Menopause and Painful Sex

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Client and therapist sit in an office, smiling.

Hot flashes.

Sleep issues.

Mood swings. 

These are the three horsemen of the meno-pocalypse.

And then there’s the fourth horseman—the menopause symptom no one talks much about, despite how common it is.

Painful sex.

Let’s talk about why you may have painful sex during menopause (and how to get the relief you deserve)!

Menopause 101

Menopause marks the end of our reproductive years, when estrogen production gradually decreases and our ovaries stop releasing eggs. This transition typically occurs between the ages of 45 and 55, but symptoms of perimenopause can occur for years prior. 

Menopause officially starts when there is a lack of a menstrual cycle for 12 consecutive months. But there are plenty of symptoms in addition to Aunt Flo’s disappearance:

  • Incontinence
  • Mood swings
  • Depression and anxiety
  • Hot flashes
  • Difficulty sleeping
  • Hair loss
  • Weight gain
  • Decreased sexual desire
  • Vaginal dryness
  • Changes in pelvic floor strength

These last three symptoms can make getting intimate the last thing on your mind. 

Estrogen and Sexual Function

Decreased estrogen levels can worsen libido and make sex less pleasurable—or even painful. That’s because low estrogen can cause vaginal tissues to become thinner and drier, often leading to pain with sex and even mild bleeding with intercourse. 

Drops in estrogen can also impact the overall strength of your pelvic floor. 

Estrogen is responsible for keeping your pelvic floor muscles in tip-top shape so they can offer appropriate support to your bladder, vaginal walls, and vulva. So, when estrogen drops, so does your pelvic floor strength.

6 Tips to Manage Painful Sex and Menopause

#1 Add moisture. 

Whether you’re looking to add moisture throughout the day or specifically during sex, a daily vulvar moisturizer and good lube with intercourse will be your new BFFs.  

#2 Use dilators or pelvic wands. 

Vaginal dilators/trainers can help desensitize your vaginal tissues and relax your muscles. Pelvic wands can provide relief for specific trigger points in the deeper pelvic floor muscles. 

#3 Stop Kegels (for now).

It’s true that menopause can weaken the pelvic floor. And, most of the time, a weak pelvic floor can benefit from Kegels. But if you’re experiencing painful sex, push pause for a bit!

Painful sex is a good indication of an overactive (or hypertonic) pelvic floor. In that case, the first step toward relief is to relax the pelvic floor through gentle stretching. Then it’s OK to move on to strengthening exercises like Kegels.

#4 Practice diaphragmatic breathing. 

Belly breathing helps to calm the nervous system and reduces muscle guarding, which increases mobility, blood flow, and relaxation to the pelvic floor. 

Place one hand on your chest and one on the abdomen. Relax your jaw and shoulders. Take a slow, gentle breath in and let the abdomen and rib cage expand. Stretch your stomach and ribs equally in all directions, like you’re opening an umbrella in your rib cage. Slowly breathe out and let your belly fall back down. 

#5 Address your stress. 

Hormonal changes that accompany menopause can increase feelings of stress and anxiety, and stress can increase pelvic floor tension. From practicing yoga to seeing a professional therapist, making small changes over time can help to decrease toxic stress—and make sex feel good again!

#6 Relax your pelvic floor.

Many exercises and stretches can help relax your pelvic floor and make sex more pleasurable. And the Relaxation Series in the V-Hive will introduce you to the most effective ones! In this four-week series, you’ll learn daily stretch routines and self-massage techniques to help you stop suffering and start living!

In just a few minutes of stretching, every other day, can help you:

  • Enjoy sex again.
  • Resolve tailbone pain.
  • Relieve UTI-like symptoms.
  • Poop and pee like a pro.

You can join the V-Hive for a month, a quarter, or a whole year—and you can get started today with a 7-day free trial.

In the meantime, try these stretches to start feeling some relief. 

Child’s Pose

Woman crouches on ground with hands out in front of her, laying down in child's pose

Kneel on the floor. Touch your big toes and spread your knees wider than your hips. Rock your hips backward onto your heels and stretch your arms forward. Exhale and move your torso closer to the ground. Hold the pose for 5-10 breaths.

Cobra Pose

Woman lies on ground and pushes up on her elbows into cobra pose

Lie stomach-down on the floor. Place the palm of your hand on the floor next to your shoulder, and hug your elbows into your body. Press the tops of your feet, thighs, and pubic bone firmly into the floor as you inhale and straighten your arms, lifting your chest off the floor. Open your chest upward toward the sky and squeeze your shoulder blades together. Hold the pose for 5-10 breaths. Breathe easy, exhaling as you release back to the floor.

Happy Baby Pose

Woman lies on ground on her back with legs in the air, holding onto legs in happy baby pose.

Lie on your back. Exhale and bring your knees to your belly. Inhale and grip the outside of your feet with your hands, opening your knees slightly wider than your torso. Bring your knees toward your armpits. Hold the pose for 5-10 breaths.

Cat-Cow Pose 

Woman on her hands and knees arches her back in cat cow poseWoman on her hands and knees arches her back and looks up in cat cow pose.

Get on all fours. Keep your hands shoulder-width apart and your knees directly below your hips. Inhale deeply and curve your lower back, bringing your head up and tilting your pelvis. Exhale deeply and bring your abdomen in, arching your spine and bringing your head and pelvis down. Repeat the stretch.

You deserve great sex. 

As you navigate menopause and painful sex, check out the V-Hive Membership’s Relaxation Series. By practicing these stretches and exercises for just a few minutes each week, you can ease pelvic floor tension, get relief from pain, and restore pleasure to sex. 

Stop suffering and start living. Your first week is on me!

Join The V-Hive

Online pelvic floor fitness programs from a board-certified Women’s Health Physical Therapist. Your first week is free.

Free Pelvic Floor Guides

Download these free guides for some simple, do-able, totally-not-weird tips to take better care of your down there.

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