It’s not uncommon for women to experience painful intercourse at some point in their life, but a new pain can be distressing and harmful to otherwise healthy sex life.
Painful intercourse – or dyspareunia (“dis-pah-ROO-nee-ah”) – is persistent or reoccurring pain in the genitals that can strike just before, during, or immediately after sexual intercourse. Another medical condition is vaginal atrophy (atrophic vaginitis). Vaginal atrophy is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause.
Sexual pain as a category of female sexual dysfunction is relevant at any age; for postmenopausal women dealing with vaginal dryness as a result of estrogen deficiency, it may well be the dominant issue. When determining the cause of a sexual problem in a postmenopausal woman, put dyspareunia caused by vaginal dryness (as well as its psychosocial consequences) at the top of the list of possibilities.
Millions of women experience pain before, during, or after sexual intercourse—a medical condition called dyspareunia. Dyspareunia, a sexual dysfunction, is known to have a variety of causes, both physical and psychological, which is why it is important to visit your women’s health care provider for an examination and diagnosis and to discuss the best treatment options.
Is Painful Intercourse During Menopause Normal?
For many postmenopausal women, dyspareunia is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with topical estrogen applied directly to the vagina. 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 also cause urinary problems.
It’s fairly normal for women going through menopause to experience pain during intercourse. The most likely cause is a lack of lubrication resulting from lower estrogen levels. For those entering perimenopause or menopause, you may experience:
- Pain in a normally pain-free sex life
- Pain at entry (initial vaginal penetration)
- Pain at each instance of penetration, including inserting a tampon
If these symptoms are present, you may be suffering from vaginal dryness, which is often also a symptom of menopause. Over-the-counter lubricants can help make intercourse more comfortable, however, there are other treatments that can provide additional relief.
Why It Happens
At menopause, you’re most likely to have pain from:
- Hormone changes. Dwindling estrogen due to menopause is the No. 1 reason for sex pain at midlife and beyond. Hormone shifts make the tissues in your vagina become thin and dry. Dryness can add friction during sex. Your vagina also stretches less, which makes it feel tight.
- Fear and worry about pain. Once painful sex happens, you may dread its return. Fear can make your muscles tight and add dryness.
- A health problem. Other issues not due to menopause may be at fault, like chronic pain syndrome in the vulva, the area around the entrance to your vagina. Or you may have a urinary tract or yeast infection, or a skin problem. Being stressed or depressed, problems with your partner or past sexual abuse can also make sex painful.
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 (Osphena) to treat moderate to severe dyspareunia in women who have problems with vaginal lubrication.
Ospemifene acts like estrogen on the vaginal lining but doesn’t seem to have estrogen’s potentially harmful effects on the breasts. Drawbacks are that the drug might cause hot flashes, and it carries a risk of stroke, blood clots and cancer of the lining of the uterus (endometrium).
Another drug to relieve painful intercourse is prasterone (Intrarosa). It’s 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.
What Are Some Other Causes for Concern?
Not all causes of dyspareunia are due to menopause. If you’re experiencing:
- Deep pain upon thrusting
- Stinging or burning
- Throbbing pain that persists hours after sex
It may be a red flag of a more serious underlying issue. Please visit your gynecologist to discuss this and to explore all treatment options.
Don’t be shy about getting help. And don’t think sexual pain is just part of menopause. Sex should never hurt. Be prepared to answer honestly and openly about your sexual health. You should have your health evaluated. We as gynecologists are here to help you determine the cause of your pain, not to judge or embarrass you. Improving your quality of life and health is our goal.