Most often, when the woman is not properly aroused (lubricated) and if the man makes an attempt to enter, it leads to irritation and pain at the time of intercourse. If the pain is always present at the time of intercourse then it could be because of hymenal obstruction, urethral disorders or congenital malformation of the vulva or vagina. It could also occur following post-operative scars and atrophic vulvo-vaginitis (common in menopausal years). If the pain is present occasionally, then one may look for some local infection and/or allergy.

Some women report an increase while others report a decrease in sexual desire at menopause. Increase in sexual desire may be because of relative freedom from pregnancy and hence one may respond and perform with greater abandon and enthusiasm. Some women harbor the misconception that menopause marks the end of their sexual career and this fear (about their waning sexuality) increases their sex drive so that they may reaffirm their femininity. A decline in sexual desire could be because of physical reasons.

During menopause (or even a few years earlier), a reduction in the secretion of the ovarian hormones may cause atrophy of the vaginal epithelium which leads to reduction in lubrication and hence pain at the time of sexual intercourse (which can be remedied by estrogen replacement therapy). This causes a decline in sexual desire and a woman avoids sexual overtures. Depression and anxiety are common features and they also tend to reduce the sexual desire.