Why can sexual intercourse become painful after menopause?

After menopause, sexual intercourse can become painful—a condition known as dyspareunia—primarily due to the significant decline in estrogen production.1

This hormonal shift leads to several physiological changes in the reproductive tract:

• Vaginal Atrophy and Dryness: The lack of estrogen causes the vaginal mucosa to become thin, dry, and fragile, a condition sometimes referred to as atrophic vaginitis.12
• Reduced Tissue Integrity: Estrogen is essential for maintaining the health of vaginal and urinary tissues and improving blood flow to mucosal surfaces. When these levels fall, the tissues lose their natural lubrication and elasticity, which often results in discomfort or pain during intercourse.31

These symptoms are a core component of the genitourinary syndrome of menopause (GSM). To address this, clinicians may recommend menopausal hormone therapy (MHT), which can include local, low-dose vaginal estrogen therapy to restore the integrity of the vaginal lining and alleviate discomfort with minimal systemic absorption.31