Painful sex, and the discomfort that can follow it part of what’s called genitourinary syndrome of menopause, or GSM respond well to treatment. There’s a real range of options, from simple products to targeted therapies. Here’s the landscape for the sexual side; our companion guides cover the vaginal and urinary sides.

Lubricants and moisturizers

The simplest place to start is with over-the-counter products. Lubricants, applied as needed during sex, reduce friction, ease discomfort, and make intimacy more enjoyable examples include KY Jelly, Astroglide, and Good Clean Love, in water- or silicone-based formulas. Vaginal moisturizers, used regularly a few times a week, keep the tissues more comfortable in between. Many women use both: moisturizers for ongoing relief, lubricants for sex.

Vaginal dilators

Vaginal dilators are smooth, tube-shaped devices of gradually increasing size, used to gently stretch the vaginal tissues and improve elasticity. Many women find them especially helpful when sex has become painful due to dryness, narrowing, or tightness. They can also reduce anxiety around penetration by letting you progress slowly and comfortably at your own pace, and they’re often used alongside lubricants and moisturizers.

Dilators let you go at your own pace easing both the physical tightness and the anxiety that can build around it.

Local vaginal estrogen

When products aren’t enough, local vaginal estrogen therapy is often the most effective treatment. Given as creams, tablets, inserts, or vaginal rings, it delivers a low dose of estrogen directly to the tissues, restoring their thickness, elasticity, and moisture which can make sex noticeably more comfortable. It is used on its own, without progesterone for uterine protection.

Intravaginal DHEA (prasterone)

Intravaginal DHEA (prasterone) is another local, hormone-based option a prescription vaginal ovule inserted once daily at bedtime. Converted locally into small amounts of estrogen and androgens, it restores the vaginal lining while keeping hormone levels in the rest of the body very low, and women often notice relief from pain during sex (dyspareunia) alongside improvements in dryness and irritation.

Ospemifene: a pill for painful sex

Ospemifene is a prescription pill in a group of medicines called selective estrogen receptor modulators (SERMs). It acts on estrogen receptors in the vaginal lining to restore thickness, elasticity, and moisture, and studies have shown it reduces painful intercourse in many women after menopause. Taken by mouth once a day, it can suit women who’d rather not use vaginal products. Because it’s a systemic medication, it may not be right for everyone.

Pelvic floor physiotherapy

The pelvic floor muscles play a big role in sexual function and comfort. Pelvic floor physiotherapists teach exercises, relaxation techniques, and strategies to improve blood flow and coordination which can ease pain and enhance sexual function. It’s a safe, non-invasive approach that many women find empowering.

If you have other menopause symptoms too

For women who also have symptoms such as hot flashes, systemic menopausal hormone therapy may be recommended, benefiting both the sexual symptoms and whole-body symptoms; local and systemic therapies can safely be used together if needed. (Our hormone-therapy guides go deeper on MHT.)

A note on laser treatments

Vaginal laser treatments (sometimes called “fractional CO₂ laser”) and other energy-based devices have been promoted for these symptoms. Some small studies suggest benefits, but larger, high-quality studies are limited and professional organizations caution that more research is needed before they can be recommended as standard treatment. Laser therapy isn’t widely covered by insurance, can be expensive, and may carry some risks; discuss it carefully with a knowledgeable provider.

When to seek help

Talk to your provider if pain during sex isn’t relieved by lubricants, or if sexual symptoms are affecting your intimacy or wellbeing.

Pain during sex that isn’t relieved by lubricants, or any unexplained spotting or bleeding, should be discussed with a healthcare provider and any lesion or lump in or around the vagina should always be examined.

This article is general information, not medical advice. Any decision about managing menopause symptoms should be made with your own healthcare provider.