Why is intercourse so painful now? It never was before. It almost feels like my vagina is shrinking.

Sexual dysfunction is unfortunately extremely common after menopause. The lack of hormones, especially lack of estrogen, profoundly impacts the health of the tissue of the vagina and vulva. These tissues atrophy, or thin out, and scarring can happen which literally shrinks the width, length and caliber of the vagina. Loss of vaginal lubrication is another part of the equation. An accompanying loss of libido, which is not inevitable but is extremely common, only further compounds the problem. There may be many other reasons for pain aside from menopause contributing to pain - such as pelvic infection or pelvic masses - that need to be ruled out. If you are experiencing pain with intercourse, it can be very beneficial to have a detailed evaluation.