Use it or lose it. Generations of women have been advised to engage in regular or frequent intercourse to avoid sexual pain. New research indicates that this advice is a myth.

Studies have found as many as 60% of perimenopausal and postmenopausal women experience pain during intercourse. According to a new study in the Journal of Obstetrics and Gynecology , that pain is not due to less frequent sex.

“I have patients worried about restarting a sexual relationship because they think they will have pain,” said L. Elaine Waetjen, MD, professor of obstetrics and gynecology at UC Davis Health, who led the study. “There is an insinuation that women have a personal responsibility for their sexual pain. This notion takes the focus away from identifying actual causes of pain and working to treat or manage those causes.”

Waetjen and her colleagues analyzed data from 2247 women with no history of sexual pain included in the Study of Women’s Health Across the Nation (SWAN), a multi-site longitudinal, epidemiologic study cosponsored by the National Institutes of Health. Participants answered questions related to frequency of intercourse, genital or urinary symptoms, and pain experienced during sexual activity in 10 questionnaires filled out between 1995 and 2008.

Though 48.4% of the study participants reported sexual pain at least “sometimes” over the course of 13 years, researchers found no consistent association between prior patterns of intercourse frequency and development of sexual pain. A history of sexual trauma also was not associated with more painful sex. Higher arousal was associated with a reduced chance of developing sexual pain.

Waetjen’s group found postmenopausal women who used hormone therapy and women who reported vaginal dryness developed sexual pain more frequently. “It seems postmenopausal hormone therapy was not significantly protective against developing pain,” she said.

Chhanda Dutta, PhD, chief of the clinical gerontology branch at the National Institute on Aging’s Division of Geriatrics and Clinical Gerontology, Bethesda, Maryland, said that the findings highlight a significant public health issue and underscore the need for more research on the underlying causes of sexual pain and how to help women alleviate their discomfort.

“We still need to understand the long-term health consequences of midlife aging and the menopausal transition in women so that we can develop better strategies to promote healthy aging for women of all races and ethnicities,” Dutta told Medscape Medical News.

Previous analyses of SWAN data found that experiencing pain during intercourse leads to reduced sexual activity.

“There are many gynecologists who specialize in older women’s health who have been waiting for evidence that supports what they believe — that reduced sexual frequency does not lead to the development of pain, but actually it’s the development of pain that leads to reduced sexual frequency,” Waetjen said, adding that the study provides evidence to counsel patients concerned they are personally responsible for their pain.

The study also found no correlation between the frequency of sex — from once a week to once every 6 months — with the pain women experienced.

“This ‘use it or lose it’ mentality some gynecologists have just doesn’t pan out with the data,” said Anne C. Ford, MD, an ob/gyn at Duke Health, Durham, North Carolina. “It will be very reassuring for women to know there’s a study that shows sexual pain doesn’t increase with a decline in sexual intercourse. You don’t have to feel guilty.”

Rachel Hess, MD, a study co-author, reported serving on a data safety monitoring board for Astellas Pharmaceuticals. The other authors reported no potential financial conflicts of interest.

The study was funded by grants from the National Institutes of Health, the National Institute on Aging, US Department of Health and Human Services, the National Institute on Nursing Research, and the National Institutes of Health Office of Research on Women’s Health.

Obstetrics and Gynecology. 2022;6:139-6. Abstract.