For many women navigating perimenopause and menopause, pain during sex can become an unwelcome and distressing reality. Known medically as genitourinary syndrome of menopause (GSM), this condition includes symptoms like vaginal dryness, burning, irritation, urinary issues, and pain during intercourse. As many as 4 in 5 women will experience some form of GSM during or after the menopause transition.
A new study from Japan offers an important perspective: women who remain sexually active tend to report fewer GSM-related symptoms, including less vaginal pain. However, experts warn against a simplistic takeaway — more sex does not automatically cure pain. In fact, for women already experiencing discomfort, continuing painful intercourse may worsen the problem.
“If it’s painful, intercourse makes it worse. Your body goes into defense mode,” says Dr. Lauren Streicher, founding director of the Northwestern Center for Sexual Medicine and Menopause. She emphasizes that painful sex is a sign that medical treatment is needed, not more sexual activity.
Regular Sex vs. Painful Sex: A Complex Link
In the Japanese study, researchers surveyed over 900 women aged 40 to 79 who had been sexually active within the past year. Those who had regular sex (defined as within the past three months) reported fewer daily symptoms like vaginal pain and dryness. They also reported stable levels of orgasm and satisfaction despite decreases in arousal and lubrication with age.
Still, researchers noted that women in the “regular activity” group were generally younger and more likely to be premenopausal — important factors that could influence symptom severity.
Experts agree that while sexual activity may help maintain vaginal health in women without pain, it’s not a substitute for proper medical treatment in those who do have pain.
Why Pain Happens — And What to Do About It
Painful sex during menopause is typically caused by low estrogen levels, which lead to thinning and drying of vaginal tissues. Over-the-counter lubricants may help in mild cases, but persistent or moderate-to-severe symptoms often require prescription treatment.
The most effective and safe option for many women is local low-dose vaginal estrogen therapy. Dr. Monica Christmas, associate director of the Menopause Society, says this treatment directly restores vaginal tissue health, improving elasticity, moisture, and comfort.
“Unlike systemic hormone therapy, there are almost no contraindications to local low-dose vaginal estrogen therapy,” she explains. The treatment is available as a cream, insert, vaginal pill, or ring, and can be used indefinitely under medical supervision.
You Deserve a Pain-Free Sex Life — Or Just Relief
Dr. Streicher stresses that painful intercourse is never something to push through. “If you have pain, stop. Talk to a menopause expert. You can absolutely have a healthy sex life — just not one that hurts.”
And sexual activity isn’t required to seek relief. “Treatment should be offered to anyone with symptoms, whether they are engaging in sexual activity or not,” says Dr. Christmas.
Ultimately, GSM is one of the few menopause-related conditions that does not improve over time without treatment. Fortunately, with proper care, many women can restore comfort, confidence, and well-being.
Related topics:
