Objective: With a paucity of information from sub-Saharan Africa, the impact of postmenopausal vaginal atrophy on women and male partners in South Africa was investigated. Methods: Four hundred individuals in South Africa (200 postmenopausal women who had experienced symptoms of vaginal atrophy, and 200 male partners) completed a structured questionnaire. Results: Sixty-eight percent of women had avoided intimacy because of vaginal discomfort; 62% of men described observing this behavior in their partners. Consequently, 52% of women and 51% of men reported decreased sexual activity - 20% of women and 18% of men believed vaginal discomfort had 'caused a big problem'. Significantly higher proportions of women than men (p<0.05) described being 'put off' having sex (27% vs. 14%) and feeling emotionally distant from their partners (21% vs. 11%). Twenty-one percent of women had used local estrogen therapy, reporting benefits including feeling 'happy' that their body was 'working again' (76%) and increased confidence as sexual partners (71%). Conclusion: For many postmenopausal women and their partners, symptoms of vaginal atrophy adversely affected sex and relationships, physically and emotionally. Substantial improvements were reported by women who received local estrogen therapy, supporting greater efforts to improve awareness and accessibility of such treatment in South Africa.