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What to Do When Sex Is Painful

Discomfort during intercourse can usually be remedied by a trip to the doctor or drugstore

One of the less-than-wonderful physical surprises as women get older is that the natural lubrication of the vagina diminishes. After menopause, this happens so gradually that you may not notice at first. But you might reach the point when intercourse becomes painful — and that can be a total turnoff.

See also: Brand-new sex with same old spouse.

What to do?

Sometimes the cure is a simple one: Buy some artificial lubrication. There are dozens of good ones, either water-based or silicone-based. The water-based ones dry up more quickly with the friction of intercourse, but they can be reactivated with saliva. Silicone-based lubes are smooth and last longer, but some women find them too slick (making it difficult to feel any friction at all) or resist the notion of introducing that compound into their bodies. In general, either one of these artificial applications will solve the pain problem — though it may take you a bit longer to get over the anticipation of pain.

Another way to redress the situation is via Replens, a moisturizer that plumps up vaginal tissue. This product requires repeated applications over time, but for some women it's a welcome answer to the issue.

Occasionally, however, the usual lubrication is not enough. A step higher in remediation of the vaginal walls is an estrogen-based product. Most women who have had cancer of any kind should stay away from estrogen; even if that describes you, however, some estrogen-based products may be safe because they are absorbed only by local tissues. (No one but a doctor can make this determination.)

For women without that complication, by contrast, estrogen-based products (or prescription estrogen creams from your gynecologist) are a godsend. The estrogen changes the vaginal wall from brittle to bountiful, making painful sex a distant memory.

Now here's what puzzles me: Why don't women and their partners reach out for these answers right away? Some believe that changes in vaginal ability are inevitable (they aren't) or cannot be corrected (they can). Others suspect the dryness is a reaction to their partner — and they may be right: Lack of lubrication is sometimes about the partner, or about deeper psychological issues that are inhibiting excitement or causing you to clench up, making intromission difficult. If there are relationship issues, or if pain during intercourse has nothing to do with dryness (from the penis banging too hard against the cervix, for example, or from some other factor such as herpes or HPV), see a doctor for diagnosis and treatment.

Don't let embarrassment keep you from seeking help: You owe yourself some answers — and some chance for repair. Sex is never supposed to be painful; if it is, an undetected medical condition may be the root cause.

Think men are immune to painful sex? Sometimes the skin around the head of the penis becomes so tight that intercourse hurts; herpes or some other condition may be to blame. Certain contraceptive devices (an IUD or the rim of a diaphragm, for instance) may also cause sensitivity or pain. But don't waste a single second speculating: Find out what's going on.

Yes, changes in the body (or even in the relationship) can make intercourse or foreplay painful. Positions that allow deeper penetration — doggie style, for example, or woman on top — may no longer be comfortable. A knee or shoulder operation may likewise be making certain accustomed positions newly painful. But these conditions can almost always be remedied — so go see what can be fixed! Pain is not inevitable, and seeking out the cause can redeem you — both of you — emotionally as well as physically.

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AARP relationships expert Pepper Schwartz offers tips for planning a weekend of great sex.

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