Vaginal dryness or painful sex is one of those menopause topics most women don’t talk about out loud – yet these are classic symptoms of vaginal atrophy in menopause, and they’re more common than you’ve been led to believe.
It can feel awkward, too intimate, or like something you’re just supposed to accept as “part of getting older”. In reality, this is a very common medical issue with a name, clear causes and – the good news – treatments that actually help.
Doctors often call it vulvovaginal atrophy, or use the newer term genitourinary syndrome of menopause (GSM). Those phrases sound scary and clinical, but they’re really just labels for what happens when low hormones change the skin and tissues around your vulva, vagina and bladder. It’s not your fault, you’re not alone, and you definitely don’t have to suffer in silence.
What is vulvovaginal atrophy / GSM?
As you move through perimenopause and into menopause, your ovaries make much less oestrogen. That hormone doesn’t just affect periods and moods – it also keeps the tissues in and around your vagina plump, stretchy and well-lubricated. When oestrogen levels drop and stay low, those tissues start to change.
The lining of the vagina becomes thinner and more delicate, there’s less natural moisture, and blood flow and collagen in the area reduce. The balance of bacteria and the pH in the vagina can shift too, which can make the tissue more easily irritated. Put simply: the whole area can feel drier, tighter and more sensitive than it used to.
Because these hormone changes can affect both the genital area and the lower urinary tract, many specialists now talk about “genitourinary syndrome of menopause (GSM)” instead of just “vaginal atrophy”. It’s the same underlying issue – low oestrogen – but the newer term acknowledges the bladder and urinary symptoms that often come along for the ride.
Vaginal dryness and symptoms of vaginal atrophy in menopause
For most women, these changes sneak up slowly. It’s easy to explain them away as stress, tight jeans or just getting older. Over time, though, a pattern appears. You might notice things like:
- Vaginal dryness that feels like burning, itching or a scratchy, raw sensation.
- Pain, pulling or a tearing feeling with penetration, and sometimes a little spotting afterwards because the tissue is fragile.
- Much less natural lubrication during sex, even if your mind and body feel turned on.
- Burning when you pee, running to the toilet more often, or suddenly feeling like you “have to go now”.
- UTIs that seem to keep coming back more than they did in your 30s and 40s.
- General discomfort from wearing tight trousers, sitting for long periods, or cycling.
None of this is “just in your head”. These are recognised symptoms of vulvovaginal atrophy/GSM that large clinics and menopause specialists see every day. But many women don’t mention them unless a doctor asks directly, so they end up quietly avoiding sex, exercise, or certain clothes instead of getting help. You deserve better than that.
Why it happens in menopause
Oestrogen is one of your body’s great caretakers. It supports skin, muscle, bone, brain – and, yes, the whole vulva and vaginal area. When oestrogen levels drop with menopause, the tissue simply doesn’t get the same support it used to.
The vaginal walls lose some thickness and elasticity. There’s less blood flow bringing nutrients and less moisture being produced, so lubrication drops. The change in pH and bacteria can tip things towards irritation and infection more easily.
None of this means you’re “broken” or dirty. It’s a hormonal shift, not a personal failure. And while it’s common, that doesn’t mean you have to put up with pain, burning or dread every time you think about sex.
Treatments that really can make a difference
Here’s the hopeful part: vulvovaginal atrophy and GSM are very treatable. Big menopause clinics and organisations are clear – you don’t have to grit your teeth and carry on.
Moisturisers and lubricants
Think of vaginal moisturisers like face cream, but for your vaginal tissue. They’re used regularly – for example, several times a week – to keep the area more hydrated and comfortable day-to-day.
Lubricants are the helpers you bring in for sex. A good water-based or silicone-based lubricant can reduce friction and make everything feel smoother. Many women find it helpful to look for products that are fragrance-free and designed for sensitive skin. Using lube is not a sign of failure; it’s simply adapting to a new phase of your body.
Local vaginal oestrogen
For many women, local oestrogen is the game-changer. This is a very low dose of oestrogen used directly in the vagina, usually as a cream, small tablet/pessary or a flexible ring. Because you apply it where it’s needed, only a tiny amount typically enters the rest of the body.
Clinical guidance shows that local oestrogen can make a big difference to dryness, pain with sex, and urinary symptoms caused by GSM. It’s still a medicine, so it needs a proper chat with your doctor – especially if you have a history of certain conditions – but for many women it’s safe, effective and life-improving.
Other prescription options
Depending on where you live, there may be non-oestrogen prescription treatments as well, such as vaginal DHEA or other medicines that act on oestrogen receptors in the vaginal tissue. These are not for everyone and require a specialist conversation, but it’s helpful to know that options exist beyond “take antibiotics for every UTI and hope for the best”.
Pelvic floor physiotherapy
When sex hurts, the pelvic floor muscles often clamp down to protect you. That’s natural – but over time, it can become part of the problem. A pelvic floor physiotherapist who specialises in women’s health can help you gently relax and retrain those muscles, reduce pain, and improve bladder control. For some women, this, combined with local treatment, is transformative.
When to talk to a doctor – and how to start the conversation
Consider booking an appointment with a GP, gynaecologist or menopause-aware doctor if:
- Vaginal dryness, burning or pain are affecting your sex life, sleep, exercise or day-to-day comfort.
- You notice bleeding after sex, bleeding that’s new after menopause, or any unusual discharge.
- You’re having frequent UTIs or bladder symptoms.
- You’ve tried over-the-counter products but they’re not enough.
If you feel shy, write a few notes before you go: when symptoms started, what they feel like, what makes them better or worse, and what you’ve already tried. You can even practise a simple opening line, such as:
- “Since menopause, sex has become painful because of dryness.”
- “I think I might have vulvovaginal atrophy or GSM and I’d like to talk about local oestrogen or other treatments.”
Remember: medical professionals in women’s health talk about this all the time. You’re not being dramatic or fussy – you’re asking for care you’re fully entitled to.
You’re allowed comfort and pleasure at every age
Vaginal dryness and Vulvovaginal atrophy is common, but it doesn’t have to be your new normal. Understanding what’s going on, knowing there are evidence-based options, and finding a doctor who listens can bring real relief and help you feel at home in your body again.
If you’d like a simple refresher of what’s happening in midlife, you can go back to the Silverlocks Menopause Guide, and from there explore more articles on sleep, mood, weight, gut health and treatment options. This is your body, your comfort and your pleasure – and you are allowed to ask for all three.
Disclaimer – The information in this article is for general education and support only. It is not medical advice and does not replace a consultation with your own doctor. Always talk to a healthcare professional about your symptoms, diagnosis, treatment options and any questions about HRT, local oestrogen, medicines or supplements.
References
- Cleveland Clinic – Vaginal Atrophy (GSM)
- Mayo Clinic – Vaginal atrophy: Symptoms & causes
- Mayo Clinic – Vaginal atrophy: Diagnosis & treatment
- Cleveland Clinic Journal of Medicine – Genitourinary syndrome of menopause
- AUA/SUFU/AUGS – Guideline on Genitourinary Syndrome of Menopause (PDF)
