Both treat painful sex and dryness caused by menopause, one as a nightly insert and one as a daily pill. Here’s what each is, its side effects, and how they compare.
Intrarosa and Osphena are prescription treatments for painful sex and vaginal dryness caused by menopause. Intrarosa is a small vaginal insert used every night. It contains DHEA, which the vaginal cells turn into small amounts of estrogen and androgens. Its main side effects are vaginal discharge and, occasionally, an abnormal Pap smear, and it has no boxed warning. Osphena is a daily pill that acts like estrogen in the vaginal tissue. Its most common side effects are hot flashes, vaginal discharge, muscle spasms and sweating, and it carries a boxed warning about uterine cancer, stroke and blood clots. Both are usually tried after lubricants, moisturizers or low-dose vaginal estrogen.
Why menopause can make sex painful
As estrogen falls, the tissue of the vagina and vulva becomes thinner, drier and less elastic. Doctors call this vaginal atrophy, or genitourinary syndrome of menopause. It’s very common, affecting about half of women after menopause, and unlike hot flashes it usually gets worse over time rather than better. It can also cause burning, itching and more frequent urinary infections. It’s treatable, and you don’t have to accept it as normal.
What is Intrarosa?
- What it is: a vaginal insert containing prasterone, a form of DHEA, a hormone the body naturally makes.
- What it’s for: moderate to severe pain during sex caused by menopause.
- How it works: the cells of the vagina convert it into small amounts of estrogen and androgens, right where they’re needed.
- How it’s used: one insert at bedtime, every night, with the applicator provided.
Intrarosa side effects
- Vaginal discharge, the most common, often from the melted insert
- An abnormal Pap smear, occasionally, in longer use
It has no boxed warning, but it hasn’t been studied in women with a history of breast cancer, and it shouldn’t be used if you have unexplained vaginal bleeding.
What is Osphena?
- What it is: a daily tablet containing ospemifene.
- What it’s for: moderate to severe pain during sex, and vaginal dryness, caused by menopause.
- How it works: it’s not an estrogen, but it acts like estrogen in the vaginal tissue while blocking estrogen in some other tissues.
- How it’s used: one tablet a day, with food.
Osphena side effects
- Hot flashes, the most common
- Vaginal discharge
- Muscle spasms
- Sweating, headache, night sweats
Osphena’s boxed warning: like estrogen, it can thicken the lining of the uterus and may raise the risk of uterine cancer, stroke and blood clots. Don’t take it if you have had breast or uterine cancer, a blood clot or stroke, unexplained vaginal bleeding, or if you’re pregnant. It also interacts with fluconazole, a common antifungal.
Intrarosa or Osphena?
| Intrarosa | Osphena | |
|---|---|---|
| Form | Vaginal insert, nightly | Tablet, daily |
| Treats | Painful sex due to menopause | Painful sex and dryness due to menopause |
| Most common side effects | Vaginal discharge | Hot flashes, discharge, muscle spasms |
| Boxed warning | No | Yes: uterine cancer, stroke, blood clots |
| May suit women who | Prefer a local treatment | Prefer a pill to a vaginal product |
Try these first
- Vaginal moisturizers used regularly, and lubricants during sex. See our vaginal dryness guide.
- Low-dose vaginal estrogen, the most common prescription treatment, with very little absorbed into the body. See HRT for menopause.
- Pelvic floor physical therapy, if muscles tighten in response to pain.
Painful sex and low desire are different problems, though one often leads to the other. If low desire is the main concern, see Addyi for low sex drive.
When to see your doctor
See your doctor for any bleeding after menopause, pain that doesn’t improve, burning or itching that persists, or urinary symptoms. These are worth checking, whatever treatment you use.
The Chinese medicine view
Chinese medicine links dryness after menopause to declining Kidney yin and blood, the body’s moistening, nourishing side. These are traditional descriptions, not a diagnosis.
Another option for this stage of life
Not every woman wants another prescription. Feminine Vitality is a sealed herbal pouch worn over the navel, with nothing to swallow and no hormones, following the traditional whole-body approach to the menopause years. It is not a treatment for vaginal dryness or painful sex, but some women choose it as part of their wellness routine. Your first course is covered by our 90-Day Satisfaction Guarantee.
See Feminine Vitality’s directions →
Reviewed October 2026. Author: Qingcai Wang, MD, PhD, developer of the Five Essences external herbal-pouch formulations, with a commercial interest in their sale. General education only; continue your medical care.
Sources: Intrarosa prescribing information; Osphena prescribing information; MedlinePlus: ospemifene.