist or family physician about it. (3) In my practice, every woman is asked about physical intimacy and any sexual concerns, including vaginal dryness and pain. It is critical that you find a compassionate physician whom you trust, can confide in and be comfortable discussing this intimate issue!

Talk with your doctor today – there is help ….and no need for the pain!

In health and happiness,


Dr. Diana

1. Bachmann, GA and Nevadunsky, NS. Diagnosis and treatment of atrophic vaginitis. American Family Physician, 2000; 61 (10): 3090-3096.
2. Mac Bride, MB, Rhodes DJ, Shuster LT. Vulvovaginal Atrophy. Mayo Clin Proc. 2010; 85 (1): 87-94.
3. Bachmann, G, Bouchard C, Hoppe D, Ranganath R, Altomare C, Vieweg A, Graepel J, Helzner, E. Efficacy and safety of low-dose regimens of conjugated estrogens cream administered vaginally. Menopause. 2009 Jul-Aug;16(4):719-27.
4. Novo Nordisk Vagifem. https://press..novonordisk-us.com/idex.php?s=43&item=252. October 2010.

Leave a comment

Please note, comments must be approved before they are published