Sexual Pain in Women: It Is Treatable, and You Do Not Have to Accept It

Quick Read Summary. Painful sex is one of the most common problems women bring to a medical provider, and one of the most consistently under-treated. Roughly 1 in 5 women in the United States will experience meaningful sexual pain during their lifetime. In perimenopause and the years following, somewhere between 30 and 60 percent of women report some degree of pain with intercourse. The number is high enough that “common” is the right clinical word. But common is not the same thing as normal, and it is certainly not the same thing as something you have to accept.

The most common causes

• Genitourinary syndrome of menopause (GSM). The modern term for vaginal atrophy. As estrogen drops, vaginal and vulvar tissues become thinner, less elastic, and less lubricated. It is the most common single cause of new-onset sexual pain in women over 40 and the most clearly treatable.
• Vestibulodynia. Pain localized to the vulvar vestibule, often with a burning quality. Can be primary or secondary.
• Pelvic floor dysfunction. Chronic tension, trigger points, or guarding patterns that make penetration physically painful regardless of how lubricated the tissue is.
• Endometriosis and other deep pelvic conditions. Endometriosis, fibroids, ovarian cysts, and adhesions can cause deep pain with intercourse.
• Psychological and relational contributors. Performance anxiety, depression, a history of sexual trauma, and relationship distress can amplify pain that started for physical reasons. For desire concerns that persist alongside or after treating the pain, what to look at when hormone therapy is not the whole answer for low libido covers these non-hormonal contributors in more detail.

What the 2025 evidence supports

The strongest current guidance comes from the 2025 AUA/SUFU/AUGS guideline on genitourinary syndrome of menopause:

• Vaginal estrogen is recommended for vulvovaginal discomfort, dryness, and dyspareunia in GSM. Strong evidence base, excellent safety profile in appropriately selected patients, minimal systemic absorption.
• Pelvic floor physical therapy is recommended for patients with concomitant pelvic floor dysfunction.
• The O-Shot (PRP injection) and CO2 Lift-V carboxytherapy are useful adjuncts, especially when first-line therapy is incomplete.

Frequently Asked Questions

Is sexual pain after menopause something I have to live with?

No. Postmenopausal sexual pain almost always has identifiable causes (most often GSM) and well-evidenced treatments.

How long does it take to see improvement?

GSM treated with vaginal estrogen or DHEA: significant improvement within 8 to 12 weeks. Pelvic floor PT: several sessions for first effect, full benefit over a few months. O-Shot and CO2 Lift-V: visible improvement at 6-12 weeks.

Is vaginal estrogen safe?

Local low-dose vaginal estrogen has very low systemic absorption and an excellent safety profile. Many women who cannot take systemic hormone therapy can safely use local vaginal estrogen. The 2025 guideline recommends it as first-line therapy.

How private is the consultation?

Sexual wellness consultations at Arbour are conducted with the same privacy and clinical respect as any medical visit. Notes are confidential within the chart. We do not share details outside the clinical team.

References

1. AUA/SUFU/AUGS. Genitourinary Syndrome of Menopause Guideline. 2025.
2. Sorrentino L, et al. Evaluation and Treatment of Sexual Pain Disorders. 2025.
3. Aslan T, et al. Efficacy and Safety of PRP Injections for Female Sexual Dysfunction. 2023.
4. PRP injection of the anterior vaginal wall improves female sexual function: a randomized controlled trial. Obstet Gynecol, 2025.

This article is educational and does not replace individualized medical advice.