Painful Sex During Menopause

>> Thursday, February 19, 2015

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This week’s question comes from a reader who is experiencing many problems as she goes through menopause. And like many of you, she has begun to experience some of the long-term side effects of hormone imbalance that go way beyond hot flashes, night sweats and irregular menstrual cycles.

Q: Since I started menopause sex has become more and more painful. Is there anything I can do to make it better?

I love this question. Why? Because it illustrates that menopause makes such an impact on a woman's life that it can even affect the way she experiences intimacy. Some women may go from enjoying an active, loving sexual relationship with their partners, to wanting to avoid sex altogether. This can be frustrating, as it puts strain on relationships, and can be scary as women wonder if there is any hope of restoring what they once had. The answer to this, of course, is yes, but it is important to try to stay positive and share what you're going through with your partner. No one said it would be easy, but if other women have survived this journey, I know you will too.

During menopause, as the levels of hormones drop, it causes the tissues of the vagina to thin significantly and become very dry due to lack of normal lubrication. It is the combined effect of these changes that eventually causes shrinkage of the vagina, and the loss of its ability to stretch.

During the excitement phase of intercourse, the normal response is an increase in vaginal moisture. This enables the erect penis to enter the vagina without difficulty, and the normal elasticity allows a pleasant stretching sensation as the man enters. However, in menopause this elasticity/stretchability is absent, as is the normal lubrication, so after penetration there is no moisture. That is why so many women experience intense burning pain - it is caused from the thrusting motion without lubrication.

The use of vaginal lubricants can help a little bit. Always choose water soluble lubricants rather than lotion, creams or oils, as these can cause vaginal infections. The best thing to do is make an appointment with your doctor to discuss this problem and make sure (through blood tests and exams) that there are no other problems going on. Because the tissues are hormone deficient, it is important to get on a good program of hormone replacement. Women have so many choices today, from traditional estrogen vaginal cream to forms like Bio Identical hormones from compounding pharmacies. After about 4-6 weeks on hormone replacement, you will start to notice the healing and restoration of the vaginal tissues back to pre-menopausal status.

Menopause can be a rough time, but if you work with your doctor and are open to share with your partner, sex can be enjoyed for a lifetime.
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