Painful Sex After Menopause

Sexual pain can affect women in all stages of life, even women who have had many years of pain-free intercourse. Often diminished estrogen levels due to age, childbirth, menopause, cancer treatments, or surgery may result in vaginal atrophy. While women struggle with this issue, it is only a temporary issue. With a few tweaks, most women can return to happy and healthy sex lives.

 What is Vaginal Atrophy?

Vaginal atrophy is a medical condition characterized by the inflammation of the vagina due to diminishing estrogen levels and is usually brought on by menopause. It results in thinning and shrinking of the vaginal walls as well as reduced lubrication. The pelvic floor muscles, urethra, and vagina may all be affected by the reduction of estrogen production.

Estrogen 101

Estrogen is a group of hormones primarily responsible for "maintaining the collagen, elastic fibers, and vasculature of the reproductive organs and urinary tract that is essential for its structural and functional integrity. It also maintains vaginal PH and moisture levels." Estrogen is produced in the ovaries, along with progesterone and testosterone.

Vaginismus

Vaginismus is a condition where there is involuntary tightness of the vagina during attempted intercourse. Reacting to the anticipation of pain, the body automatically tightens the vaginal muscles, bracing to protect itself from harm. Sex becomes uncomfortable or painful, and entry may be more difficult or impossible depending upon the severity of this tightened state. See Basics, Symptoms, Causes, or diagnosis for more information.

Vaginal Atrophy

When vaginal atrophy goes undiagnosed and a woman continues to attempt to engage in intercourse, vaginismus may develop. It is important in these situations to address both the vaginal atrophy and vaginismus. Both problems will need to be treated to ensure full resolution. Without addressing the vaginal atrophy, it will be difficult to resolve the vaginismus as it may continue to be triggered by pain from the atrophy condition.

Vaginal Dryness, itchiness, and/or burning

Discomfort and/or painful sexual intercourse

Slight spotting/bleeding during intercourse

Increased frequency of UTIs

Increased vaginal infections

Increased vaginal PH levels

Has sex become increasingly uncomfortable?

Does your vaginal feel like "sandpaper"?

Do you have any vaginal dryness, itching, and/or burning?

Have you noticed any decreases in your natural lubrication?

Have pelvic/gynecological exams become uncomfortable?

Have there been changes in the outer appearance of the vagina? Shrinking folds of skin? Less pubic hair?

Is there a reason you may be experiencing a drop in estrogen production—approaching menopause, cancer treatment, etc.?

Menopause | Defined as 12 months since a woman's menstrual cycle; average age 51.3 years; not a single event; symptoms last on average 3.8 years.

Menopause | Vaginal Atrophy is a common symptom of menopause. It has been estimated that over 50% of menopausal women will develop atrophy. Some estimates are even higher at 75-90%.

Cancer Treatments | Cervical, Ovarian, Breast, Uterine.

Both chemotherapy and radiation therapy can cause ovarian failure. With little to no estrogen being produced, menopause is brought on. Vaginal atrophy can also be a side effect of treatment for cancers that are not specifically located in the pelvic region.

Surgery | Surgical removal of the ovaries immediately brings the onset of menopause and can cause vaginal atrophy to develop.

Childbirth and Breastfeeding | Following childbirth and while breastfeeding, some women experience a drop in estrogen levels causing vaginal dryness.

• Personal lubricants help make the vaginal canal more slippery so there is less dryness and friction during penetration.
• Vaginal moisturizers help alleviate ongoing vaginal dryness (examples: Replens, olive oil, coconut oil).
• Kegels are pelvic floor exercises that help to draw blood flow to the vagina, increase elasticity, and strengthen the pelvic floor muscles. They also help to improve control over the vaginal muscles.
• Estrogen is primarily used to help rebuild the tissue or lining of the vagina. This leads to increased lubrication. There are many different options in using estrogen ranging from vaginal cream, suppositories, or rings, and hormone replacement therapy (HRT). Be sure to discuss any and all hormone-based treatments with your physician.
• Professionally trained physical therapists can provide pelvic floor therapy for the treatment of vaginal atrophy as well as any accompanying vaginismus.
• For women with vaginal atrophy and no accompanying vaginismus, regular and consistent use of vaginal dilators is often suggested. The typical protocol follows inserting a lubricated dilator, leaving it in for a period of time each day, then gradually increasing the size of the dilator inserted.