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What Causes Painful Sex after Menopause, and How Do You Treat It?

The condition affects up to 45 percent of postmenopausal women, says the North American Menopause Society

Photo by Gustavo Fring from Pexels

As cisgender women enter menopause, their periods become more irregular, and they start to experience symptoms, such as hot flushes, mood changes, weight gain, and vaginal dryness. Between 17 percent and 45 percent of women report painful sex (dyspareunia) after menopause, says the North American Menopause Society (NAMS) in its article entitled “Pain with Penetration.”

Dyspareunia can be caused by different factors, such as hormonal changes (e.g., reduction of estrogen), medical issues (e.g., vaginismus, vulvodynia, and endometriosis), or psychological barriers (e.g., sexual trauma). The good news is that there are treatments to alleviate or eliminate pain during sex during and after menopause.

Why Sex Hurts

Painful sex after menopause can be caused by hormonal changes, health conditions, and psychological factors. Painful sex, or dyspareunia, for cisgender women before or after menopause can be caused by the following:

Hormonal changes. During menopause, the ovaries produce less estrogen, which leads to the drying, thinning, and inflammation of tissues in the vagina, a condition called vaginal atrophy. “Less estrogen means less vaginal lubrication and a less stretchable vagina,” says the North American Menopause Society. Vaginal atrophy and the lack of adequate lubrication are the leading causes of sex pain in midlife and after menopause.

Vaginismus. “Vaginismus is a condition involving involuntary contraction of the pelvic floor that prevents vaginal penetration or makes it painful and difficult,” explains Dr. Amanda Olson, a doctor of physical therapy and pelvic floor rehabilitation specialist. Cis women who suffer from vaginismus may have trouble not only with penetrative sex but also with using a tampon and having a gynecological examination.

The causes of vaginismus aren’t clear yet, but it has always been associated with fear and anxiety of having sex. In some cases, this condition may be triggered by fear and anxiety after a traumatic experience in the past.

Medical conditions. Existing medical conditions can cause painful sex. These conditions include ovarian cyst, endometriosis, skin diseases, yeast or urinary tract infection, vulvodynia, and vestibulodynia, among others. Vulvodynia is chronic pain in the vulva while vestibulodynia is chronic pain in the vestibule or the area around the vaginal opening and inside the inner lips of the vulva.

Psychological factors. Mental and emotional factors may also contribute to painful sex. This can be common in women who associate the female genitals and sexual relations with fear and injury. A woman’s state of mind contributes to her sexual response, says the American College of Obstetricians and Gynecologists in these FAQs on painful sex. Feelings of fear, guilt, shame, and embarrassment make it difficult for a woman to relax and feel arousal, which in turn, may result in pain during sex.

How to Treat the Pain

Treating painful sex and maintaining sexuality after menopause are possible through different treatments. Ask your health-care provider about trying the following treatments for painful sex after menopause:

Vaginal moisturizers or lubricants. Vaginal dryness is one of the primary symptoms of menopause. Less lubrication in the vagina during penetrative sex causes tightness and discomfort. To counter this, use a generous amount of a water-based lubricant during intercourse.

Water-based lubricants are versatile and can be suitable for unprotected intercourse or for use with latex products, such as condoms or sex toys. Silicone-based, oil-based, and other lubricant products are also available. The key is to find the type most suitable for you. Don’t hesitate to consult your gynecologist or sex therapist for advice.

You can also use a vaginal moisturizer or salve before and after intercourse to relieve vulvar pain caused by dryness and irritation.

Low-dose vaginal estrogen. A health-care provider may prescribe a topical low-dose estrogen to women with severe dryness and pain related to menopause. Using a vaginal cream can help enhance the thickness and flexibility of the vaginal tissues and improve blood circulation. Estrogen can be taken orally, but vaginal estrogen carries less risk and side effects than oral estrogen does.

Pelvic floor physical therapy. A pelvic floor physical therapist uses different hands-on techniques, such as massages and applying pressure to the pelvic area to help loosen and relax the tightened tissues in the area. Your physiotherapist may also guide you through a series of safe and effective exercises to strengthen your pelvic floor muscles.

Sex therapy or counseling. Relationship problems and psychological factors can contribute to painful sex. These are addressed through sex therapy and counseling. A mental health professional or a sex therapist can help you work through your fear and anxiety about sexual intimacy and communication with your partner.

Self-care. Take care of your reproductive health. Be gentle when cleaning your vulva and vaginal area. Use mild soap and plain water, and pat the area dry. Stay away from perfumed bath bombs, gels, feminine wash, and antiseptics that can disrupt the healthy balance of bacteria and pH levels in the vagina. Also, exercise regularly, and maintain a balanced diet to keep your body healthy.

Vaginal stimulation. Regular exercise and stretching help strengthen the muscles and keep them flexible. Regular vaginal activity, such as penetrative sex, manual stimulation, and using vaginal trainers, also helps maintain the flexibility of the pelvic floor muscles and the tissues in the vagina. Talk to your physiotherapist about safe vaginal-stimulation activities that you can do by yourself and with your partner.

Pain during penetrative sex is common in all women, not only those in menopause. However, it’s not often talked about because many women feel embarrassed about talking about their reproductive health. There’s no shame in talking about women’s health issues, including painful sex, especially to your partner and to your health-care provider.

Dyspareunia is treatable and manageable. No woman should be made to feel that she cannot ask for help when it comes to her health issues.

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