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3 Easy Ways to Treat Painful Sex After Menopause

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Painful sex (also known as dyspareunia) is a common symptom of menopause. According to a 2013 survey, 44% of women report pain with intercourse after menopause 1.

In this article, we’re going to examine the underlying reason why sex is painful after menopause and then summarize solutions that can prevent and cure pain with sex.

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Why is sex painful after menopause?

Loss of estrogen after menopause causes vaginal changes such as vaginal dryness and inadequate vaginal lubrication that can lead to painful sex 2, 3.

The medical term for vaginal changes due to loss of estrogen is vaginal atrophy (or atrophic vulvovaginitis or the genitourinary syndrome of menopause). And, unlike hot flashes and night sweats, vaginal atrophy is a chronic and progressive condition that usually worsens with time.

If you’re approaching menopause or well beyond it, vaginal atrophy is likely what’s behind your vaginal pain with sex. Vaginal atrophy is associated with a constellation of vaginal symptoms 4 that could cause pain during intercourse:

  • Shortened or narrowed vaginal canal
  • Decline in the quantity and quality of vaginal lubrication
  • Decline in collagen in the vulva
  • Thinner and less flexible vaginal walls
  • Vaginal surface bleeding that occurs after minimal trauma
  • Loss of the protective covering that covers the clitoris

Depending on your unique symptoms, you may feel deep vaginal pain, vaginal soreness, irritation of the tip of the clitoris, or even experience tearing during or after penetrative sex.

Estrogen and vaginal health

Post-menopausal woman sitting by the river. Post-menopausal woman sitting by the river.
Although women live 1/3 of their lives after menopause, sex can be enjoyable and pain-free.

Estrogen plays a crucial role in sexual health because it is responsible for keeping the vaginal lining thick and supple - which allows the vagina to lubricate and stretch during penetrative sex.

As you transition through menopause and beyond, estrogen levels remain low, so the vagina will continue to lose flexibility and moisture. As a result, painful sex tends to get worse with time.

Although women will live over one-third of their lives after menopause, you don’t have to let the loss of estrogen limit your ability to have pleasurable and pain-free intercourse. Treatment can address the loss of estrogen, reverse vaginal atrophy, and help make sex comfortable and enjoyable for years to come.

How to cure painful intercourse after menopause

The first thing you should do is find a lubricant and moisturizer you like. Vaginal lubricants and vaginal moisturizers are available over-the-counter without a prescription.

If vaginal lubricants or moisturizers are inadequate, talk to a trusted medical provider and explain your concerns in detail. They may recommend prescription therapy - such as topical vaginal estrogen or systemic hormone therapy 5.

Treatment for painful sex can:

  • Lubricate the vagina to make friction during sex more comfortable
  • Moisturize the vagina to prevent chafing or tearing
  • Add estrogen back to the vagina to restore sexual function - including suppleness, flexibility, and lubrication

Your choice of treatment depends on your health history, personal preferences, and the severity of your symptoms - and we’ll guide you through your options below. So, if you’ve been thinking “I need to find a cure for vaginal pain with sex” - you’re in the right place.

Tip #1 Use a lubricant

Lubricant for painful sex after menopause. Lubricant for painful sex after menopause.
Use a lubricant that is similar in pH and osmolality to natural vaginal secretions.

Lubricants are a treatment option for postmenopausal women with mild to severe pain with sex who require additional lubrication to feel comfortable during sexual activity.

Lubricants for sex are available over-the-counter. But according to research by the World Health Organization, most lubricants on the market are not formulated for the delicate vaginal microbiome and could damage the vaginal skin (or epithelium). Look for a lubricant with an osmolality that does not exceed 380 mOsm/kg.

Apply your lubricant just before or during sexual activity. Lubricants work by sitting on top of the skin to help ease friction that would otherwise cause pain during sex. Unlike vaginal moisturizers or prescription treatments, a lubricant will not help restore moisture or treat soreness due to loss of flexibility or changes to the shape of the vaginal canal. But it can be used in combination with other treatments.

Tips for using a lubricant:

  • It’s recommended to choose a lubricant that is most similar to natural vaginal secretions 6. We like Good Clean Love Lubricant or Yes Water-Based Personal Lubricant.
  • Look for either a water-based or silicone-based lubricant. Both are safe to use with condoms. A silicone-based lubricant may last a little longer than a water-based lubricant. But a water-based lubricant won’t stain clothing or bedsheets.
  • Avoid oil-based lubricants. If you are using condoms during sex, steer clear of oil-based lubricants since oil-based ingredients can break down latex condoms. Oil-based ingredients may also be more irritating.
  • Avoid lubricants that contain fragrances or tingling or warming effects. The ingredients in these lubricants can cause irritation and make dryness and pain during sex worse.
  • Experiment with different lubricants and have fun!

Tip #2 Apply a vaginal moisturizer consistently

Vaginal cream for painful sex after menopause. Vaginal createElement for painful sex after menopause.
Research suggests that hyaluronic acid is the most effective over-the-counter vaginal moisturizer.

Moisturizers are different from lubricants because they’re meant to be absorbed into the vaginal skin. Vaginal moisturizers work in the short term to ease irritation. Over time, if used regularly, vaginal moisturizers can help restore suppleness and flexibility to the vaginal skin which can prevent tearing during sex and make sex more comfortable.

Vaginal moisturizers are available over-the-counter. However, there can be significant differences in the quality and effectiveness of these products. If you’re looking for an evidence-based solution, there is research to suggest that hyaluronic acid is the most effective over-the-counter treatment for painful sex after menopause 7. There is also evidence to suggest that coconut oil is an effective external vulvar moisturizer, but its effectiveness as an internal vaginal moisturizer has yet to be researched.

Vaginal moisturizers are available in many different forms:

  • Gels or creams you can apply with a tampon-like applicator or with a clean fingertip
  • Suppositories that you can insert inside of the vagina which absorb into the skin

Tips for how to use a vaginal moisturizer:

  • Avoid vaginal moisturizers that contain fragrances.
  • Look for a vaginal moisturizer that contains hyaluronic acid.
  • Apply a vaginal moisturizer consistently and as often as needed.
  • If applying a vaginal moisturizer internally, it’s preferable to apply it before bed so that the product can be absorbed.
  • Vaginal moisturizers can be used both internally and externally.

Tip #3: Apply a low-dose vaginal estrogen

Vaginal cream for painful sex after menopause. Vaginal cream for painful sex after menopause.
Vaginal estradiol is a prescription medication that's available as a cream (pictured here), suppository, or ring.

For women with moderate to severe painful sex that is not resolved by moisturizers or lubricants, vaginal estrogen can be a safe and effective option.

Vaginal estrogen (also known as topical estrogen or local estrogen) is a prescription medication that is applied twice weekly. It contains a low dose of estrogen that helps to replace loss of estrogen in the vagina.

After about 2 weeks of using vaginal estrogen, you’ll start to notice increased moisture and lubrication. Within about 4 to 6 weeks, the integrity of the vaginal tissues is restored, and you should feel comfortable during sex again 8.

Vaginal estrogen is available in different forms, and research shows all forms are similarly effective 9:

  • Cream that you can apply with a tampon-like applicator or with a clean fingertip
  • Suppositories that you insert which dissolve and absorb in the skin
  • Suppositories containing a cream base that you insert with a clean fingertip
  • A ring that you insert in the vagina

When it comes to hormone-based prescription treatment for painful sex, you can also take systemic estrogen. Systemic estrogen (also known as hormone replacement therapy or menopause hormone therapy) can help replace loss of estrogen in the entire body - including the vaginal tissues. However, systemic estrogen carries an elevated risk of cancer and heart disease, and many women do not want or cannot take it.

How does vaginal estrogen compare to systemic estrogen regarding safety? Research shows that vaginal estrogen is only absorbed in low doses by the vaginal tissues and not by the rest of your body 5. Two large clinical analyses concluded that vaginal estrogen is not shown to carry an elevated risk of cancer or heart disease 10,11. Since it may be necessary to manage symptoms for several years or decades, using a vaginal estrogen that’s minimally absorbed throughout the body can be a safer option for most women.

Tips for how to use vaginal estrogen:

  • Vaginal estrogen is applied twice weekly or as directed by the prescribing physician.
  • It is recommended to delay intercourse at least 1 hour after applying estrogen 6. This will allow time for the medication to absorb and will avoid transmission to your partner.
  • Because vaginal estrogen is not absorbed by the rest of your body, professional medical guidelines state that a progesterone is not needed 5.
  • If you have a history of breast cancer, research shows that vaginal estrogen can be safe. You can take vaginal estrogen if you have approval from your oncologist 5.
  • Vaginal estrogen can also be used in combination with moisturizers and lubricants.

Vaginal estrogen is a prescription medication that’s not available over-the-counter. However, you can get vaginal estrogen online through Interlude. We offer an easy online consultation, prescription medication, and delivery to your door.

Disclaimer: This information isn't a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
References
1 Wysocki S, Kingsberg S, Krychman M. Management of Vaginal Atrophy: Implications from the REVIVE Survey. Clin Med Insights Reprod Health. 2014 Jun 8;8:23-30. doi: 10.4137/CMRH.S14498. PMID: 24987271; PMCID: PMC4071759.
2 Sutton, Kate S., et al. "To lube or not to lube: experiences and perceptions of lubricant use in women with and without dyspareunia." The journal of sexual medicine 9.1 (2012): 240-250.
3 Seehusen, Dean A., Drew C. Baird, and David V. Bode. "Dyspareunia in women." American family physician 90.7 (2014): 465-470.
4 Mehta, Aasta, and Gloria Bachmann. "Vulvovaginal complaints." Clinical obstetrics and gynecology 51.3 (2008): 549-555.
5 Multiple authors. "The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.” Menopause: The Journal of The North American Menopause Society Vol. 27, No. 9, pp. 976-992 DOI: 10.1097/GME.0000000000001609
6 Edwards, D, and N Panay. “Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?.” Climacteric : the journal of the International Menopause Society vol. 19,2 (2016): 151-61. doi:10.3109/13697137.2015.1124259.
7 Chen, Junya et al. “Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial.” The journal of sexual medicine vol. 10,6 (2013): 1575-84. doi:10.1111/jsm.12125
8 Z Kingsberg, Sa et al. “Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy.” International journal of women's health vol. 1 105-11. 9 Aug. 2010, doi:10.2147/ijwh.s4872
9 Suckling, J et al. “Local oestrogen for vaginal atrophy in postmenopausal women.” The Cochrane database of systematic reviews ,4 (2003): CD001500. doi:10.1002/14651858.CD001500
10 Bhupathiraju S, Grodstein F, Stampfer M, et al. Vaginal estrogen use and chronic disease risk in the Nurses’ Health Study. Menopause. 2018;26(6):603-610
11 Crandall CC, Hovey K, Andrews C, et al. Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women’s Health Initiative Observational Study. Menopause. 2018;25(1):11-20.
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