Sex, Pain, and Menopause: What No One Told Us

Pain during sex isn’t rare—and it’s often misread. According to the American College of Obstetricians and Gynecologists, up to 75% of women will experience painful intercourse at some point in their lives. For those navigating midlife, the root cause is frequently overlooked: the hormonal shift that reshapes everything from desire to physical response.

“[Women] are not even discussing it—whether they don’t know they can be treated, they just think it’s normal, or they’ve tried to talk about it, and they’re not getting the help that they need,” says Dr. Mary Claire Haver, OB/GYN, and menopause educator whose digital platform reaches over 2 million women. Her blunt, science-backed take resonates because this story is all too familiar.

The issue isn’t only cultural discomfort around sex—it’s clinical. Many healthcare providers still lack the training to recognize menopause-related changes, especially when they show up in the bedroom.

Even our founder, Halle Berry, was once misdiagnosed. After experiencing intense pain during sex, she was wrongly told she had an STD. The real cause? Vaginal atrophy—a result of thinning vaginal tissue due to estrogen loss. “It felt like razor blades in my vagina,” she shared during a groundbreaking conversation with former First Lady Jill Biden at A Day of Unreasonable Conversation. It was a bold moment that cracked open a deeper dialogue about what women endure in silence.

Filling the Knowledge Gap

“Until we train the trainers and change the training programs to include realistic menopause care, we’re probably a generation away from being able to confidently walk into your healthcare provider’s office and have a reasonable discussion about your menopause,” says Dr. Haver.

Her pivot into menopause care came out of personal necessity—realizing that her medical education hadn’t prepared her for her own hormonal transition. That led her to develop The Galveston Diet, a menopause-focused nutrition plan, and later write the bestselling book of the same name.

Today, she continues to bridge that gap with her latest release, The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts—a guide to everything from sleep to sex and the science behind what’s shifting in your body.

Menopause, Libido & Vaginal Atrophy

Sexual desire in midlife doesn’t disappear—it changes. For women, libido is more likely to be contextual, emotional, and responsive, unlike men, whose arousal tends to be more spontaneous. “It’s a basic mismatch,” says Dr. Haver. And that gap only widens as hormones shift.

Estrogen and testosterone loss in midlife can affect both the physical and neurological aspects of arousal—from decreasing the size and sensitivity of the clitoris to altering the brain’s desire center. Many women notice it takes longer to get aroused, to orgasm, or even to want sex at all.

Add to that the very real physiological symptoms: less vaginal elasticity, decreased mucus production, and a higher likelihood of tearing or discomfort during friction. These shifts aren’t just inconvenient—they can be painful and even dangerous. Vaginal atrophy, also known as genitourinary syndrome of menopause (GSM), brings burning, dryness, and an increased risk of yeast infections and STDs. Research shows STD and STI rates rise in postmenopausal women due to thinner, more fragile tissue and altered immune defenses.

Estrogen decline also disrupts the vaginal and urinary microbiomes, weakens the urethra, and makes recurring UTIs more likely. According to a 2019 NIH study, nearly half of postmenopausal women experience them. Pelvic floor dysfunction—caused by hormonal shifts—can also lead to pain during or after sex due to muscle spasms or laxity.

The Case for HRT: Local and Systemic Solutions

Menopause may be inevitable—but suffering through it isn’t. There are safe, effective ways to treat the physical symptoms, especially those impacting sexual health.

Localized hormone therapies—like creams, rings, suppositories, or vaginal pills—help restore elasticity, reduce dryness, and strengthen tissue. “Replacing hormones in that area can be really, really powerful,” says Dr. Haver. They don’t work overnight, but consistent use brings real relief. (For breast cancer survivors, be sure to speak with your doctor about specific options.)

When it comes to chronic UTIs, Dr. Haver insists HRT—not antibiotics—is often the answer. “If we restore the natural health and tissue and thickness and elasticity and mucus, the ability to fight off the bacteria that just live in the area, then you’re less likely to get a UTI,” she explains.

For libido, systemic HRT may be more appropriate—especially after other causes like relationship issues or pelvic pain are ruled out. While the FDA has only approved libido-enhancing drugs for premenopausal women (Addyi and Vyleesi), they’re often denied by insurance. For menopausal and postmenopausal women, testosterone therapy is commonly prescribed off-label via compounding pharmacies or repurposed male medications.

Lubricants Can Still Help

While not a standalone fix for vaginal atrophy, lubricants can make sex more comfortable—especially when paired with hormone therapies. Dr. Haver recommends water-based lubes, which are less irritating to sensitive tissue. “I think every woman who’s on her menopause journey should use a lubricant,” she says. “It just makes everything better.”

A Growing Movement

In 2021, Dr. Haver opened the Mary Claire Wellness Clinic in Houston to meet the growing demand for thoughtful, evidence-based menopause care. Her patient waitlist was a clear signal: Women are ready for better answers and better outcomes.

“The clinic’s been insanely successful,” she shares, “and I’m going to start training other providers on how to do menopause care.”

This next chapter in women’s health isn’t about resignation but reclamation—of knowledge, choice, and pleasure.

“I’m not willing to accept the status quo,” says Dr. Haver. And neither are we!