How to Cope with Vaginal Dryness and Painful Sex During Menopause

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Let’s face it, love can hurt. And I’m not talking about the achy-breaky, he-left-me-for-a-younger-model-and-broke-my-heart kind of hurt. I’m talking about the physical pain that can be associated with intercourse during menopause.

There’s actually a medical term for this painful intercourse: dyspareunia (I would like to have a word with the folks who came up with this term!!). If you’re experiencing pain during sex, you could be suffering from vaginal atrophy (VA). The term “atrophy” can be defined as the wasting away of body tissue or an organ, typically due to the degeneration of cells.

Vaginal atrophy is just that: a thinning (and inflammation) of the vaginal wall. VA occurs when there’s a drop in levels of estrogens, produced by the ovaries. Estrogens maintain the structure and function of the vaginal wall, elasticity of the tissues around the vagina, and production of vaginal fluid. When it comes to the vagina, thin is out!

As if graying hair, sagging tatas and expanding waists weren’t enough, we now find out that our vaginas are aging too!

We seem to hear more about hot flashes, sleeplessness, and memory loss — but vaginal discomfort is every bit as difficult and critical to deal with as other menopausal symptoms. Vaginal symptoms can negatively impact not only on your relationships and sexuality, but can affect your quality of life and self-image.   Most women don’t even know what VA is, nor understand that it is a chronic problem that requires ongoing treatment and IS treatable.

What are the symptoms of VA?

  • Vaginal dryness
  • Vaginal burning
  • Vaginal discharge
  • Genital itching
  • Burning with urination
  • Urgency with urination
  • More urinary tract infections
  • Urinary incontinence
  • Light bleeding after intercourse
  • Discomfort with intercourse
  • Decreased vaginal lubrication during sexual activity
  • Shortening and tightening of the vaginal canal

If you feel you’re left high and dry, you’re not alone. Vaginal dryness affects as many as 75 percent of postmenopausal women. Between 17 and 45 percent of postmenopausal women say they find sex painful, according to The North American Menopause Society (NAMS).

According to the Women’s Health Concern, only 25 percent of these women seek treatment. What may be even more disconcerting is that, according to the International Menopause Society, 70 percent of women say their healthcare providers rarely or never raise the subject with them.

The Closer survey found that vaginal discomfort caused 58 percent of the North American women who were surveyed to avoid intimacy and 64 percent to experience a loss of libido.

The NAMS notes that pain during sex (or simply the fear of pain during sex) can trigger performance anxiety or arousal problems in some women. This also can diminish lubrication or cause involuntary — and painful — tightening of the vaginal muscles, called vaginismus. It’s a vicious vaginal cycle.

What’s a hot-blooded mama to do?

  • Try pelvic floor therapy. According to Harvard Medical School, this is a relatively new — yet safe and effective — technique. A physical therapist uses massage and gentle pressure to relax and stretch tightened tissues in the pelvic area. You also learn exercises to help strengthen your pelvic floor muscles, which may have been weakened by aging, childbirth or hormonal changes.
  • A little personal lubricant or moisturizer can go a long way in the bedroom. However, your vagina may need more than a lube job. Non-hormonal vaginal lubricants can help decrease friction and discomfort during intercourse. Be sure that they are water-based and designed for vaginal use. Petroleum-based lubricants can harbor bacteria in the vagina and lead to infection, as well damage latex condoms.Vaginal moisturizers (similar to moisturizing your face (most women find these helpful to use every day) can help relieve dryness and rebalance the acidity of the vagina. Both lubricants and moisturizers provide temporary relief of symptoms but do not treat the underlying condition of vaginal atrophy.
  • If you’re lubed to the max and still have no relief, see your menopause specialist. If you don’t have one, you can find some helpful tips here.
  • Ask your specialist for a pelvic exam of the vagina and cervix, and a Pap test to take a sample of cells from the cervix. Also have your vaginal secretions and the acid level in your vagina checked. You may need to provide a urine sample if you’re experiencing unusual urgency or a leaky bladder.
  • Hormone treatment options include local estrogen therapy (LET) and systemic estrogen therapy. LET is estrogen applied directly to vaginal tissues, so it goes directly to the affected area, with minimal absorption of estrogen into the bloodstream. LET is available in creams, a ring and a tablet. Systemic hormone therapy (HT) allows estrogen to circulate throughout the bloodstream to all parts of the body. It’s available in many forms: a pill, injection, patch, gel and spray. Systemic HT is most often prescribed for multiple whole-body symptoms of menopause, including night sweats, hot flashes, and others.Some women need a combination of treatments.
  • Communicate with your partner. Honesty is definitely the best policy. If you’re avoiding sex due to pain, your partner could misinterpret it as your dissatisfaction with the relationship (or the sex).

It’s been about 10 years since my vagina found itself stranded on a desert island and took my sex drive with it! Since rescuing it, my life is full, happy and satisfied. Remember: Your symptoms are treatable. You can have a happy vagina again!

“The big O” does not mean “the big Ouch.” Recapture the rapture in bed.

Suffering in silence is OUT! Reaching out is IN! 

After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • cindy bobst

    I been going thought menpause for a while would like to know what happem when done will my body know

    • Ellen Dolgen

      First you go through perimenopause – which is the symptom laden 2-10 years before you reach menopause. You have reached menopause when your period has been over for 12 consecutive months. Then there is peri-menopause. Many women find that their symptoms ease up, but not everyone. There is no one size fits all. You can reach more info about this in this Health News Flash. No matter where you are in your journey, Cindy, I hope your symptoms start easing up soon.

  • You always provide such useful information, Ellen. Just when you think you know it all WHAM! Here comes Ellen with some more topical information for us! Thanks.

    • Ellen Dolgen

      Thanks, Cathy! I am thrilled that you find the info helpful.

  • Thanks for the info Ellen. Filing this away if I ever need it.

    • Ellen Dolgen

      I am here for you, if you every need some support!

  • Seems that, as is usually the case with most things, communication is key. With your doctor, your spouse, perhaps even with yourself. Thank you for keeping the conversation going, Ellen! I always learn something helpful from your posts.

    • Ellen Dolgen

      Perfectly said, Lisa! My motto is: Suffering in silence is OUT! Reaching out is IN!

  • Aging is so different than it was for our mothers. I had no idea there were so many options for getting help. Really important to get this info out there. Thanks.

  • Thanks for the great information. I’m hoping I never need it!

    • Ellen Dolgen

      Me too, Lois! Knowledge is power….so I am glad you have the info!

  • I’m starting to experience the first signs of aging…gray hair, gravity, a few wrinkles here and there. And to be honest, this post horrifies me. OMG, I had no idea.

    • Ellen Dolgen

      Angela, I am sorry if I scared you…..the purpose of the blog is to educate women so that can be proactive about their health, rather than reactive.

  • Yes, one of those rather unexpected side effects….doctors do say use it or lose it!

    • Ellen Dolgen

      Haha!!! Yes, they do!

  • Happy vagina! This is such great information and so necessary. Happy to have found you and happy to be able share this info with others.

    • Ellen Dolgen

      Yes – we all want a Happy Vagina!!! I am glad the info is helpful, Hakikah!

  • I have the opposite of these systems actually and those it was annoying. After reading about this condition, I’ll stop complaining about what I’m dealing with.

    • Ellen Dolgen

      Feel free to complain anytime!

  • linda

    Hi Ellen:) Love this subject because it is so necessary to talk about. I will never forget my first experience with vaginal dryness; it was like my vagina got a few shots of botox– that’s how swollen I was after sex… those lips didn’t need any plumping…OUCH! Since then I discovered I was suffering from vulvandinia–a form of vaginal atrophy. I keep a water bottle in my bathroom and small one in my purse. After peeing I spray and pat dry rather then wipe. It really makes a difference, especially those of us who pee as if we were pregnant. I swear,menapause is a combination of feeling pregers and adolescents.HAHAHA LOL! The thing that has also helped with dryness besides replens and glide lube is, a good pro biotic for women. It seems to balance everything out… down there. Oh, and keeping my vag completely hair free makes me feel 10 pounds lighter, and also the fact that the hair on my head wasn’t the only thing that was turning grey. Again, so thankful for you Ellen and everything that you do. Ive learned to laugh about all the changes with many awsome women.

    • Ellen Dolgen

      Vulvodynia is a tough one to diagnose. I hope you have a really good menopause specialist to help guide you with the best treatments for this.

      • linda

        Thankyou for your concern. And yes, I have a great doctor! This condition has to be treated with a special prescription medication. As long as I take care of myself I get less flare ups. It use to really get me down but realized it can always be worse. Just so thankful for the support of my Doctor and this very special sister hood:)

        • Ellen Dolgen

          So happy you have a great doctor! Take good care of you!

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