If sex has started to feel uncomfortable or painful since you hit perimenopause or menopause, you are not alone. This is a common issue we see, and many people just put up with it.
We want to be clear: painful sex is not a normal or inevitable part of getting older. It’s a sign that something has changed in your body that needs attention. And the good news is, it’s very treatable.
Here’s what’s actually going on – and what we can do about it.
Why causes painful sex at menopause?
What actually changes in your body
The short answer is oestrogen. Oestrogen is the hormone that keeps the tissues of your vagina, vulva, and urethra healthy, moist, and flexible. During perimenopause and menopause, your oestrogen levels drop significantly – and those tissues respond.
Without adequate oestrogen, the vaginal walls become thinner, drier, and less elastic. The natural lubrication your body produces decreases. The tissues around the vaginal opening can become more sensitive or even fragile. This is known medically as Genitourinary Syndrome of Menopause (GSM) – and it affects a significant number of women after menopause, though many never receive a proper explanation or treatment.
What symptoms can this cause?
The result of these tissue changes can be:
• Pain, burning or stinging during or after sex
• Dryness that makes penetration uncomfortable
• Soreness that lingers after sex
• A feeling that things have “tightened up” or changed in texture
• Increased sensitivity or irritation even without sexual activity
Do pelvic floor muscles have a role in painful sex at menopause?
Tight muscles vs weak muscles — why it matters
Oestrogen loss doesn’t just affect skin and mucous membranes – it also affects muscle tissue. The pelvic floor muscles can become less supple, less coordinated, or may tighten in response to pain or dryness. This is called high tone – and it’s quite common in menopausal women experiencing painful sex.
Many people assume pelvic floor problems are always about weakness. But tight, overactive pelvic floor muscles can be just as problematic – and they’re a common contributor to pain during sex at menopause. Treatment for tight muscles is very different from treatment for weak ones, which is why a proper assessment matters so much.
A pelvic floor physiotherapist can assess whether your muscles are tight, weak, uncoordinated, or some combination – and then treat the actual cause rather than guessing.
What does treatment look like?
What happens at your first appointment
Your first appointment is mostly about understanding your history and your symptoms. We’ll ask about your births, your menopause experience, what’s changed and when. If you’re comfortable, we’ll do a pelvic floor assessment – this is internal, but always with your consent and at your pace. We use this to understand exactly what’s happening with your muscles and tissues. From there, we’ll explain what we’ve found and build a treatment plan together.
Do I need a GP referral first?
No – you can book directly with us. You don’t need a referral to see a pelvic floor physiotherapist in New Zealand. If we feel a GP opinion or gynaecology input would help you, we’ll let you know and can work alongside your other health providers.
How long does treatment take?
It varies depending on what we find and how long symptoms have been present. Many women notice meaningful improvement within two to four sessions. Treatment might include manual therapy to release tight muscles or scar tissue, exercises to improve muscle strength and coordination, education on tissue care and lubricants, and advice on local hormonal options to discuss with your GP. We’ll give you a realistic picture at your first appointment.
When should I seek help?
Now. Not after you’ve tried to push through it for another year. Not once it gets bad enough that you’ve stopped being intimate altogether.
The earlier you address these changes, the easier they are to treat. Tissue that’s been dry and irritated for a long time takes longer to respond than tissue that’s been treated early. And the psychological impact of painful sex — the avoidance, the anxiety, the effect on relationships — is real and worth taking seriously.
You deserve to feel comfortable in your body. This is treatable.
Ready to talk to someone? Book a pelvic floor assessment in Wellington – we’ll work out exactly what’s going on and create a plan that’s right for you.
Also in this series:
• Blog 2: Prolapse and Menopause: Why It Often Appears Later in Life
• Blog 3: Why Leaking Gets Worse at Menopause – Even If It Was Never a Problem Before
Frequently asked questions
Is it normal for sex to become painful at menopause?
It is very common – but that doesn’t mean it’s something you just have to accept. Painful sex at menopause is usually caused by changes in oestrogen levels that affect the vaginal tissues and pelvic floor muscles. At our Wellington clinic, we see this regularly and there is a lot we can do to help.
Can a pelvic floor physiotherapist help with painful sex after menopause?
Yes, absolutely. A pelvic floor physio can assess the specific cause of your pain – whether that’s tissue changes, muscle tightness, scar tissue, or a combination – and create a treatment plan tailored to you. Most women see significant improvement with physiotherapy.
Why has sex become painful at menopause when it was fine before – even after having children?
This is one of the most common questions we hear. For many women, childbirth leaves a degree of vulnerability in the pelvic floor that oestrogen helps compensate for over the years. When oestrogen drops at menopause, that compensation stops and symptoms that were previously hidden can appear. It doesn’t mean something has suddenly gone wrong – it means your body needs a different kind of support.
What is genitourinary syndrome of menopause (GSM)?
GSM is the medical term for the group of symptoms that can affect the vagina, vulva, and bladder when oestrogen levels drop at menopause. Symptoms include vaginal dryness, tissue thinning, pain during sex, and increased bladder sensitivity. It is very treatable – both through physiotherapy and, in some cases, local oestrogen prescribed by your GP.
How do I know if I need to see a pelvic floor physio about painful sex?
If sex has become uncomfortable or painful — even occasionally — it’s worth getting assessed. You shouldn’t have to manage this alone or wait until it gets significantly worse. The earlier you seek help, the easier symptoms are to treat. You can book a pelvic floor assessment at our Wellington clinic and we’ll work out exactly what’s going on.
If you need help we are happy to see you – Book your pelvic floor assessment in Wellington now.