If vaginal intercourse/penetration is still uncomfortable, even after using the treatments already discussed, it could be due to shrinking or shortening of the vagina. You might try getting a set of vaginal dilators in different sizes that you can use to gradually open the vagina. Generally this involves regularly inserting the smallest dilator until it’s comfortable, then moving to the medium and larger sizes. Some women prefer using a dildo (an object shaped like an erect penis) to achieve the same goal. Both would be used with a vaginal lubricant. Even though they are available without a prescription, be sure to ask your gynecologist for more detailed advice about how to use them.
If you think your challenges go beyond just physical changes in the vagina and you’re experiencing low libido (sex drive), see Breastcancer.org’s section on Sex and Intimacy. This section takes a much broader look at sexuality after menopause—not just the physical side, but the emotional and psychological sides, too.
“Keep working with your gynecologist to find the solution that’s right for you. If at any point you feel that your questions or concerns are not getting addressed, it’s ok to ask your provider to refer you to someone who can help. Sex counselors (who are usually healthcare providers) and sex therapists (mental healthcare providers) are trained to evaluate and treat sexual issues. To find a cerified sex counselor or sex therapist in your area, you can visit the American Association of Sex Educators, Counselors, and Therapists (AASECT).”
-- Lynn Wang, M.D., gynecologist, Lankenau Hospital, Main Line Health System, Wynnewood, PA.