What do I do about painful sex? - Ellen Dolgen
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What do I do about painful sex?

Dear Ellen,

I adore my husband, but our sex life is virtually non-existent for the past 3 years.  When we have sex it hurts so badly I have to hold back the tears.  Can you help me?

                                                                                                                                     Sincerely, Beth

Dear Beth,

I am so sorry that you are going through so much.  I am happy you reached out for support.

It is very possible that you are experiencing vaginal atrophy/dryness .

You are not alone. Vaginal atrophy/dryness affects as many as 75% of postmenopausal women. This is a silent symptom of menopause that is defined as the thinning and inflammation of the vaginal wall that generally impacts women in their menopausal journey.  It occurs when there is a reduction in levels of estrogens which are produced by the ovaries.  Estrogens are responsible for maintaining the structure and function of the vaginal wall, elasticity of the tissues around the vagina, and production of vaginal fluid. Just between us, until I began my own perimenopause and menopausal journey, the only lining I had ever concerned myself with was located inside my blazer! I now understand the difference between a thick, healthy, well estrogenized vaginal lining vs. a thin, dry lining due to menopause – after estrogen loss. These vaginal and cellular changes are not pretty ladies!  When it comes to the vagina – thin is out!

Vaginal dryness impacts all areas of a woman’s life and affects the people who love them, too!!  Most women don’t even know what VA is, nor understand that it is a chronic problem that requires ongoing treatment and IS treatable.

So let’s get down to it:

What are the symptoms?

  • 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


So what’s a gal to do???

Make an appointment to see a menopause specialist. A menopause expert is trained in the ins and outs of perimenopausal and menopausal symptoms—including vaginal dryness and painful sex—and is your best bet at achieving a happy vagina once more. If you don’t have a specialist check out my Menopause Specialist Directory.  The specialists listed here have been recommended by the sisterhood.

Ask for:

A pelvic exam to examine the pelvic organs; look at the vagina and the cervix.

A Pap test to take a sample of cells from the cervix. Get your vaginal secretions and the acid level in  your vagina checked.

A urine sample might need to be included, if you are experiencing unusual urgency or a leaky bladder.

There is no one-size-fits-all solution; every woman is different.  Some women need a combo of a few treatments.  Here are  a few options to speak with your specialist about:

  • 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. It is important to understand that lubricants and moisturizers provide temporary relief of symptoms but do not treat the underlying condition of vaginal atrophy.
  • 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
  • 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.
  • 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!

Good Luck!  Keep me posted!

Remember: Suffering in silence is OUT! Reaching out is IN! 



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