What can I do about vaginal pain during intercourse?

DEAR DOCTOR K:

I’m in my late 50s. Lately, I have vaginal pain every time my husband and I have intercourse. I mentioned this to some friends, and it turns out a few of them also experienced vaginal pain, starting around menopause. What is causing this problem? And what can I do?

DEAR READER:

If you’re in your late 50s, you probably have gone through menopause. At menopause, levels of the hormone estrogen plummet. This causes the vaginal lining to become thin and produce fewer lubricating secretions, resulting in dryness and irritation. The vagina becomes shorter and less elastic, and the vaginal opening narrows. All of these changes can make intercourse uncomfortable, painful or impossible.

A condition called pelvic floor hypertonus often develops around menopause in response to this vaginal pain. It causes the muscles surrounding the vagina to involuntarily tighten in response to any attempt at entry. It can make intercourse even more difficult.

There are things you can do to reduce your discomfort during sex, several of which require working with your doctor to obtain prescription medicines:

  • Use plenty of lubricant when you have intercourse. Also, consider regular use of long-acting vaginal moisturizers.
  • If you are postmenopausal, consider low-dose vaginal estrogen therapy, which can help restore vaginal health. A new oral drug, ospemifene (Osphena), may also help with vaginal dryness and discomfort. It is supposed to stimulate the vagina (but not other organs) the way estrogen does.
  • Consider steroid creams, which effectively treat vaginal inflammation.
  • Try pelvic floor physical therapy. This technique uses hands-on physical therapy to relax muscles in the lower pelvis. It is very effective for many women in treating persistent vaginal or pelvic pain.
  • Do Kegel exercises to strengthen your pelvic floor muscles.
  • Apply an anesthetic gel in and around your vagina before intercourse. Ask your doctor for a prescription.
  • Apply a frozen gel pack wrapped in a towel to your vulva to ease irritation after sexual activity.
  • Rinse your vulva in cool water after sex.
  • Use lubricated vaginal dilators regularly. These products consist of a set of plastic round-tipped cylinders that range in size. The small cylinders have a diameter of about three-quarters of an inch. The large cylinders are the diameter of a fully erect penis.┬áVaginal dilators can be used if your vagina tightens involuntarily during intercourse. They are also helpful if your vagina has become short or narrow over time. For many women, using dilators regularly for about five minutes every night can dramatically increase comfort with intercourse.

Pain with intercourse is something that people don’t like to bring up with their doctors. I remember patients who had been having the problem for 10 to 20 years, but never mentioned it to me for the longest time. You may well be able to improve the problem with any of the above approaches that don’t require your doctor. If not, don’t hesitate to ask your doctor for help.