What Is Genitourinary Syndrome Of Menopause
This is a fancy term used to describe the vaginal symptoms some people experience during menopause. The vulva and the vagina become thin and dry, causing burning, irritation, vaginal discharge, and pain or soreness with sex. Because your bladder and urethra also respond to low estrogen, you may also experience symptoms like pain with urination, frequency of urination, or more frequent urinary infections. Because all of these symptoms may go hand-in-hand, genitourinary syndrome of menopause or GSM seems to be a more inclusive term.
Why Does Sex Hurt After Menopause
Post-menopausal intercourse pain is due to the decrease in the bodys estrogen levels. Estrogen is responsible for the normal functioning of your reproductive organs, including the vagina. The hormone stimulates the release of natural lubricants and usually stimulates the repair of damaged cells in your vaginal lining.
Without your bodys normal production of estrogen, you may notice vaginal dryness, laxity, burning, pain, and itching. For many women, those symptoms amplify with sexual intercourse. Altogether, these symptoms represent a condition called vaginal atrophy.
Whats more, is that sexual activity encourages blood flow to the vagina. If you avoid sex, you may experience even more tissue thinning and pain.
Risk Factors And Etiology
In the past decade, the literature concerning the causes of pre-menopausal dyspareunia has rapidly grown. Numerous etiological and maintaining mechanisms, both organic and psychological, have been proposed . However, this growth in the premenopausal etiological literature has not carried over to postmenopausal dyspareunia. Comparable dyspareunic pain occurring during or after the menopausal transition has almost unanimously been attributed to aging, decreased estrogen levels in the genital tract, and resulting vaginal dryness and atrophy . Related to these changes, decreased sexual arousal and lack of lubrication are other proposed mechanisms responsible for pain during intercourse .
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Gsm And Sex After Menopause
Genitourinary syndrome of menopause is a collective name that refers to the urinary tract and vaginal problems women experience when they are going through menopause or are postmenopausal. GSM symptoms can include pain during sex, bladder control issues, the urgency to urinate and a lack of lubrication. Researchers recently examined the prevalence of GSM and how it affects the ability of women to enjoy sex.
Dr. Amanda Clark and a team of researchers surveyed over 1,500 women over the age of 55 between March and October 2015. Most of the women were white and 48 percent reported no sexual activity in the six months leading up to the study. The results of the study were presented at the North American Menopause Society annual meeting.
Within two weeks of a visit to a gynecologist or primary care doctor, the researchers approached the women after selecting them as participants using digital health records. The survey asked women about their history of urinary, sexual and vulvovaginal symptoms. The questionnaire was compiled for the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire with questions the researchers specifically designed.
How To Relieve Painful Sex After Menopause: Monalisa Touch
You have many options for relieving painful sex, including lubricants, moisturizers, hormone therapy, and more. But the providers at Suncoast Womens Care truly believe in the power of one special treatment: MonaLisa Touch.
MonaLisa Touch is a gentle, noninvasive treatment that can improve vaginal symptoms after menopause, including pain, laxity, and dryness. The fractional CO2 laser delivers energy to your vaginal tissue, stimulating your bodys natural healing processes. The laser energy also helps your body produce new cells and increase the production of collagen and elastin, two important components of healthy vaginal tissue.
The procedure is quick, with most sessions taking no longer than five minutes. You also wont endure any downtime, so you can return to your normal daily activities as soon as youre through. You should, however, abstain from sex for a day or two after your treatment. Some patients experience minor sensitivity or swelling after MonaLisa Touch and prefer to wait until it subsides. \You may notice improvements after just one session, but most patients return for a few sessions, each spaced out by about six weeks.
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Let Yourself Experiment Sexually
Lets state the obvious: None of the most common menopause symptoms, from hot flashes to night sweats to fatigue and occasional incontinence, sets you to up to feel desirable. Before these side effects take a toll on your self esteem, talk to your doctor about ways to manage them.
Just come in right away, says Dr. Valle. As time goes on, some problems can get worse and worse.
Realize, too, that you may have to work a little harder than usual to get out of your funk and in the mood. That means more foreplay, watching porn , trying out sex toysor just learning to relax.
Dont think your sex life ends once you go through menopause, assures Valle. I know an 80-year-old woman who still has sex with her partner. Its a different stage of life, but a good sex life is still possible.
Womens Wellness: Painful Sex After Menopause
DEAR MAYO CLINIC: I am in my late 50s and have recently found that sex is becoming quite uncomfortable. I am assuming this is because Im past menopause, but whats the best way to make sex less painful?
ANSWER:Dyspareunia, the term for painful vaginal sex, is quite common. Estimates vary, but surveys of postmenopausal women not on hormone therapy report dyspareunia in as many as 20 to 30 percent. Its often divided into three categories: superficial pain, deep pain or both. Most women complain of superficial pain, which occurs upon vaginal penetration. Often, the pain has a sharp or burning quality. Deep pain occurs with deep penetration or thrusting. For some women, dyspareunia is temporary. For others, it can become chronic.
After menopause, painful intercourse often is associated with changes due to decreased estrogen levels. The vaginal tissues tend to become less elastic, more fragile, and more susceptible to bleeding, tearing or pain during sexual activity or during a pelvic exam. It can make sex painful or even impossible. The loss of estrogen can cause urinary problems, which also can make sex uncomfortable. Lack of sexual activity contributes to loss of tissue health and elasticity.
There also are a number of other treatment options. Vaginal lubricants help decrease pain during sex and can be applied as often as needed. Keep in mind that oil-based lubricants may degrade condoms. Vaginal moisturizers used every two to three days can help maintain vaginal moisture.
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Common Questions About Treatment Options
I have a history of breast cancer, Am I able to use any treatments?
If you have had breast cancer, you should talk to your healthcare provider. It is safe to use lubricant and moisturizers. If these dont work, there is a possibility you could use other treatments, but this should only be done in consultation with your oncologist.
How about herbal remedies and soy products to treat my vaginal symptoms and pain with sex?
We do not have enough data or information to support the use of herbal remedies or soy products to treat vaginal symptoms or pain with sex during menopause. Therefore, we cannot recommend these options.
Take Home Points
- Sexual health is a very important part of your overall health.
- Dryness and thinning of the vagina is the most common cause of painful sex at midlife and beyond.
- Be comfortable discussing these matters with both your partner and healthcare provider. Remember, this is totally appropriate conversation to have.
- There are a number of safe and effective treatments options to help you get better and improve your quality of life.
Painful Sex After Menopause Is Common And Treatable From The Harvard Womens Health Watch
Millions of women experience pain before, during, or after sexual intercoursea medical condition called dyspareunia. This common problem can sap sexual desire and pleasure, strain relationships, and erode a womans quality of life. For postmenopausal women, in particular, it can bring up issues of aging and body image. Many women suffer in silence because theyre embarrassed or cant find a doctor who specializes in problems of this nature. The May 2012 issue of the Harvard Womens Health Watch describes how dyspareunia can be treated, and guides women to get the help they need.
Painful intercourse has many possible causes, including hormonal changes, medical and nerve conditions, skin diseases, and emotional problems such as anxiety and depression. Often, several are at work. The decline in estrogen production at menopause can thin vaginal tissue, resulting in dryness, burning, and pain. Another culprit is vestibulodynia, a chronic pain syndrome that causes discomfort with any kind of touch or pressure in the area around the vagina. Psychological factors may be involved, especially in women who associate the vaginal area with fear or injury.
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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:
What You Can Do To Relieve Pain
Try these tips to boost your sexual pleasure:
Go for more glide. Use a lubricant before and after sex to ease pain due to dryness. Silicone and water-based products are both sold over the counter. If one brand bothers your skin, try others.
Moisturize. A vaginal moisturizer can ease dryness over the long term. Use it routinely, not just before sex.
Make time for foreplay. Spending more time getting aroused makes you wetter. Don’t focus just on The Big Act. Take time to caress, have oral sex, or try varied positions. Talk to your partner about what feels good and what doesn’t.
Wash with care. Avoid using soaps, shower gels, bubble bath, and bath oils in the vaginal area. These can dry skin. A warm-water rinse will do the job. Also skip sprays and perfumes. When you’re having problems, wash your underwear in mild soap. Make your undies white cotton, too.
Have more sex. “Use it or lose it” is true when it comes to the health of your sex organs. Being aroused improves blood flow. So when you have sex often, you’re less dry. Self-pleasure can help if other sex acts hurt.
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Is Lube Safe To Go Inside
Lubricants are generally effective for their intended use to provide additional lubrication to vaginal tissue during sexual activity to decrease discomfort. However, vaginal exposure to lubricants can also have toxic side effects long after their use that pose considerable risk to reproductive health.
When To Seek Medical Care For Painful Intercourse
A woman should always consult a health care professional if she is experiencing new or worsening pain, bleeding, or discharge following intercourse.
Pain related to intercourse is a condition most appropriately checked by a primary health care professional or a women’s health specialist . Other specialists, such as a psychiatrist, psychologist or a urologist, may also be consulted depending on the underlying cause.
Pain during intercourse is generally not an emergency. A woman should seek care in a hospital’s emergency department if she experiences any of the following symptoms:
- New onset of pain or pain more severe than previous episodes and that lasts more than just a few minutes
- Bleeding following pain, particularly new onset or severe pain
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Painful Sex And Vaginal Dryness
Sexual intimacy is supposed to be an enjoyable experience that brings you and your partner closer together. But when sex becomes painful, it can have a major impact on your life and your relationship.
An estimated three in four women experience frequent pain during sex at some point in their lives, often the following menopause. Some women only experience pain during penetration, while others experience deep pain with each thrust. In some cases, throbbing or burning pain sensations emerge slowly and continue long after intercourse has ended.
Although a variety of factors can contribute to the development of dyspareunia, the problem is most common during and after menopause, when reproductive hormone imbalances are more likely to interfere with your bodys sexual response, weaken your vaginal tissues, and decrease your normal lubrication.
Hormones And Sex Drive
Sexual desire often wanes with age. Around the late 40s and 50s, many women begin to experience a reduced sex drive. While physical symptoms of menopause can undermine sex drive, hormonal changes also play a role. During menopause, the body stops producing estrogen. Testosterone levels also decrease in women around midlife.
During menopause, the hormones that regulate sex drive, reproduction, mood and more begin to ebb, and these declining levels can negatively impact sexual function and desire. Hormones act as messengers in the body to control a vast array of functions. Three hormones are believed to affect female sexuality to some degree:
- Estrogen: The main female hormone regulates the menstrual cycle, female sex organ development and the lining of the uterus. During perimenopause, estrogen levels begin to drop dramatically. Menopause occurs when estrogen levels are too low for the uterine lining to thicken.
- Testosterone: Women have natural testosterone levels. This hormone is produced by the ovaries to help make estrogen. Testosterone declines naturally with age, especially after menopause. Some studies have suggested higher testosterone levels are associated with greater sexual behavior and desire in women.
- Progesterone: This female hormone supports pregnancy and controls the menstrual cycle along with estrogen. As with estrogen, progesterone levels decline during menopause. It’s believed changing progesterone levels impact female sexual behavior.
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Pain During Sex After Hysterectomy: Why It Happens And How To Treat It
Dyspareunia is a big, intimidating word for something most women dread: experiencing pain during sex. Especially for women who have recently undergone a partial or total hysterectomy, painful sex can be scary and even heartbreaking. Not only is it frustrating, it also causes some women to feel embarrassed or ashamed of their bodies and prevents them from participating in fulfilling sexual relationships. These reactions can make it difficult for women to discuss their symptoms with the doctors who may be able to help relieve their pain.
If you experience pain during sex after hysterectomy, you need to know that having your uterus removed does not inherently impact your sexual function in any permanent way. Research has shown that you dont need a uterus to have a fulfilling and healthy sex life.
However, you also need to know that youre not alone in experiencing pain. Due to recovery time, surgical menopause, and the emotional aftermath of a hysterectomy, many women experience painful sex for a time after this major surgery. But by honoring your bodys healing process and seeking appropriate treatment with your doctor, it is possible to ease back into pain-free sex in a healthy way.
What Medical Treatments Are Available For Painful Intercourse
Treatment of pain during intercourse depends on the cause. Introital pain may be treated when the cause is identified.
With an adequate history, physical examination, and laboratory testing, the doctor should be able to pinpoint the cause of dyspareunia. This will allow for the development of a plan of action that will afford the best possibility of resolution of the pelvic pain syndrome.
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Why Has Intercourse Become Painful After My Hysterectomy
An EmpowHER reader writes: In the months after my hysterectomy and removal of my ovaries, my vagina just stopped lubricating even when I felt sexually excited. So my husband and I went to the drug store and bought some non-prescription lubricant. That did help a bit but I still have pain when we try to start intercourse. The pain is right at the opening of my vagina. Lately, weve been avoiding sex altogether.
Your story is a common one. After a womans ovaries are removed, her estrogen levels are very low. Estrogen has many actions in a womans body including maintaining the cells in glands at the vaginal opening and in the lining of the vagina. When estrogen levels are normal, these cells produce lubricating secretions. The secretions protect the vagina and the tissue surrounding the vaginal opening from infection and irritation. Low estrogen levels lead to a decrease in production of these secretions.
Doc Talk: Why Does It Hurt When I Have Sex
Experiencing pain during sex can seem like a normal occurrence, with nearly 3 out of 4 women saying they have had pain during sex at some point in their lives, according to The American Congress of Obstetricians and Gynecologists . For some women, the pain may only be mild soreness, but for others, the pain can be deep and chronic. Recurring pain during sex is called dyspareunia, it is a medical condition where there is pain or discomfort in a woman’s labial, vaginal, or pelvic areas during or immediately following sex.
While you may be reluctant to share your sexual experiences with your Womens Health Connecticut provider, it is important to speak honestly and openly with your ObGyn if sex is more painful than pleasurable. We spoke with two providers at Womens Health Connecticut Dr. Elisa Benzoni of Specialists in Womens Healthcare and Dr. Gayle Harris of Connecticut Women OB/GYN, to discuss the main causes of painful sex and treatments that can help women experiencing dyspareunia.
What are the causes of painful sex?
Dr. Harris: Common causes include menopause, infections, a history of sexual abuse or assault and musculoskeletal and neurologic conditions.
How can patients address sexual abuse with their doctors and how would you advise them to ease any symptoms they may have?
What is vaginismus and can it cause painful sex?
Painful Sex: Vaginitis and Vulvodynia
What is Vaginitis and how does it cause painful sex?
What is vulvodynia and how can it cause painful sex?
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