Painful sex? You can do something about it.

There’s no reason why your life during, and after, menopause couldn’t be healthy and exciting. Understanding how your body is changing is important to staying healthy and enjoying this time of your life. This includes your sex life. What sex life, you ask?

Menopause presents some challenges, but it doesn’t mean it’s the end of your sex life. An open conversation with your doctor might help you realize you’re not the only woman experiencing vaginal dryness or even pain during sex. Painful sex is called dyspareunia. It has many possible causes including hormonal changes, medical and nerve conditions, skin problems, and emotional issues such anxiety or depression.

The most common reason women 50 and better experience painful sex is vulvovaginal atrophy, a medical name for a vulva and vagina that no longer have the benefits of estrogen. The decline in estrogen production during menopause can thin vaginal tissue, causing dryness, burning and pain. Eventually, a decrease in blood flow to the vulva and vagina can cause the area to atrophy, as cells die off and are not replaced. These changes can lead to a vagina that is less stretchy, less lubricated, and less comfortable during intercourse.

The good news is that there is something you can do about it. For one thing, arousal improves blood flow, so having sex more often increases natural lubrication. Topical estrogen applied directly to the vulva and vagina in the form of creams, rings or tablets can improve dyspareunia in 93 percent of women who use these methods. Oral pills or patches can also be used, but you should discuss side effects with your doctor. Most topical applications have minimal side effects.

You can also use vaginal moisturizers that can be obtained over-the-counter. You can use moisturizers routinely, not just before sex. Talk to your partner about what feels good and what doesn’t, and make time for foreplay.

Another good practice is to avoid using soap, shower gel and bath oils in the vaginal area. These products can dry skin and cause discomfort during sex. Wash with mild soap using only your hands (not a washcloth), and wear cotton undies.

It can be difficult to talk to a doctor about private issues like painful intercourse, but sex should never hurt. An exam might pinpoint a problem that can be treated easily. A skin rash or an infection can be treated with drugs or topical creams. Pelvic floor therapy might also help, including massage to relax and stretch delicate tissue and exercises to ease tightness and strengthen pelvic muscles.

Finding a doctor you can talk to is very important. And your well-being – including your sex life – is very important. It’s imperative to make a specific appointment to focus on these issues rather than trying to tack them onto an annual visit. Sex and pain and libido are part of a time-consuming conversation and it’s in your best interest to invest the time. As a doctor, I encourage you to give it the time it deserves. Sometimes a treatable illness goes on for years, affecting a woman’s health, sex life and even state or mind. A doctor who listens can provide answers and help guide you to a healthy and fulfilling life at any age.

Other pelvic health topics:
Urinary incontinencePelvic floor issues

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