Are You Experiencing Painful Sex After Menopause?

Pain with inter­course is both nor­mal and com­mon after menopause. This is usu­al­ly due to changes in the vul­va and vagi­na, which occur with low­er estro­gen lev­els. While many menopausal symp­toms, such as hot flash­es and night sweats, often dimin­ish with time, this symp­tom often wors­ens unless treat­ed.

The hor­mon­al changes of menopause lead to a con­di­tion called vagi­nal atro­phy or thin­ning of the tis­sues of the vagi­nal walls. Vagi­nal lubri­ca­tion is also decreased. These changes can result in painful inter­course, and an increased chance of trau­ma from sex­u­al activ­i­ty, which can result in tears in the tis­sue and spot­ting or bleed­ing. This can progress to nar­row­ing of the vagi­nal open­ing, mak­ing inter­course very painful or impos­si­ble.

Some women also expe­ri­ence more fre­quent vagi­nal infec­tions after menopause. Uri­nary tract infec­tions may also become more com­mon.

The most effec­tive treat­ment for menopausal changes in the vul­va and vagi­na is local vagi­nal estro­gen. This is a much low­er dose of estro­gen than estro­gen pills or patch­es that are used for estro­gen replace­ment. Vagi­nal estro­gen does not result in sig­nif­i­cant increas­es in blood lev­els of estro­gen. There­fore, it does not car­ry the risks that sys­temic estro­gen may pose. It is very safe for most women, even those for whom estro­gen pills or patch­es are con­traindi­cat­ed. There are also very few, if any side effects in most women.

Vagi­nal estro­gen can be sup­plied as a cream, vagi­nal tablet, or a ring worn in the vagi­na. There is also an oral tablet that can be used for vagi­nal atro­phy.

These med­ica­tions require a pre­scrip­tion. It is best to meet with your physician/​health care provider to dis­cuss what option is best for you. As with any new med­ica­tion, your per­son­al health his­to­ry should be reviewed. Vagi­nal estro­gen is con­traindi­cat­ed in a very small group of women.

In addi­tion to pre­scrip­tion med­ica­tions for vagi­nal dry­ness and painful inter­course, vagi­nal lubri­cants and mois­tur­iz­ers are help­ful. Sev­er­al over-the-counter lubri­cants can be pur­chased for use dur­ing inter­course. These will have the imme­di­ate effect of decreas­ing fric­tion on the thinned tis­sues and mak­ing sex less painful. Vagi­nal mois­tur­iz­ers can be used sev­er­al times week­ly, not just at the time of sex­u­al activ­i­ty. These will pro­vide some relief from dry­ness and the symp­toms of atro­phy.

Painful inter­course after menopause is not abnor­mal or unusu­al, but there are very safe ways to improve it. Many women do not con­sid­er these treat­ments because of unfound fears. Your health care provider can help you choose a treat­ment that is safe and appro­pri­ate for you. Call to sched­ule an appoint­ment and dis­cuss your con­cerns with your physician.