How common is painful sex after childbirth or menopause?

The prevalence of painful sex following childbirth and during the menopausal transition is far higher than most women expect. These are not isolated experiences but widespread issues that deserve proper medical attention and treatment. Understanding how common these difficulties are can help you feel less alone and more empowered to seek help.

Both postpartum and menopausal pain share a common thread: they stem from physical changes in the genital tissues. After birth, trauma and healing are at play. During menopause, declining oestrogen leads to tissue thinning and dryness. In both cases, the pain is real, treatable, and should never be dismissed as something you simply have to endure.

Painful Sex After Childbirth: The Numbers

Nearly all women report some degree of discomfort the first time they have sex after giving birth. The prevalence remains significant as healing progresses:

• First 6-7 weeks: Studies reveal that approximately 60% of women find intercourse painful during this early postpartum period.
• Six months postpartum: Around 30% to 37.5% of women continue to experience painful intercourse at this stage, even after the acute healing phase.
• Twelve months postpartum: Research tracking women to one year shows that roughly 12% still report persistent pain, with some studies indicating rates as high as 31% at three months.
• Two years postpartum: Even at 24 months, approximately 11% of first-time mothers continue to experience pain during sex.

These figures challenge the common assumption that postpartum pain resolves quickly. For many women, discomfort extends well beyond the traditional six-week recovery window and requires active management rather than passive waiting.

Why Does Pain After Childbirth Happen?

The reasons for postpartum dyspareunia are varied and often overlapping. Physical trauma during delivery, including tears, episiotomy, or instrumental birth, can lead to scar tissue formation and tenderness. Hormonal changes, particularly in breastfeeding mothers, cause significant vaginal dryness due to low oestrogen levels. Pelvic floor muscles may become overactive or tense as a protective response, creating deep pain with penetration. Psychological factors such as fear of pain, anxiety, and exhaustion also contribute to muscle guarding and reduced arousal.

Painful Sex During Menopause: The Numbers

Painful intercourse becomes increasingly common as women enter perimenopause and menopause, largely due to declining oestrogen levels:

• General prevalence: Between 25% and 45% of postmenopausal women report experiencing painful sex, with some studies suggesting figures as high as 42%.
• Peak age groups: Women aged 55 to 64 show the highest prevalence, with 10.4% reporting painful sex in the UK's National Survey of Sexual Attitudes and Lifestyles.
• Genitourinary Syndrome of Menopause (GSM): This umbrella term encompasses vaginal dryness, painful intercourse, and urinary symptoms. GSM affects 27% to 84% of postmenopausal women, with around 50% experiencing moderate to severe symptoms.
• Chronic symptoms: Unlike hot flushes, which often improve with time, GSM typically worsens progressively without treatment.

Despite the high prevalence, only a small minority of women receive treatment. Many suffer in silence, believing these symptoms are an inevitable and untreatable part of ageing.

Why Does Menopause Cause Painful Sex?

Oestrogen is essential for maintaining the health, thickness, elasticity, and lubrication of vaginal tissues. As oestrogen levels decline during menopause, the vaginal walls become thinner, drier, and less elastic. The natural acidity of the vagina changes, increasing vulnerability to infections and irritation. These changes lead to pain at the vaginal entrance or deep inside during penetration. Some women also experience pelvic floor tension, where muscles tighten protectively in response to discomfort. Additionally, reduced blood flow and tissue elasticity mean that penetration can cause tearing or micro-trauma.