When Intimacy Doesn’t Feel Right: Understanding Women’s Intimate Health at Every Stage of Life
By Dr. Chio Ogbejesi, MD, Obstetrics & Gynecology
There are some conversations women have easily, and others they keep to themselves.
Intimate health is often one of the latter.
A woman may notice dryness, irritation, discomfort during sex, changes after having a baby, or new symptoms during perimenopause and wonder if she is simply supposed to accept them.
She isn't.
Changes in intimate health are common throughout a woman's life, but persistent pain, burning, dryness, itching, or discomfort deserves attention. These symptoms can have different causes, and understanding the cause is an important part of finding the right solution.
As an obstetrician and gynecologist, one of the most important things I want women to know is that you should never feel embarrassed to talk about changes in your intimate health.
Your health is your health—including the parts that may feel difficult to discuss.
Your Body Changes, and That's Normal
A woman's reproductive and intimate health can change significantly throughout her life.
Pregnancy, childbirth, breastfeeding, hormonal changes, perimenopause, and menopause can all affect the vulva and vagina.
For example, estrogen helps maintain vaginal moisture, elasticity, and healthy vaginal tissue. When estrogen levels decrease, particularly around menopause, vaginal tissue can become thinner, drier, and less elastic. This may contribute to burning, irritation, reduced lubrication, and painful sex.
These changes are physical—not a reflection of your femininity, attractiveness, or relationship.
Why Can Sex Become Painful?
Pain during intimacy can happen for many reasons.
Sometimes the explanation is straightforward. Vaginal dryness can increase friction and make penetration uncomfortable.
But painful sex can also be associated with pelvic-floor muscle problems, vulvar skin conditions, infections, endometriosis, ovarian cysts, hormonal changes, or other gynecologic conditions.
The location of the pain can also provide important clues.
Some women feel pain at the vaginal opening. Others experience deeper pelvic pain. Some describe burning or irritation, while others experience aching, pressure, or sharp pain.
This is why there isn't one treatment that works for every woman.
The first step is understanding what is actually causing the discomfort.
What About Vaginal Dryness?
Vaginal dryness is particularly common around perimenopause and menopause, but it can happen at other stages of life as well.
Women may experience dryness after childbirth or while breastfeeding because of hormonal changes. Certain medications and medical treatments can also contribute.
Dryness can lead to more friction during sex, which may result in irritation or pain.
Fortunately, there are several ways to manage it.
Vaginal moisturizers can provide ongoing moisture, while personal lubricants can reduce friction during sexual activity. ACOG notes that both can help with vaginal dryness and painful sex.
If symptoms continue despite these measures, it is worth speaking with an obstetrician-gynecologist about other treatment options.
Intimate Care Doesn't Have to Be Complicated
Many women believe they need special washes, fragrances, sprays, or douches to feel clean.
In reality, the vagina has its own natural environment, and some products marketed for intimate hygiene can actually irritate sensitive tissue.
Avoid douching and strongly fragranced products around the vulva. A simple, gentle approach is usually better. ACOG recommends avoiding products such as feminine sprays, deodorants, and scented products that can irritate the vulvar area.
If your vulva feels irritated, sometimes the best thing you can do is simplify your routine.
Gentle care is still care.
After Pregnancy and Childbirth
Having a baby is an extraordinary physical experience, but recovery does not end when you leave the hospital.
Pregnancy and childbirth can affect the pelvic floor, vaginal tissues, and perineum. Some women experience soreness or discomfort after delivery, while others notice changes in lubrication or sexual comfort later.
Breastfeeding can also be associated with vaginal dryness because of hormonal changes.
If sex remains painful after childbirth, don't assume you simply need more time or that you have to live with it.
Give your body time to heal, communicate openly with your partner, and speak with your healthcare professional if pain persists.
Depending on the cause, treatment may include addressing dryness, pelvic-floor therapy, or other appropriate medical care.
Perimenopause and Menopause: You Are Not Alone
Menopause is a natural stage of life, but that does not mean every symptom should simply be endured.
As estrogen levels change, some women experience vaginal dryness, burning, itching, reduced lubrication, painful sex, urinary symptoms, or recurrent urinary tract infections. These symptoms may be part of what healthcare professionals call genitourinary syndrome of menopause (GSM).
The good news is that treatment options exist.
Depending on your symptoms and medical history, a healthcare professional may recommend nonhormonal options such as vaginal moisturizers and lubricants. For some women, prescription treatments such as low-dose vaginal estrogen may also be considered.
The right choice depends on the individual woman.
That is why a conversation with your gynecologist matters.
Don't Ignore Pain Because You Think It's "Normal"
This is one of the most important messages I want women to take away.
Common does not mean you have to suffer through it.
If intimacy consistently hurts, don't simply tell yourself:
"Maybe this is just part of getting older."
"Maybe this is what happens after having children."
"Maybe I should just tolerate it."
Pain is worth investigating.
A gynecologist can ask questions about where the pain occurs, when it started, what it feels like, whether it happens every time, and whether there are other symptoms.
Sometimes the cause is easily addressed. Other times, additional examination or testing may be needed.
Either way, knowing the cause gives you a better path forward.
Simple Steps You Can Take Now
If you're experiencing mild intimate discomfort, consider starting with a few simple changes:
1. Pay attention to your symptoms.
Notice when the discomfort occurs and what seems to trigger it.
2. Avoid irritating products.
Skip douches, perfumes, scented sprays, and other products that may irritate the vulva.
3. Consider appropriate lubrication.
A personal lubricant can reduce friction and make intimacy more comfortable. If you use condoms, choose a lubricant compatible with the type of condom you use.
4. Give yourself time.
Intimacy does not need to be rushed. More time for arousal may help your body respond naturally.
5. Talk to your partner.
If something hurts, say so. You never need to continue an activity that causes pain.
6. Talk to your gynecologist when symptoms persist.
Persistent or recurring symptoms deserve a proper evaluation rather than repeated self-treatment.
When Should You See a Gynecologist?
Make an appointment if intimate pain or discomfort is persistent, recurrent, or interfering with your quality of life.
You should also seek medical evaluation if you have unusual discharge, persistent itching or burning, pelvic pain, pain with urination, or bleeding associated with sex. Some of these symptoms can be signs of conditions that require specific treatment.
And if you experience bleeding after menopause, don't ignore it. Talk with your healthcare professional.
Your symptoms are worth discussing—even if you aren't sure whether they are "serious enough."
Your Intimate Health Is Part of Your Overall Health
Women's health is not divided into convenient categories.
Your reproductive health, hormonal health, pelvic health, sexual health, emotional wellbeing, and overall health are connected.
So if something changes, listen to your body.
You deserve to feel comfortable in your own body. You deserve to have honest conversations with your healthcare team. And you deserve treatment when a medical problem is affecting your quality of life.
There is no shame in asking for help.
There is no shame in saying, "This hurts."
And there is certainly no shame in wanting to feel better.
Your intimate health matters at every stage of life.
By Dr. Chio Ogbejesi, MD, Obstetrics & Gynecology
Medical disclaimer: This article is intended for general educational purposes and is not a substitute for an individualized medical evaluation, diagnosis, or treatment. If you have persistent, severe, or unexplained symptoms, please consult a qualified healthcare professional.