### Causes of Painful Sex During Menopause As you go through menopause, you might find that sex becomes less enjoyable and even painful. This condition, known as dyspareunia, affects 17% to 45% of postmenopausal women. Here are some common causes: - **Vaginal Thinning and Dryness**: Lower estrogen levels reduce blood flow to the vagina, causing the tissue to become dry, thin, and fragile. This can make intercourse painful. - **Pelvic Floor Dysfunction**: Muscles around the bladder and vagina can spasm or become loose or tight, causing discomfort. - **Not Enough Sex**: Avoiding sex due to pain can worsen the condition. Regular sexual activity can improve blood flow and strengthen vaginal tissue. - **Other Health Problems**: Conditions like untreated diabetes, heart disease, and high blood pressure can affect sexual function. - **Less Arousal**: Reduced estrogen can make it harder to become aroused, leading to less lubrication and more discomfort. - **Scar Tissue**: Scars from surgery or childbirth can become more painful after menopause due to thinner vaginal tissue. ### Non-Menopausal Causes - **Vaginismus**: Fear of pain can cause involuntary tightening of vaginal muscles, making intercourse difficult or impossible. - **Vulvodynia**: The outside of the vagina may sting or burn during sex. - **Skin Conditions**: Eczema, psoriasis, and other skin conditions can irritate vaginal skin. ### When to See a Doctor or Therapist If lubricants and vaginal moisturizers don’t provide enough relief, it’s time to see a gynecologist or OB/GYN. They can help diagnose the cause of your pain and recommend treatments. In some cases, a therapist may also be helpful, especially if psychological factors like anxiety or fear are contributing to the discomfort.