Dr Sylvia Kama-Kieghe, FRCGP — NHS GP & Women’s Health Doctor

Still having painful sex even though you are using lubricant?

Vaginal dryness with pain is common. It can develop after a hormone shift such as menopause or breastfeeding. It can also happen with some types of birth control, after a hysterectomy where the ovaries were affected, or during some forms of cancer treatment. 

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5 steps you can consider

Here are simple changes you can make yourself, knowing when you need a proper assessment:

1. Use vaginal moisturiser  

• Moisturiser: maintenance for the tissues between sex
• Lubricant: reduces friction during sex

If you only use lubricant before sex, you may still be sore on other days. Use a moisturiser specifically meant for use around the vagina and follow the product label for how often to apply it.

Avoid face cream, random body lotion, or products not intended for use around the vagina, as these can irritate the vulval skin. 

2. Use water-based lubricant before sex

Apply water-based lubricant before sex starts, inside and around the vagina. This applies whether you are having sex with a partner, using fingers, or using a toy.

If the product stings or becomes tacky, try another brand. A pharmacist can also help if you are unsure which product to choose.

3. Avoid irritation and know when to get assessed

Perfumed products around the vulva can make dryness worse. This includes:

• Perfumed soap
• Feminine washes
• Intimate cleansers
• Douches

If moisturiser, lubricant, and avoiding these products still leave you sore, don’t just keep buying another product. It may be time for a proper assessment.

4. Give your body time to become aroused

Your tissues need blood flow and time to lubricate.

If penetration happens while you are dry, the tissues are unprepared. Pain can cause the pelvic floor to guard itself, which may cause pain to start earlier the next time.

5. Consider local vaginal oestrogen

When hormones are part of the picture, local vaginal oestrogen can come as a cream, gel, pessary or tablet.

Full benefits can take up to 3 months. Stopping after two weeks and deciding hormones do not work may mean the treatment has not had enough time.

If there is still no improvement after three months, a review may be needed to adjust the type, dose, or diagnosis.

Know the red flags

Book an appointment if you develop:

• Bleeding after sex
• Bleeding between periods
• Bleeding after menopause
• Unusual discharge with a strong or bad odour alongside fever or pain
• Pain in the pelvic, abdominal or vulval area

Pain by itself also deserves a full consultation, especially if it is affecting your sleep, work or ability to have sex.

When you see your doctor, explain how long the symptoms have lasted, what you have tried, what has failed, and exactly where the pain happens.

Key takeaway

If lubricant isn’t enough, don’t assume you simply need more lube. Work through the five steps, and if the problem persists or pain is affecting your life, get assessed.

⚠️ Important Disclaimer — If you are experiencing vaginal dryness, pain, bleeding, unusual discharge, or if anything concerns you, speak to your doctor. This information is for educational purposes only and should not replace an assessment by a healthcare professional. 

More Reading

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• Best Natural Vaginal Lubricants When You Are Perimenopausal
• Fibroid Surgery Checklist: What Your Surgeon Won’t Tell You
• 5 Reasons You Didn’t Know For Vaginal Bleeding After Sex
• 10 Signs You’re Already in Perimenopause — And What to Do Next