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What Is Dyspareunia Due To Menopause

How Do You Fix Dyspareunia

What is Menopause & what are its symptoms explains Dr. Manjula Anagani – TeluguOne

Certain nonmedication therapies also might help with dyspareunia:

  • Desensitization therapy. You learn vaginal relaxation exercises that can decrease pain.
  • Counseling or sex therapy. If sex has been painful for some time, you might have a negative emotional response to sexual stimulation even after treatment.
  • Duchesnay Usa Maker Of Osphena Applauds Expanded Coverage For Treatments For Dyspareunia Due To Menopause Under Medicare Part D

    ROSEMONT, PA, /PRNewswire/ Duchesnay USA commends the clarification by the Centers for Medicare and Medicaid Services of the statutory intent of Prescription Drug Benefits Section 1860D-2 of the Social Security Act. In its statement, the CMS confirmed that drugs indicated for the treatment of moderate to severe dyspareunia due to menopause are not excluded from Medicare Part D coverage when prescribed in a manner consistent with this labeling.

    Dyspareunia is a common postmenopausal condition, with as many as one in three postmenopausal women experiencing pain during intercourse. It is a chronic and progressive medical condition brought about by the decrease in estrogen levels in menopause causing changes in the vaginal tissues. These changes can lead to a medical condition called vulvar and vaginal atrophy , a component of genitourinary syndrome of menopause , which can lead to painful sex. Left untreated, dyspareunia due to menopause may worsen.

    This is an important step towards helping postmenopausal women access newer FDA-approved therapies that are both safe and effective, said Graziella Soulban, Senior Director, Medical Affairs at Duchesnay. We are working with plan sponsors to increase access to additional treatments for women suffering from moderate to severe dyspareunia due to menopause.

    For more information, including full Prescribing Information and Boxed Warning, visit osphena.com.

    WARNING: ENDOMETRIAL CANCER AND CARDIOVASCULAR DISORDERS

    What Tests Are Done To Diagnose Dyspareunia

    To locate the source of the pain and diagnose any medical conditions, healthcare providers may perform the following:

    • Physical exam: This examination could include a pelvic exam, rectal exam and Pap test. Your healthcare provider may also collect a sample of vaginal fluid and urine to test for signs of infection.
    • Ultrasounds: Transvaginal ultrasound can get a better view of the female reproductive system.
    • Laparoscopy: In rare cases, laparoscopy is used if other tests are inconclusive.

    Read Also: Is Dizziness A Symptom Of Menopause

    How Do I Manage Symptoms Of Dyspareunia

    There are some things you can do on your own to manage the pain you feel during or after sex:

    • Use a water- or silicone-based lubricant to help with vaginal dryness.
    • Try sexual activities or positions that do not cause pain.
    • Take over-the-counter pain reliever before sex.
    • Find time to relax and de-stress before having sex.
    • Apply ice packs to the vulva after sexual intercourse.

    What Questions Should I Ask My Doctor

    Dyspareunia

    Painful sexual intercourse can be physically and emotionally difficult. Some questions you may ask your healthcare provider are:

    • What is causing my pain?
    • What treatments are available?
    • Is there anything I can do to decrease my pain?
    • How long will it take to feel better?

    A note from Cleveland Clinic:

    Pain during sex can lead to physical discomfort, emotional distress and loss of intimacy. If having sex hurts you, contact your healthcare provider. Do not feel embarrassed to discuss your symptoms. Treating the problem can help your sex life, intimacy and confidence.

    Last reviewed by a Cleveland Clinic medical professional on 10/14/2021.

    References

    Read Also: Are Sweet Potatoes Good For Menopause

    Vulvovaginal Symptoms Resulting From Declining Endogenous Estrogen

    With the decrease in endogenous production of estrogen as a result of menopause, either natural or surgically induced, tissues can become atrophic. Estradiol, the primary form of estrogen produced by a womans ovary during her reproductive years, plays an essential role in maintaining the elasticity and health of her genital tissues. Declining levels increase tissue fragility and the risk for vaginal and urinary infections, irritation, dryness, urogenital pain, and the probability of vaginal tissue trauma., Atrophic vulvovaginitis is characterized by genital mucosa that has compromised elasticity, decreased moisture, and compromised integrity as well as tissue erythema and inflammation.,

    It does not take long for the effects of estrogen insufficiency to surface, symptoms often occurring within 12 months of the cessation of menstruation, either as a result of natural or surgical menopause. These symptoms also re-occur within 12 months of discontinuation of postmenopausal hormone therapy. Atrophy associated dyspareunia is often associated with the sexual distress and other complaints of sexual dysfunction., Reactive lowered desire is common as well as direct impact on the marital relationship.

    lists the estrogen-deficient atrophic changes that results from tissue that cannot remain lubricated. This tissue is at risk for damage during sexual penetration or intercourse and therefore may lead to dyspareunia.,,,,

    Managing Postmenopausal Dyspareunia: An Update

    Faculty:

    Susan Hostetter, PhD, WHNP-BC, FAANP, is a professor at Saint Louis University School of Medicine, Department of Obstetrics, Gynecology & Womens Health, Division of Uro-Gynecology, in St. Louis, Missouri.

    Intended audience: This continuing education activity has been designed to meet the educational needs of nurse practitioners who provide care for menopausal and postmenopausal women.

    CE approval period: Now through June 30, 2019 Estimated time to complete this activity: 1 hour CE approval hours: 1.0 contact hour of CE credit and 1.0 con-tact hour of Pharmacology credit

    Goal statement: To initiate the conversation with patients about genitourinary syndrome of menopause and postmenopausal dyspareunia so that the problem can be identified and treated according to each womans needs, desires, and preferenceswith the goal of improving her quality of life.

    Needs assessment: This activity for Womens Healthcare is based on a CE presentation developed by the NPWH Education Committee and presented at the NPWH annual conference held in Seattle, Washington, in October 2017. In this article on managing postmenopausal dyspareunia, the author guides womens healthcare providers in starting the conversation to identify the problem, performing an evaluation to confirm the presence of an underlying causemost likely GSMand implementing an individually tailored approach to diminish both the GSM symptoms and the resulting dyspareunia.

    Recommended Reading: Can A Woman Lactate After Menopause

    Who Gets Dyspareunia When Does It Occur For Women

    Postpartum dyspareunia is common, though not widely talked about. It is often the result of overactive pelvic floor muscles after delivery. During a vaginal delivery, the pelvic floor must both stretch and contract during the pushing phase. After delivery, the pelvic floor can fatigue and go into spasm, similar to a hamstring cramp during a marathon. Often, a new mom won’t realize that her pelvic floor is tight or in spasm until she is cleared for intercourse after 6 weeks. Imagine not knowing you have a hamstring cramp for 6 weeks, and then trying to run another marathon.

    Dyspeurenia can also be caused by inadequate lubrication in the vagina due to estrogen deficiency. During breastfeeding, estrogen levels are low, which can lead to dryness and pain with penetration. Estrogen levels are also affected in women using oral contraceptives. Dyspareunia can be a side effect of oral birth control in women with no previous history of pregnancy, delivery, or pain.

    Dyspeurenia can also be the result of painful scar tissue and delayed healing after a vaginal delivery, particularly if you underwent an episiotomy or had perineal tearing. Other causes include chronic UTIs, repeated yeast infections, STIs, endometriosis, or skin disorders.

    How Is Dyspareunia Treated

    Lisa’s Story – Moderate to Severe Painful Intercourse Due To Menopause: You’re not Alone!

    Some treatments for sexual pain do not require medical intervention. For example, in the case of painful intercourse after pregnancy, wait at least six weeks after childbirth before attempting intercourse. Make sure to practice gentleness and patience. In cases in which there is vaginal dryness or a lack of lubrication, try water-based lubricants.

    Some treatments for sexual pain do require prescription medication. If vaginal dryness is due to menopause, ask your healthcare provider about estrogen creams, tablets, rings or other medications. Other causes of painful intercourse also may require prescription medications.

    For cases of sexual pain in which there is no underlying medical cause, sexual therapy might be helpful. Some individuals may need to resolve guilt, inner conflicts regarding sex or feelings regarding past abuse.

    Also Check: Is Lightheadedness A Symptom Of Menopause

    Treatment Options For Vaginal Dryness

    There are several topical estrogen therapies to replace estrogen in your genital area to aid in the production of vaginal lubricants. Replens is a vaginal moisturizer used to address vaginal dryness. Replens was as effective as a local estrogen cream in alleviating pain during intercourse in postmenopausal women with vaginal dryness.

    There is also a new technology available in the United States called Mona Lisa Touch, which is a drug-free alternative to solving this common problem.

    The Mona Lisa Touch a quick, painless laser procedure that delivers controlled energy to the vaginal tissue. It stimulates collagen production and is safe for those who are unable to use hormones. The full treatment requires 3 visits, 6 weeks apart, and takes less than 5 minutes per visit. No anesthesia or pain medication is needed.

    Another possible treatment option is the recently FDA-approved medication, Osphena. This drug has some of the same effects as estrogen in producing vaginal lubrication, but it does not carry the same risks for patients with histories of endometrial or breast cancers. The Food and Drug Administration approved the drug ospemifene to treat moderate to severe dyspareunia in women who have problems with vaginal lubrication.

    Another drug to relieve painful intercourse is prasterone . Its a capsule you place inside the vagina daily.

    Hormone therapy may be another option to address fluctuating estrogen levels during this stage of your life.

    Commit To Regular Sex

    When you don’t have regular sex, especially after menopause, your vagina can change shape. It may become smaller, making penetration painful even if you’re aroused. One way effective treatment is regular sex. While this may not seem logical, you’ll start to see that your vaginal lining has gained elasticity, and you’re able to handle longer and deeper thrusting. If you are not in a sexual relationship, vaginal dilating can help to keep things relaxed.

    Also Check: Menopause Light Headed

    Alternative Management Tips For Dyspareunia

    Alternative treatments can also be a useful way to manage dyspareunia. These treatments will not tackle the hormonal cause behind most women’s sexual discomfort, but they are effective in helping the woman overcome physical discomfort and relationship stress. Alternative treatments include desensitization therapy, couple counseling, and cognitive behavior therapy.

    While these measures often help women learn how to better manage and prevent the initial onslaught of dyspareunia, they do not directly target the underlying cause of many women’s dyspareunia, hormonal imbalance. However, there are several natural dyspareunia treatments that can help bring reproductive hormones back to healthy levels.

    When Should I Contact My Doctor

    Female Dyspareunia

    Contact your healthcare provider if there are symptoms such as new or worsening pain during sex, bleeding, genital lesions, irregular periods, vaginal discharge or involuntary vaginal muscle contractions. For pain with no underlying medical cause, ask for a referral to a certified sex counselor or therapist.

    Read Also: Heightened Sense Of Smell Perimenopause

    Annual Well Woman Visit

    Annual check ups are an integral part of maintaining your overall health. At Conejo Women’s Medical Center we have quick and easy annual exams. These include pelvic exams, breast checks, colorectal screening and routine labwork.

    This is a yearly exam that covers important screenings, evaluations, and immunization information based on one’s age and individual risk factors. A complete physical examination is performed, including discussion regarding maintaining a healthy lifestyle and minimizing health risks. Appropriate laboratory and radiologic testing is ordered as needed. Prescriptions and treatment are offered as indicated.

    How Do I Talk To My Doctor About Painful Sex

    Talk openly with your healthcare provider about any pain during sexual intercourse. Some questions your healthcare provider may ask you are:

    • Where is the pain occurring?
    • How often does the pain occur?
    • How long have you been having painful intercourse?
    • What does the pain feel like?
    • What medications are you taking?
    • Have you had any prior surgeries in the area?
    • Have you been treated for any conditions of the vagina?

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    How Your Doctor Can Help

    Don’t be shy about getting help. And don’t think sexual pain is just part of menopause. Sex should never hurt. Get an exam to help pinpoint the cause. This will help steer you to the right treatment.

    If the pain is due to menopause:

    • Your doctor may prescribe low-dose estrogen to ease vaginal dryness. Three types — a cream, tablet, and ring — go right into your vagina.
    • Estrogen-like pills may also be an option. They act like estrogen in your body to treat painful sex and help improve some vaginal tissue changes that come with menopause.

    If the pain is due to something else:

    Physical Causes: Entry Pain

    Vaginal dryness: What you need to know

    Entry pain may be associated with vaginal dryness, vaginismus, genital injury, and others.

    Vaginal dryness: During sexual arousal, glands at the entrance of the vagina secrete fluids to aid intercourse. Too little fluid can lead to painful intercourse.

    Inadequate lubrication can arise from:

    Vaginismus: The involuntary contraction of the pelvic floor muscles causes vaginismus, leading to painful sexual intercourse.

    Women with vaginismus may also experience difficulty with gynecological examinations and tampon insertion.

    There are several forms of vaginismus. Symptoms vary between individuals and range from mild to severe. It can be caused by medical factors, emotional factors, or both.

    Genital injury: Any trauma to the genital region can lead to dyspareunia. Examples include female genital mutilation , pelvic surgery, or injury arising from an accident.

    Painful intercourse is also common after childbirth. Some research suggests 45 percent of participants experienced postpartum dyspareunia.

    Inflammation or infection: Inflammation around the vaginal opening is called vulvar vestibulitis. This can cause dyspareunia. Vaginal yeast infections, urinary tract infections, or sexually transmitted infections can also lead to painful intercourse.

    Irritation or allergic reactions to clothing, laundry detergents, or personal hygiene products may also cause pain.

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    Dyspareunia In Postmenopausal Women: A Critical Review

    Alina Kao

    1Department of Psychology, McGill University, Montreal, Quebec, Canada

    2Department of Psychology, Sex and Couple Therapy Service, McGill University Health Centre , Montreal, Quebec, Canada

    3Department of Obstetrics and Gynecology, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec, Canada

    Abstract

    Copyright

    Copyright © 2008 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

    More related articles

    How Long Does It Take To Recover From Dyspareunia

    The recovery time for dyspareunia varies depending on the underlying cause for the pain you feel during sex. The good news is that you can find relief and recover from painful sex. Whether it is medication, counseling, surgery or using lubricationyour healthcare provider can find a treatment that can improve or eliminate dyspareunia.

    Recommended Reading: Are More Frequent Periods A Sign Of Menopause

    Da Vinci Robotic Surgery

    If the need arises Conejo Women’s Medical Center is able to provide da Vinci trained surgeons for your surgical needs. Using minimally invasive techniques you will have a quicker recovery time, and less time in the hospital.

    Dr. McMurray is a certified Robotic surgeon who offers minimally invasive surgery for multiple Gynecologic conditions such as, pelvic pain, fibroids, abnormal bleeding, ovarian masses, and endometriosis.

    Painful Sex After Menopause: Causes And Treatments

    Home Remedies and Treatments for Dyspareunia in Post ...

    As your periods become more erratic and then stop, youll see a number of changes in your body and health. Although every woman is different, symptoms like hot flashes, mood changes, trouble sleeping, and weight gain are normal during this time.

    Between 25 and 45 percent of postmenopausal women say they have pain during sex. When sex hurts, you may avoid it, which could affect your relationship.

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    How Small Is Too Small For A Man

    Micropenis: When a Penis Really Is Too Small According to Palmers statistics, an SPL of three and two-thirds inches or less indicates a micropenis. Even then, U.S. doctors hesitate to recommend surgery for a man whose SPL is longer than three inches. Thats because surgery is controversial and risky.

    Alternative Medicine For Dyspareunia

    Alternative medicines and supplements generally involve little to no risk and can be an extremely effective for preventing and treating dyspareunia in its entirety, depending on the initial cause. In the case of herbal supplements, there are two main types to take into consideration: phytoestrogenic and hormone-regulating herbal supplements.

    Phytoestrogenic herbal supplements

    Similar to the phytoestrogenic foods, these supplements, such as chaste berry, contain estrogenic components produced by plants that help regulate hormones. By taking plant-based estrogens, women can maintain higher estrogen levels to prevent or stop dyspareunia. Sufficient amounts of estrogen will maintain the elasticity and health of genital tissues by also providing adequate vaginal lubrication.

    Hormone-regulating herbal supplements

    These non-estrogenic supplements, including Macafem, stimulate the endocrine system and treat underlying hormonal imbalances. By stimulating natural hormone production, these supplements promote healthy estrogen levels to ultimately prevent or stop the effects of dyspareunia. They can be taken throughout a woman’s life as they trigger natural hormonal development instead of artificial replacement.

    Additionally, there are other types of supplements that promote a healthy hormonal balance, including soy protein.

    Recommended Reading: How To Increase Breast Size After Menopause

    Who Should Not Take Osphena

    Osphena should not be used if you have unusual vaginal bleeding, have or have had certain types of cancers, have or have had blood clots, had a stroke or heart attack, have severe liver problems, are allergic to Osphena or any of its ingredients, or think you may be pregnant. Tell your healthcare provider if you are going to have surgery or will be on bed rest.

    Management Of Postmenopausal Dyspareunia

    Sexual Disorders – Vaginismus – Dyspareunia

    Goals of management are to relieve GSM symptoms, facilitate sexual activity according to the womans desires, and improve quality of life. In all cases, a womans specific preferences determine the goals.

    Initial treatment

    For some women, the source of dyspareunia may be as simple as irritation resulting from use of perfumed soaps. Therefore, the first stepfor these women and, in fact, for nearly all womenis to implement a protective skin-care routine. Women should use fragrance-free, hypoallergenic products and avoid use of potential irritants, including feminine washes, perineal wipes, and even certain types of toilet paper.

    If irritant avoidance is insufficient in resolving dyspareunia and a woman wants to continue or resume sexual activitywhich itself has vulvovaginal health-promoting effectsshe has several inexpensive options that are available on grocery store and drugstore shelves or on Internet websites. For example, she can try using a lubricant immediately before and/or during sex. Lubricants, the effects of which are temporary, reduce vaginal tissue irritation due to friction. OTC lubricants are available in oil-, water-, and silicone-based liquid or gel formulations. Although these products are generally safe, the woman should be advised that some of them contain ingredients that may themselves induce dermatologic reactions.

    Hormonal treatments

    Vaginal estrogen therapy

    Ospemifene

    Prasterone

    Other treatment options

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