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.
How Can You Prevent Dyspareunia Occurring
To prevent painful sex depends on the potential cause. There are things you can do to help prevent some causes of painful sex including:
- Increase foreplay to increase natural lubrication
- Use oestrogen preparations if you are postmenopausal and it is appropriate
- Use water-based lubricants, or olive oil
- Practise safe sex to prevent the STIs which may cause dyspareunia
Painful Sex After Menopause: Causes And Treatments
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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Pain May Be Caused By Surgical Menopause
After your body has fully healed from a hysterectomy, its still possible for you to experience painful sexparticularly if the procedure involved removing your ovaries. Removing the ovaries creates a sudden drop in estrogen levels in the body and sends you directly into what is known as surgical menopause.
In addition to commonly-discussed symptoms like hot flashes, mood swings, and night sweats, menopause also marks the beginning of vaginal atrophy, or atrophic vaginitis. Atrophy means muscles and tissues of your pelvic area get thinner and weaker due to surgical menopause, causing side effects like incontinence and uncomfortable sex. Many women also struggle with vaginal dryness during menopause, which can make sex more painful.
Menopause is the most significant hormonal shift in a womans body, aside from puberty and pregnancy. It brings about major bodily changes and can involve a significant amount of stress, embarrassment, and discomfort even when it occurs naturally. Undergoing menopause suddenly and at a younger age than expected can be quite a shock. We know that psychological factors like these have a great deal of influence on sexual function, and its possible that the difficult emotions associated with surgical menopause might be contributing to the pain you experience during sex. The good news is that there are a wide variety of treatment options available to you, should your menopause symptoms become unacceptably disruptive.
Sex Isnt Supposed To Hurt
Jennifer T. Anger, MD
Just because painful sex is very common, that doesnt mean you should accept it as “normal.” The occasional minor soreness may be nothing to worry about, but you shouldnt be dealing with intense chronic pain.
Sex should be a pleasurable experience, and if its not, speak up to your partnerand your doctor, Dr. Anger says.
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How Does Menopause Affect Sexual Function In Women
Just as every women experiences menopause differently, women may or may not experience changes in sexual function after menopause. Since estrogen levels are lower after menopause, some women may notice that their libido, or sex drive, is decreased. Low estrogen levels can also lead to a decreased blood flow to the vagina, resulting in difficulty with lubrication or in dryness which that can make sexual intercourse less pleasant and painful for many women.
Not all women report negative changes in sexual function after menopause. For example, some women may find sex to be more pleasurable without the fear of unwanted pregnancy or without the potential stresses of having small children.
Other Conditions That Cause Pain
Pain during sex isnt always due to atrophy. It could also be a sign of these conditions:
Vestibulodynia. The vestibule is the area where the vulva the outer parts of the vagina including the clitoris, clitoral hood, and labia connects with the vagina. In some women, the vestibule becomes very sensitive to touch. Having sex or inserting a tampon is very painful. Doctors can treat this condition with local anesthetic creams or gels, physical therapy, and mental health counseling.
Vulvodynia. This condition causes pain or burning in the vulva without any obvious cause. About 60 percent of women with vulvodynia are unable to have sex because of the pain. Treatments include topical anesthetics, physical therapy, and mental health counseling.
Vaginismus. In this condition, the muscles around the vagina contract painfully during sex, or whenever something is inserted into the vagina. It may be triggered by fear after a traumatic experience. Treatments include a dilator to widen and relax the vagina and physical therapy.
Cystitis. Bladder inflammation can cause pain during sex because the bladder sits right on top of the vagina. At least 90 percent of people interviewed by the International Cystitis Association said interstitial cystitis negatively affected their sex life. Treatments for cystitis include medication, nerve blocks, and physical therapy. Relaxation techniques, heat, or cold may also help relieve discomfort.
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Whats Happening In A Woman’s Body
GSM is associated with a decrease in estrogen and other sex steroid hormones and may include genital dryness, burning, irritation, lack of lubrication, discomfort or pain, and urinary symptoms such as frequent nighttime urination or pain on urination.
The 2013 Clarifying Vaginal Atrophys Impact on Sex and Relationships survey found that menopausal women with vaginal discomfort were likely to avoid intimacy and experience loss of libido. Thirty-five percent of women with vaginal atrophy said they put off having sex, and 49 percent said it resulted in less satisfying sex.
Falling estrogen levels resulting in dryness and thinning of vaginal tissues can cause intercourse to be uncomfortable for between 17 and 45 percent of postmenopausal women, according to the National Menopause Foundation. Discomfort can range from a tight feeling to severe pain.
The more the tissue is uncomfortable, the more a woman may guard and tighten, said Amy Stein, a New York-based physical therapist who specializes in treating pelvic floor dysfunction. The pelvic floor consists of the muscles, ligaments, tissues and nerves that are like a hammock supporting the bladder, uterus, vagina and rectum.
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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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?
Find A Lubricant You Love
Vaginal dryness is totally treatable, says , MD, clinical professor of ob-gyn at Yale School of Medicine. One option is an over-the-counter vaginal moisturizer designed to be used regularly, say two to three times a week, rather than just before sex. Take a walk down through your local drugstore, and you’ll see many different brands.
Then when you’re ready to hit the bedroom, apply a water- or silicone-based lubricant intended to be used in the moment, so you get even more of an assist. If you’ve never checked out lubricants before, you’ll be amazed at all the varieties, including natural, additive-free versions and some that come in single-use packets for a quickie on the go.
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Menopause Can Have Mental And Emotional Effects Too
Most people dont like their period, but when it goes away you feel your age, Dr. Rowen tells SELF. For some people, the idea of losing their period can be psychologically distressing.And as we mentioned, your hormones, specifically estrogen and progesterone, change during menopause. And this change may cause feelings of anxiety and depression. Lower estrogen can also trigger hot flashes that make it difficult to sleep, leading to mood swings and anxiety. Coupled with any emotional distress from losing your period, and you understandably may not be in the mood to have sex. If you feel down for more than two weeks, you may be depressed and want to speak with a therapist, the Cleveland Clinic recommends. However, finding a therapist can be a long, and often stressful, process. . Generally, you will want to start by asking your insurance company for a list of providers. If you dont have insurance, websites like Open Path include therapists who offer reduced-fee sessions.
Painful Sex And The Menopause
After menopause, up to half of all women have pain before, during, or after sex. And sex after menopause doesnt get talked about often. And yet, contrary to what some people may think, women do continue to be sexual beings as they age.
According to a survey presented at the North American Menopause Society, almost half of women believe that its normal for sexual function to decline after menopause, and only about a third had ever tried to get help correcting the menopause symptoms that were interfering with their sex lives.
A survey suggests that 84% of menopausal women find sex painful. In the survey, nearly 70% said their relationships had suffered as a result. A whopping 81% percent didnt know that vaginal atrophy or age-related vaginal drynessa common issue for many menopausal womenis a medical condition.
Why does vaginal dryness happen during perimenopause or menopause?
Bladder and urinary problems
Another common problem is bladder or urinary symptoms often recurrent cystitis or recurrent urinary tract infections . It might just be feeling a need to void more frequently, or getting up more during the night. Theres also a higher incidence of thrush and other vaginal infections like BV .
Hormones are important great sex
Top tips to help with vaginal dryness
its worth trying self-help options in the first instance. There are a variety of ways to relieve vaginal dryness and thus make sex easier and more pleasant:
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Dealing With Sexual Pain After Menopause
Local estrogen and lubricants may help.For many women, menopause brings with it the onset of sexual pain. This wasn’t much of an issue in the past when women didnt live so long. “In 1900, the average woman died at 51 years of age,” says sexual medicine specialist Andrew Goldstein, MD, an associate professor at George Washington University.
Treat it with estrogen?The natural drop in estrogen causes the vagina to become drier and the tissues to become thinner, a situation that can cause pain during penetration. Using lubricants can help, but estrogen helps some women more.
Many women are concerned about taking estrogen orallyhormone replacement therapy or HRTafter a 2002 study suggested a strong link to breast cancer, but doctors have widely divergent opinions about that. Some found the study was flawed and believe that with the proper variety and dosage of hormones, the risk should be small. But a study published in 2007 suggests the decline in breast cancer since 2003 correlates to a decline in oral HRT prescriptions.
She Lost Interest in Sex, Then It Began to Hurt
Doctors and decades later, Lillian blames menopause for her sexual pain Read moreMore about sexual pain
Treatment Solutions For Sexual Discomfort
Finding the right solution for sex-related pain depends on its underlying cause. If that cause isnt readily apparent, a more exhaustive investigation can often reveal the reason for persistent discomfort.
In addition to performing a comprehensive physical exam, including a pelvic exam, we ask about your medical history to find out if you have any conditions or take any medications that may obstruct your normal sexual response. We also ask about your sexual history, to find out if any events in your past affect how you feel about sex.
Effective treatment for one woman may simply mean changing a prescription medication that interferes with natural lubrication, while a woman whos living with the aftereffects of an episiotomy or perineum tear from a recent childbirth may get the best results from physical therapy or surgery.
Hormone replacement therapy , or the supplementation of reproductive hormones that your body no longer makes, has long been the go-to treatment option for menopausal women affected by vaginal dryness and sexual pain.
Although HRT in the form of low-dose topical vaginal estrogen can be highly effective for some women, its a short-term solution that isnt medically appropriate for all women.
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Conditions That Can Cause Painful Intercourse
- Vaginal dryness
- Vulvodynia, a condition that causes stinging, burning, and irritation in any area of the vulva
- Vulvar vestibulitis, which refers to the narrowing and thinning of the vaginal walls
- Physical abnormalities like pelvic floor dysfunction, cysts, or growths
- Bacterial infections, such as vaginitis
Causes And Solutions For Painful Intercourse
Sexual intimacy is meant to be an enjoyable experience that draws you and your partner closer together. But when sex becomes painful, you may find yourself doing anything and everything just to avoid it.
While theres no doubt that painful intercourse can have a major impact on your life and your relationship with your partner, its nothing to agonize over or feel embarrassed about. This fairly common problem three in four women experience pain during sex at some point in their lives can usually be resolved with the right approach.
Here at Womens Healthcare of Princeton in Princeton, New Jersey, weve helped many women overcome painful intercourse and restore their sexual health, and were confident that we can help you, too.
What Causes Pain During Intercourse After Menopause
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.
Bring In The Cavalry For Symptoms Support
Part of this journey includes changing the narrative of how we traditionally thought of menopause. You may need more than one professionals help, more than one treatment, and more understanding. Menopause isnt just physical changes.
Psychological symptoms, such as anxiety, stress, and depression, can also happen. These changes can affect sexual intercourse and sexual desire.
Theres a plethora of therapies, medications, and resources for women in menopause that can address the sense of losing femininity and sexual attractiveness. Engaging in mind-body activities can help relieve those symptoms that interfere with sexual intimacy, desire, and even sleep quality. These include:
Theres no one answer to approaching menopause. It requires many approaches, and often itll take some time to find the right therapy and lifestyle change.
Stress relief techniques should be explored extensively as well. They can also improve sexual intimacy, stimulation, and feeling more comfortable with sexual activity after menopause.
The Physiology Of Sex After Menopause
You might be familiar with the stereotype of menopausal women portrayed in the mediacrotchety, dried-up, and sexless after menopause. And yeah, your body is changing and this change comes with side effects, but you dont suddenly have a vagina-less Barbie body. Sex is still a basic part of your human experience and you can still enjoy it.
However, its best to just come out and say it: menopause will change your sex life. There are several reasons why:
- Vaginal atrophy. During menopause your body halts estrogen production. A decrease in estrogen can lead to vaginal atrophy, which the Mayo Clinic defines as thinning, drying and inflammation of the vaginal walls. While that sounds scary, dont worry, there are treatments available. But before we go further its important to note that vaginal atrophy doesnt just affect your vaginal canal. It can also come with symptoms like recurring UTIs, burning when you urinate, and an urgency to urinate. In short, vaginal atrophy affects everything about your vulva, and not just the parts you use for sex. Its normal, and you shouldnt be embarrassed or ashamed. Most menopausal people have some of these issues!