Less sex during menopause transition not associated with increased risk of sexual pain

Reviewed by Emily Henderson, B.Sc.Jul 7 2022

Having sex less often during the transition to menopause is not associated with an increased risk of developing pain with intercourse, according to a new study published recently by the Journal of Obstetrics and Gynecology.

This 13-year study examined whether a reduction in the frequency of sex is responsible for women's symptoms of sexual pain during the transition to menopause. The study also examined other factors potentially associated with sexual pain.

Women have been told by the popular media and some physicians that if you 'don't use it, you'll lose it,' meaning if women don't remain sexually active, especially through the menopause transition, they will lose the ability to have comfortable sex. But this study provides some empirical evidence against this popular notion."

Elaine Waetjen, primary investigator of the study and professor of obstetrics and gynecology at UC Davis Health

Painful intercourse is reported in 20% to 59% of perimenopausal and postmenopausal women. This study gathered questionnaire data annually across the first 10 visits of the Study of Women's Health Across the Nation (SWAN), a multicenter, multiracial and multiethnic prospective study of the menopausal transition. Inclusion criteria for this study were those ages 42-52 years who self-identified as Black, Hispanic, Japanese, Chinese or White.

Of the 2,247 women with no sexual pain at the baseline, 1,087 (48.4%) developed sexual pain at least "sometimes" up to 10 follow-up visits over 13 years. Participants completed questionnaires at each visit, gauging frequency of participation in sexual behaviors, genital or urinary symptoms and pain experienced during sexual activity. Some of the study's other findings:

• Women were most at risk for developing sexual pain in late perimenopause and postmenopause, independent of age
• Use of systemic hormone therapy did not appear to reduce this risk of developing sexual pain
• Reporting of vaginal dryness had the strongest association with developing pain
• Engaging in oral sex and having a higher frequency of arousal were associated with a reduced chance of developing sexual pain
• History of sexual trauma was not associated with sexual pain among this older cohort

"Our study results provide a critical public health and clinical message: women whose sexual intercourse activity declines do not appear to be at higher risk for developing sexual pain compared with women who maintain or increase sexual frequency," Waetjen said. "Women and their health care professionals should focus on developing individualized strategies to prevent and treat sexual pain and not attribute pain to reduced intercourse frequency."