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Painful Sex In Menopause

Painful intercourse during menopause is a symptom experienced by 17% to 45% of postmenopausal women and can manifest as dryness, tightness, or acute pain. Following intercourse, some women may encounter vaginal soreness or burning. Continuous neglect of this condition, particularly engaging in infrequent sex without adequate lubrication, can exacerbate inflammation, leading to the tearing and bleeding of vaginal tissues. [1] Moreover, sexual discomfort isn't limited to internal factors; conditions like vulvodynia, which causes chronic pain in the external genital area, among other non-menopausal factors, can also contribute to pain during sex. The repercussions of painful sex extend beyond physical discomfort, potentially leading to performance anxiety or arousal issues due to the dread or expectation of pain. This anxiety can reduce natural lubrication and provoke vaginismus, an involuntary tightening of vaginal muscles that further intensifies discomfort. This creates a detrimental cycle that underscores the complexity of sexual health issues and the importance of addressing them holistically.

Why is Sex Painful in Menopause?

As estrogen levels fall as women approach and pass menopause, the resulting dryness and thinning of vaginal tissues can cause penetration and intercourse to be uncomfortable for many women. The genitourinary syndrome of menopause (GSM) is a term that describes various menopausal symptoms and signs associated with physical changes of the vulva, vagina, and lower urinary tract. GSM includes not only genital symptoms (dryness, burning, and irritation) and sexual symptoms (lack of lubrication, discomfort or pain, and impaired function), but also urinary symptoms (urgency, dysuria, and recurrent urinary tract infections [UTIs]). [2]

What Can You Do About Painful Sex in Menopause?

There are many avenues to help reduce pain during sex, including: Symptom Relief Strategies:

• Vaginal moisturizers and lubricants: Utilize lubricants to minimize discomfort during intercourse.
• Pelvic floor physical therapy
• Vaginal dilators: Vaginal dilators are cylinder-shaped devices made from plastic or medical-grade silicone that can be used to treat pelvic pain disorders, vaginal tightness, and sexual pain. They can also help strengthen pelvic floor muscles and make vaginal tissue more elastic, which can help with pain during penetration
• Sex therapy/counseling: Seek support to help navigate sexual health and intimacy conversations.

Hormonal Treatments:

• Vaginal Estrogen Therapy: To alleviate vaginal dryness and discomfort, estrogen is available in various forms, including vaginal estradiol tablets, gels & creams, and vaginal suppositories or rings. Studies have shown there is no evidence of increased early breast cancer risk in patients who used vaginal estrogen therapy, compared with patients who did not use HRT. [3] That said, always consult with a healthcare provider to understand your personal risks and benefits.
  • Standard doses of estrogen therapy can also be combined with vaginal creams.

Non-Hormonal Treatments:

• Prasterone (Intrarosa): This vaginal insert is a non-estrogen treatment that provides dehydroepiandrosterone (DHEA) to the vagina, alleviating pain during intercourse due to GSM.
• Ospemifene (Osphena): A daily pill that eases painful intercourse for women with moderate to severe GSM, not recommended for those at high risk for breast cancer.

Symptom-specific Medications:

• • Steroid creams for vaginal inflammation, antibiotic creams or pills for vaginal infections