Painful sex and the menopause (or peri-menopause)

After menopause, up to half of all women have pain before, during, or after sex. And sex after menopause doesn’t 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 it’s 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 didn’t know that “vaginal atrophy” or age-related vaginal dryness—a common issue for many menopausal women—is a medical condition.

 Why does vaginal dryness happen during perimenopause or menopause?

During menopause, hormones become unbalanced. It starts with periods stopping, which throws off the normal balance of oestrogen and progesterone. This in turn causes the levels of other hormones to fluctuate, affecting systems throughout the body and causing a variety of symptoms. Within the lining of the vagina, the cells become thinner and there is less collagen in there so it becomes less elastic and there is also less blood supply so it basically dries out. It mostly causes a lot of irritation, soreness and pain during intercourse but there may even be discomfort with everyday things like walking, sitting down and exercising. 

Bladder and urinary problems

Another common problem is bladder or urinary symptoms – often recurrent cystitis (especially after intercourse) or recurrent urinary tract infections (bladder infections). It might just be feeling a need to void more frequently, or getting up more during the night. There’s also a higher incidence of thrush and other vaginal infections like BV (bacterial vaginosis).

 Hormones are important great sex

Oestrogen: As the most important female hormone, oestrogen is crucial for women’s health. This includes sexual health. Oestrogen not only plays a role in heightening sensitivity during sexual activity, it also keeps vaginal tissue healthy. The form of oestrogen known as estriol is especially important, since estriol is responsible for stimulating the mucus membranes in the vaginal walls. Without enough estriol, vaginal tissue can become dry and fragile. The vaginal lining thins and secretes less fluid, and pH balance shifts to become more alkaline. At best, this makes sex less enjoyable due to lack of lubrication and elasticity. At worst, it can make sex downright painful. The changes wrought by low oestrogen also increase the risk for infections such as UTIs, as well as other urinary problems like leakage.

Progesterone: Progesterone helps support women’s libido. It is also essential for moderating the effects of oestrogen. Because oestrogen promotes cell growth, the moderation progesterone supplies is important to keep that cell growth in check. Oestrogen and progesterone are normally produced in a natural counterbalance during a woman’s monthly cycle, but when menopause disrupts this cycle, progesterone can drop to where it may be too low for women to maintain a normal sex drive.

Testosterone: Though testosterone is typically thought of as a male hormone, women do need a small amount of testosterone for a number of processes in the body. One of these is sex drive. Testosterone plays a huge role in sexual response for women. Without enough testosterone, women simply can’t get “in the mood” no matter how much they may want to. Testosterone also affects lubrication and orgasm for women.

 Top tips to help with vaginal dryness

  it’s 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:

  • Avoid intimate washing with soap, bath oils and shower gels – they can aggravate dryness. Instead, use lukewarm water alone or with a soap-free cleanser. 

  •  Allow the vagina to “breathe” by not wearing underwear at night, and wearing cotton underwear during the day. 

  • Lubricants should be used for intercourse but not the usual suspects – as most lubricants available at the pharmacies have additives. Lubricants such as Yes, Sylk, Replens and KY Pure have no additives and are better to use

  • Vaginal moisturisers such as Regelle can also work quite well to improve the vaginal environment

  • If these measures don’t help, your doctor can prescribe hormone treatment. Hormone replacement therapy alleviates dryness, but if you can’t or don’t want to take HRT, you can use oestrogen applied "locally", that is just to the vagina, to increase the flow of natural lubrication

  • There are different options including an oestrogen cream (applied using an applicator), pessaries, small tablets (again inserted with an applicator) or an oestrogen-releasing vaginal ring which stays in place for three months at a time. 

 Some women find that they llose their desire for sex after the menopause. It’s normal for sex drive to reduce over the years, but it can be made worse by depression, menopausal symptoms, relationship problems and stress.

These problems are often temporary and being able to talk things through with an understanding partner may be all that’s needed. But if symptoms of the menopause or of depression persist, then it may be best to see a doctor for treatment. 

Treating menopausal symptoms may boost your sex drive indirectly by improving your general well-being and energy levels, but restoring your hormone levels can also improve sensation.

 If you experience painful sex it’s best to seek advice, whether from your pharmacist or a doctor. Whatever you do, don’t suffer in silence!

Gavin O'Sullivan