Painful Sex After 50 ‘Is 100 Percent Treatable,’ Says Menopause Expert Dr. Mary Claire Haver
Discover the treatments that can help in a recent 'What Matters With Liz' podcast episode
For millions of women navigating perimenopause, an uncomfortable and often unspoken problem can quietly reshape one of the most personal parts of our lives: sex becomes painful. But according to one of the country’s leading menopause experts, it doesn’t have to stay that way. On a recent episode of the podcast What Matters With Liz, board-certified ob-gyn, Menopause Society certified practitioner and New York Times best-selling author Mary Claire Haver, MD, addressed the issue of painful sex after menopause head-on and delivered a message many women need to hear: “[It] is 100 percent treatable.”
What is GSM, and why does it cause painful sex?
The condition at the center of this conversation is called genitourinary syndrome of menopause (GSM). Dr. Haver explains that it occurs when women lose elasticity and lubrication (leading to vaginal dryness) and the vaginal tissues begin to shrink. These physical changes are the most common cause of pain during intercourse for women in perimenopause and menopause, she said.
Woman's World Answers
Host Liz Vaccariello, editor in chief of Woman’s World, introduced the topic on her podcast by reading a question submitted by a reader: “I am in my early 50s and I still feel vibrant. But my sex drive is non-existent. When I attempt to make love with my husband and it hurts, it’s not enjoyable. What can I do? Am I just done having sex already?”
Dr. Haver’s response was immediate and unequivocal. “You are not done,” she said.
Two common issues that cause pain during sex
One of the most important distinctions Dr. Haver drew during the conversation was between two separate challenges women may face.
“There are two things happening here,” she explained. “There’s desire—the want for intimacy. That lives in the brain. And then there’s the ability to act on that without pain. That’s a separate issue.”
Understanding this distinction matters because the treatments are different for each. Pain during intercourse in this population is most often caused by GSM, which is a physical condition with a physical solution. But diminished desire is a separate issue rooted in brain chemistry, and it, too, can be addressed.
Dr. Haver recommended that women experiencing pain start with an exam from someone trained in sexual medicine to confirm the diagnosis and rule out any other underlying medical conditions first.
Vaginal estrogen is nearly ‘risk-free’
From there, the most effective treatment for painful sex is vaginal estrogen, she reveals. “Vaginal estrogen, when given appropriately, will cure the pain,” Dr. Haver explains.
For women who may be concerned about the safety of estrogen therapy, particularly those with a history of breast cancer, Dr. Haver offered reassurance. Local estrogen therapy applied in the genital area does not become systemic, she explained. That means it stays where it is applied, rather than circulating throughout the body.
“You can have active breast cancer and use vaginal estrogen,” Dr. Haver said. “It’s local—like putting topical cortisone on your arm.”
This point is significant because fears about estrogen have historically kept many women from seeking treatment. Dr. Haver made clear that local vaginal estrogen and systemic hormone therapy are not the same thing, and the localized treatment carries essentially no risk when used properly with guidance from your physician. “This is easy for us,” Dr. Haver said.
What if your desire doesn’t come back?
For women whose pain during sex is resolved but who still struggle with low desire, Dr. Haver outlined additional treatments that might help.
“If desire doesn’t return on its own, we have options for that too,” she said. “We have testosterone—not yet FDA-approved, but widely used. And there are two FDA-approved prescriptions that work on dopamine in the brain to increase receptivity.”
Dr. Haver recommended starting by addressing the pain first. “I would start there. See if we can eliminate the pain and make intimacy comfortable again,” she said. Once pain is no longer a barrier, desire may return on its own. If it doesn’t, those additional treatments targeting the brain’s chemistry are available.
It’s okay not to want sex
While much of the conversation focused on solutions for women who want to reclaim their intimate lives, Dr. Haver also offered an important reminder: Not every woman wants that, and that is completely valid. “We need to normalize women who don’t want to want it. That’s okay,” she said.
But for those who do miss that part of their lives, Dr. Haver urged them not to push through pain out of a sense of duty. “For goodness’ sake, don’t grin and bear it. Don’t do it out of obligation. That only makes everything worse,” she said.
The bottom line on treating painful sex
The conversation underscores a reality that affects a vast number of women: Pain during sex after menopause is extraordinarily common, yet many women assume nothing can be done. Some don’t raise the issue with their doctors. Others believe that discomfort is simply an inevitable part of aging.
For women who recognize themselves in the reader’s question—who still feel vibrant but are struggling with pain or the loss of desire—the takeaway is clear: Help is available, treatment is effective and no one should feel they have to accept pain as the new normal.
As Dr. Haver put it: “If you miss that intimacy and you don’t want to hurt, we can help you.”
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