Many women experience painful sex after menopause. There are safe and effective treatments for this condition, known as genitourinary syndrome of menopause, or GSM. But studies show that it takes a good percentage of women a long time to find relief, and some don’t get any at all.
“[Painful sex] is highly prevalent and negatively affects sexual intimacy and quality of life, but women are embarrassed to talk about it,” said Dr. JoAnn Pinkerton, executive director of the North American Menopause Society and professor of obstetrics and gynecology at the University of Virginia Health System.
Many Women Wait Before Treatment
The five-nation 2010 Women’s Voices in the Menopause study found that 25 percent of women (and 32 percent of women in the United States) who had been prescribed treatment for their vulvovaginal symptoms had experienced symptoms for at least one year. Five to 11 percent had waited at least three years before seeking treatment.
“Women thought that it was a natural part of aging that they should accept,” Pinkerton said. “We want women to be able to talk to their clinicians about symptoms and we want clinicians to ask women about their symptoms.”
Joan Price, a septuagenarian author of three books on older adult sex, wrote in Better Than I Ever Expected: Straight Talk about Sex After Sixty, “Yes, there are challenges to sex after 60, but there are also creative solutions.”
Many women readers wrote to Price about their personal struggles. They described confronting the dual challenge of having painful sex and of seeing doctors who couldn’t come up with a diagnosis.
“They feel they’re broken,” Price told Next Avenue. She advises women to ask for a referral to a specialist if their doctor cannot help.
“We are sexual beings lifelong. There is no expiration date on our sexual pleasure,” Price said.
What’s 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 Atrophy’s 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.
A Physical Therapy Treatment
Though women may not immediately turn to physical therapy when struggling with painful sex, it may be a useful option.
An “overactive pelvic floor” (which may contribute to conditions such as vulvodynia and vaginismus) can spasm during intercourse, Stein said. “If it keeps going, you could end up with sex becoming a turn-off.” she said. Anxiety may then lead to more tightening. The author of the book, Heal Pelvic Pain, Stein said many physical therapists perform an internal and external exam. They work on alignment, manual therapy for pain and massage to lengthen muscles. They teach women how to use therapeutic wands to release inner trigger points and how to use dilators to open up the vagina.
Stein teaches diaphragmatic (belly) breathing and encourages women to meditate, do yoga, tai chi, or “anything to calm the nervous system down.”
A Domino Effect
Vaginismus and vulvodynia were joined together in 2015 in the DSM-V under the diagnosis genito-pelvic pain/penetration disorder.
“Generally, one leads to the other,” said Sari Cooper, a certified sex therapist in New York.
“One piece that often doesn’t get integrated is the partner,” Cooper said. “Many women feel obligated to have sex with their partner. Sometimes there is a domino effect. The male partner may develop an avoidance tactic because he doesn’t want to hurt his partner or they want to rush through it and he develops an erectile disorder.”
Cooper said it’s important to educate the partner. It may also help to take intercourse off the table while the woman is going through treatment.
“What happens [then] is a beautiful thing. They open up the menu of sexual connection between the couple,” she said.
Other Treatments for Painful Sex After Menopause
Pinkerton suggests women also try the following remedies for painful sex after menopause:
- Treat vaginal tissues with a prescription low-dose vaginal estrogen via cream, suppository or ring. This is minimally absorbed, unlike hormone replacement therapy, which goes into the bloodstream. Pinkerton said labels warning of severe health consequences don’t apply to these local treatments and should be changed because they scare women away, as this editorial explains.
- Use an over-the-counter lubricant or moisturizer at least twice a week to maintain a healthy vaginal pH. Use natural products such as coconut oil or olive oil to moisturize the vulva area.
- Use long-lasting silicone-based lubricants during intercourse.
- With or without a partner, have regular stimulation to increase blood flow to the area.
- Women who have not been sexually active for a while should be patient: It can take up to three months to get back to normal.
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