Stress & Resilience

Nurse Note As a nurse, I want you to know this: painful sex is a real symptom, not an inconvenience you should minimise. Many women only mention it after months or years of discomfort because they feel embarrassed, or they think it is “just age.” Please do not wait that long if it is affecting you. A gentle, informed conversation with a healthcare professional can open the door to simple, effective support. Maybe sex used to feel easy, natural, or at least comfortable enough not to think about. Then, somewhere in your forties or early fifties, something changed. Penetration may feel dry, stingy, tight, burning, or sore afterwards. You might find yourself avoiding intimacy, not because you do not care, but because your body has started sending signals you cannot ignore. Painful sex during perimenopause is more common than many women realise, but that does not mean you have to put up with it. In this article, we’ll look at why it can happen, what is often misunderstood, what may help, and when to speak with a healthcare professional. Perimenopause Symptom Checker What is painful sex? Painful sex can be common during perimenopause, but pain should never be treated as something you must silently endure. A helpful way to think about it is this: it may be common, but it is still a symptom. Your body is giving you information. Sometimes that information is related to hormonal changes. Sometimes it is linked to pelvic floor tension, infections, skin changes, stress, relationship strain, medication, or another gynaecological condition. The medical term for painful sex is dyspareunia. It can mean pain before, during, or after sex. The pain may feel sharp, burning, tight, raw, deep, cramping, or like friction. Some women notice it only with penetration. Others feel soreness for hours or even days afterwards. During perimenopause, this can feel especially confusing because your periods may still be coming, your hormone levels may be fluctuating, and you may not think of yourself as “menopausal” yet. But perimenopause is a transition, and intimate symptoms can begin before your final period. Why perimenopause can make sex painful Perimenopause is the stage leading up to menopause. During this time, oestrogen levels do not simply decline in a straight line. They rise and fall unpredictably. These hormonal shifts can affect the vulva, vagina, bladder, urethra, mood, sleep, and sexual desire. Oestrogen helps support the tissues around the vagina and vulva. It helps maintain natural moisture, elasticity, blood flow, and the thickness of the vaginal lining. When oestrogen fluctuates or falls, some women notice: Vaginal dryness Burning or stinging during sex A feeling of tightness or reduced stretch Soreness at the vaginal opening Itching or irritation Light spotting after sex More urinary urgency or recurrent urinary symptoms Lower desire, especially if sex has become uncomfortable These symptoms are often described under the umbrella term genitourinary syndrome of menopause, or GSM. This means changes affecting the genital and urinary tissues associated with lower oestrogen levels. The term can sound clinical, but the experience is very human: discomfort, worry, avoidance, frustration, and sometimes grief for how your body used to feel. Sex After Menopause What painful sex can feel like Not all pain during sex is the same. Paying attention to the type and location of pain can help you explain it more clearly if you speak to a clinician. Pain at the entrance of the vagina may feel like: Burning Stinging Rawness Friction A “tearing” feeling Tightness or difficulty with penetration This can happen with vaginal dryness, vulval irritation, skin sensitivity, reduced arousal, pelvic floor tension, or conditions affecting the vulval skin. Deeper pain may feel like: Cramping Aching Pressure Pain with certain positions Pain that feels internal or pelvic Deeper pain may be linked to pelvic floor muscle tension, fibroids, endometriosis, ovarian cysts, pelvic inflammation, previous surgery, or other pelvic health concerns. It is worth getting checked, especially if it is new, persistent, or worsening. The emotional side matters too. Painful sex is not just a physical issue. It can affect how you feel about your body, your confidence, your relationship, and your sense of closeness. Many women start bracing for pain before sex even begins. Over time, that anticipation can cause the pelvic floor muscles to tighten. This can make penetration feel even more uncomfortable, creating a difficult loop: pain, worry, tension, more pain. This does not mean “it is all in your head.” It means the body and mind are deeply connected. Pain changes how the nervous system responds. If your body has learned that sex hurts, it may protect you by tightening, withdrawing, or reducing desire. You are not broken. Your body may need gentler care, better lubrication, hormonal support, pelvic floor support, or time to feel safe again. Why Has My Libido Disappeared? Common Causes and Gentle Support What is commonly misunderstood One of the biggest misunderstandings is that painful sex is just part of getting older. It is not. Another misunderstanding is that using lubricant means something is wrong with you. It does not. Lubricant is a practical comfort tool, not a failure. Many women need more lubrication during perimenopause because natural moisture may be reduced, even when they feel emotionally interested in sex. It is also worth knowing the difference between a lubricant and a vaginal moisturiser. A lubricant is used during sex to reduce friction. It works in the moment. A vaginal moisturiser is used regularly, whether or not you are having sex. It helps hydrate the vaginal tissues over time and may reduce everyday dryness or irritation. Some women need both. Could it be something other than hormones? Yes. Hormonal changes are a common cause, but not the only one. Painful sex can also be linked to: Thrush, bacterial vaginosis, urinary infections, or sexually transmitted infections Vulval skin conditions such as lichen sclerosis or eczema Pelvic floor muscle tension or vaginismus Endometriosis, fibroids, ovarian cysts, or pelvic inflammatory disease Previous childbirth trauma, tears, episiotomy, surgery, or scar tissue