Ouch! Are You Dealing With Painful Sex After Menopause?

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Let’s talk about sex, baby! We’ve come a long way in removing barriers that prevented public discourse about sex and sexuality since that Salt-N-Pepa song debuted in 1991, but some topics still seem taboo — like painful intercourse after menopause.

Information and honest discussion about menopause is far more available now than even 10 years ago. The changes perimenopause and menopause wreak on our bodies, emotions and health are more widely understood now than ever. We know menopause can leave us with low libido and a lack of lubrication, but mainstream conversations about pain during penetration (which wasn’t present prior to menopause) still seem shameful and secretive.

While lower libido and less lubrication could be partially to blame for vaginal penetration discomfort, even when those two concerns are addressed, some women still experience penetration pain because menopause can thin the vaginal wall and diminish its elasticity.

Collagen keeps our joints working well, our bones healthy and strong and keeps our faces looking young by giving skin its plumpness and flexibility. It helps with healing and facilitates the healthy flow of blood and nutrients to the cells. However, the diminishing estrogen levels of perimenopause leave a lower flow of blood to the vagina, in turn causing lower collagen production there. Vaginas lose their cushion and flexibility, which can hurt during penetration, even when artificial lube is applied.

“Estrogen is similar to putting lotion on your hands in the wintertime, but to your vagina. It helps keep the tissue in the vagina supple and less susceptible to tearing and thinning of the walls during penetration. Without estrogen routinely there, the potential space of the vagina may become smaller and thinner,” explains Dr. Christine Greves of Orlando, FL, and ob/gyn expert for drugwatch.com. “Regular vaginal intercourse/penetration helps increase blood flow to the vaginal walls, which can help with preventing discomfort with intercourse, ultimately.”

Of course, if you’re in perimenopause, sex with or without a partner might be the last thing you’re interested in! What’s a woman to do if she wants to keep her options open to enjoy sex after menopause?

Dr. Greves firmly believes that speaking with your doctor about any and all sexuality concerns is imperative. Assuming no other medical concerns prevent it, you could be prescribed either oral hormones that help with a number of perimenopausal sexual symptoms like libido and lubrication or vaginal suppository hormones for more targeted assistance.

For those who are post-menopausal, never fear! Even if the triumvirate of sex killers — low libido, low lubrication and thin vaginal walls causing pain during penetration (medically referred to as Genitourinary Syndrome of Menopause or GSM) — has struck, there is still hope. Talk to your doctor to see if you’re a candidate for hormone therapy. If you’re eligible, vaginal hormones can help even after menopause and certain types have fewer side effects or potential concerns than oral hormones.

Dr. Greves also suggested using low-cost tools called vaginal dilators. Similar to vibrators (which can also be used), dilators come in sets of different sizes and are inserted in the vagina (usually with lubricant) to help increase blood flow to the area and hopefully restore elasticity as the size of the dilator is increased after a comfort level is achieved with each new size.

A 2020 study found that pelvic floor therapy and massage can improve blood flow and restore elasticity in vulvovaginal tissues while helping relax the pelvic floor muscle in postmenopausal women with GSM. There are various pelvic floor therapies, including exercises and external or internal massage. If you’re interested in this form of treatment for post-menopausal pain during intercourse, it’s best to consult an accredited professional with experience, expertise and excellent client reviews due to the very intimate nature of the therapy. The International Pelvic Pain Society (IPPS) and the American Physical Therapy Association (APTA) are online resources to find a qualified pelvic floor physical therapist if your healthcare practitioner isn’t able to give you a referral.

Finally, there is a treatment that uses a laser to stimulate collagen growth in the vaginal lining. While a Canadian report rounding up studies on this type of therapy didn’t confirm measurable benefits (some women even experienced burning), it is an available option for those who may have tried everything else without success.

When it comes to sexual intercourse, menopause doesn’t have to be a death sentence if you’re willing to have open dialogues with healthcare providers and your sexual partner. There is help available and any embarrassment you might initially experience bringing up your concerns will likely fade quickly, especially if it gets you back to enjoying sex the way you did before menopause.

 
Do any of you find sex to be painful as you grow older? What do you do about it? Let us know in the comments below.