Painful sex after menopause—medically known as dyspareunia—is a common but distressing concern that affects many women. The primary cause is Genitourinary Syndrome of Menopause (GSM), previously referred to as vulvovaginal atrophy (VVA). GSM results from declining estrogen levels, which can thin and dry vaginal tissues, leading to discomfort, irritation, and pain during intimacy.
The good news: several prescription treatments are available to help restore comfort and intimacy. This article outlines the most effective medical options for women seeking relief.
Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice. Always consult a licensed healthcare provider before starting or changing any hormone therapy.
Understanding the Cause: Genitourinary Syndrome of Menopause (GSM)
When estrogen levels fall after menopause, the vaginal and vulvar tissues lose elasticity, become thinner, and produce less natural lubrication. These changes lead to GSM, which can include:
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Vaginal dryness, itching, and burning
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Painful intercourse (dyspareunia)
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Urinary urgency and frequency
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Recurrent urinary tract infections (UTIs)
Recognizing GSM as the root cause of painful sex allows for targeted and effective treatment.
First-Line Prescription Treatments: Local Hormonal Therapies
Vaginal Estrogen Products
These treatments deliver estrogen directly to vaginal tissues, minimizing systemic absorption and aiming to restore lubrication, elasticity, and tissue thickness.
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Creams: Estrace and Premarin Vaginal Cream are applied directly inside the vagina.
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Tablets/Suppositories: Vagifem, Yuvafem, Imvexxy—small tablets inserted into the vagina.
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Rings: Estring and Femring—flexible rings inserted for slow release of estrogen over weeks.
Benefits: Highly effective for treating vaginal dryness, atrophy, and dyspareunia.
Safety: Generally safe due to minimal absorption, even for some women with cancer histories. Always consult a healthcare provider for personalized guidance.
Vaginal DHEA (Prasterone, Intrarosa)
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Mechanism: Converted within vaginal cells into active estrogens and androgens, improving tissue health.
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Administration: A once-daily vaginal insert.
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Benefits: Proven to reduce painful sex and dryness due to GSM.
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Safety: Very low systemic absorption, making it a safe option for many women.
Oral Non-Estrogen Prescription Options
Ospemifene (Osphena)
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Mechanism: A selective estrogen receptor modulator (SERM) that mimics estrogen’s beneficial effects on vaginal tissue.
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Administration: Once-daily oral pill.
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Indication: Approved for moderate to severe dyspareunia due to menopause, especially for women who cannot or prefer not to use vaginal estrogen.
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Side Effects: Hot flashes, muscle spasms, and vaginal discharge. Because it works systemically, risks such as blood clots may apply—discuss these with your doctor.
Other Prescription Considerations (Often Adjunctive)
Systemic Hormone Replacement Therapy (HRT)
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Mechanism: Oral or transdermal estrogen, often paired with progesterone if the uterus is intact.
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When to Consider: Best for women who have multiple menopause symptoms (like hot flashes, insomnia, or night sweats) in addition to painful sex.
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Risks: Higher systemic risks than local therapy; not usually first-line for GSM alone.
Prescription Lubricants and Moisturizers
Most vaginal moisturizers and lubricants are available over the counter, but in some cases, a provider may prescribe specialized formulations or devices for severe vaginal dryness and pain.
What to Discuss with Your Doctor
When seeking help for painful sex after menopause, it’s important to:
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Detail your symptoms: When pain occurs, its severity, and whether dryness, burning, or urinary symptoms are present.
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Review your medical history: Especially cancers or clotting disorders.
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Share your preferences: Local treatments versus oral pills, daily versus long-lasting options.
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Get a physical exam: To rule out other possible causes of pain.
Conclusion
Painful sex after menopause is both common and highly treatable. From local estrogen therapy and vaginal DHEA to oral ospemifene and systemic HRT, there are multiple safe and effective prescription options available. No woman should suffer in silence—discuss your symptoms openly with a healthcare provider. With the right dyspareunia treatment, comfort and intimacy can be restored.
At Heally, we connect patients with experienced providers who can determine whether which prescription is right for you. If you’re considering a prescription for relief from painful sex, schedule a free consultation with a licensed Heally provider today.
Sources
- Journal of Menopausal Medicine: The Recent Review of the Genitourinary Syndrome of Menopause
- Mayo Clinic: Vaginal Atrophy Overview
- Medicine Plus: Vaginal Estrogen Uses
- PubMed Central: Local Effects of Vaginally Administered Estrogen Therapy: A Review
- Harvard Medical School: DHEA supplements: Are they safe? Or effective?
- FDA Label: OSPHENA Medication Guide
- Drugs: Osphena Uses and Dosing
- Mayo Clinic: Ospemifene (oral route)
- Cleveland Clinic: Hormone Therapy for Menopause Symptoms
- Mayo Clinic: Menopause hormone therapy: Is it right for you?
Medical Disclaimer
This content is for educational purposes only and should not be taken as medical advice, diagnosis, or treatment recommendation. Information about prescriptions and therapies is provided for general understanding and may not apply to individual situations. Always consult a qualified healthcare provider before making decisions about testing, treatment, or lifestyle changes that could affect your health.
Important Note
FDA-approved medications and diagnostic tools discussed in this article have specific indications, dosing, and monitoring requirements. Off-label uses or unregulated supplements may carry additional safety, quality, and effectiveness risks. Never start, stop, or change any medical regimen without guidance from a licensed clinician who can consider your full medical history and current health status.
