By: Red Hot Mamas

Published: November 9, 2016

Contributed by Dr. Barb DePree- Red Hot Mamas Medical Expert

Between my menopause care practice and my website (MiddlesexMD.com), I talk to a lot of women who are experiencing the physical changes of menopause. One email I received a few weeks ago posed a poignant question: “Will sex be painful for the rest of my life?”

The writer said she’d had painful intercourse for a few years, and was hoping it would pass. She finds herself not wanting to have sex, because her expectation of pain outweighed the expectation of pleasure. No surprise! And she’s not at all alone, for whatever comfort that gives her–or you.

Once a woman transitions through menopause, she will be postmenopausal for the rest of her life. That means there is no source of estrogen, which results in what we call chronic and progressive vaginal atrophy. The effects of this are increasing vaginal dryness and thinning and narrowing of the vagina. This is not something that will reverse itself over time; without treatment, it only progresses. (I know! This is not something our mothers prepared us to expect!)

The majority of postmenopausal women who want to continue to have intercourse need to compensate for the loss of estrogen. Localized estrogen (provided as a cream, ring, or tablet) replaces the estrogen your body used to produce, directly in the area where it can have positive effect. Or Osphena, an oral non-hormonal treatment, is very effective as well.  This localized hormone treatment  or Osphena is preferred for women whose only menopausal issue is painful intercourse. There are very few risks associated with the localized estrogen therapies (ACOG-the American Congress of Obstetrics and Gynecology-made the statement earlier this year that this localized application of estrogen is safe for breast cancer patients) . But if additional symptoms of menopause–mood, hot flashes, sleep disorders, and more–affect quality of life, HT is definitely worth evaluating.

If painful intercourse isn’t adequately treated with localized estrogen, there may be a secondary cause of pain, like vaginismus.  Vulvodynia is another cause of painful intercourse that has additional treatment options. It is important to give feedback to your health care provider to be sure that the sources of pain are properly identified and treated.

It may be that vaginal tissues are now healthy, but because you’ve avoided intercourse you could now benefit from dilators. Regular use of dilators will gradually stretch your vaginal tissues so that intercourse is comfortable again. Another little-discussed reality is that with the loss of estrogen, the vagina changes from a pleated skirt to a pencil skirt: It loses its pleats, called rugae, which earlier expanded when more space was needed (as for childbirth).

Alas, the sexual enjoyment that came so easily, with so little effort, is now a different story. But the effort of regaining sexual comfort is worth the time and energy! Along with questions and problems I hear from women, I’m privileged to hear from patients about their successes, so I know it can happen!

Dr. Barb DePree gynecologist, NAMS certified menopausal provider and founder of the website middlesexmd.com