Can I do anything about painful sex after menopause?

DEAR DOCTOR K:

Ever since I went through menopause, sex has become painful. My doctor says this is because of vaginal atrophy. Is there anything I can do?

DEAR READER:

Pain that occurs before, during or after sex is a common problem for many women following menopause. Most often, the cause is vaginal atrophy, but there are other causes, too.

The pain can range from mild to excruciating. I’ve heard patients describe it as burning, stinging, sharp or extreme tenderness. The pain may be located in the outer genitals (vulva) or within the vagina. Many women feel discomfort mainly in the nerve-rich area around the vaginal opening.

Vaginal atrophy occurs when vaginal tissue deteriorates because of estrogen loss. Your body’s production of estrogen declines at menopause. As a result, vaginal tissue may become thinner, less lubricated and less elastic. Over time these changes can result in dryness, burning, itching and pain.

Sometimes vaginal pain with sex is a clue to other conditions. An infection of the vagina can lead to pain with sex; it also produces vaginal discharge. An infection of the tissues around the ovaries can lead to pain with sex; it also produces pelvic pain (also fevers and generally feeling ill) even when a woman is not having sex.

A bacterial infection of the bladder can cause pain with sex; it also causes frequent and painful urination. A condition called interstitial cystitis or painful bladder syndrome can cause pain with sex; it also causes the same symptoms as a bacterial infection of the bladder.

Vaginal atrophy is a more common cause of pain with sex, particularly when there is pain only with sex and not at other times. Fortunately, vaginal atrophy has several effective treatments, often requiring a combination of medications, other therapies and self-care. One or more of the following should help you manage discomfort and increase sexual pleasure:

  • Vaginal estrogen. Local low-dose estrogen helps most women with vaginal atrophy. It comes in a cream, a small tablet inserted in the vagina (Vagifem) and a flexible vaginal ring that’s worn continuously (Estring). Vaginal application releases little estrogen into the bloodstream. It carries less risk of side effects than systemic hormone therapy. Discuss the pros and cons of vaginal estrogen with your physician. It isn’t yet clear if it is safe for women with a history of breast cancer.
  • Lubricants. Non-hormonal vaginal lubricants and moisturizers may help reduce friction and pain during sex. Lubricants are applied just before sex; moisturizers are applied more regularly, for longer-term relief.
  • Sexual techniques. Extend foreplay to increase moisture in the vaginal tissues before intercourse. Switch positions, and experiment with different ways of being intimate. Communicate with your partner about what does and doesn’t feel good.
  • Lidocaine. This numbing ointment is applied to the area surrounding the vaginal opening before and after sex. It may help ease sexual discomfort.

Finally, frequent sexual activity can help stretch and strengthen muscles and increase blood flow and lubrication.

Related Information: Harvard Women’s Health Watch