Painful Sex? How to Relieve Vaginal Dryness

Many women suffer in silence during painful sex, unaware that there are treatment options for vaginal dryness, and its effects are far-reaching.

Vaginal dryness affects a woman’s health, intimate relationships and quality of life. I know because it affected my health and love life.

It occurs most often after menopause, but it can also develop during breast-feeding or at any other time your body’s estrogen production declines.

Estrogen, important for maintaining vaginal health and lubrication, is the hormone that actually plumps up the cells in the vagina. When estrogen levels decline, the vaginal walls can become thinner, less elastic and dryer.

The result is vaginal dryness, also known as vaginal atrophy (VA), which is a chronic progressive condition contributing to painful intercourse.

According to the North American Menopause Society (NAMS), up to 75% of menopausal women may experience vaginal dryness as they age. I was not alone, but I must admit no one was talking about it, other than my extremely supportive husband.

Are you suffering from vaginal dryness?  Or is your partner?

Symptoms include:

  • Vaginal dryness
  • Burning and itching
  • Irritation or soreness
  • Pain and bleeding during intercourse or urination
  • Shortening and tightening of the vaginal canal

When a woman experiences pain during intercourse, it is no surprise that her desire for sex may decrease.  A physical condition such as vaginal dryness can avalanche into an emotional response affecting both relationship and self-esteem.

With severe vaginal dryness, the tissues of the vagina become dry and sometimes fragile and inflamed. As a result, they are more prone to injury, tearing, and bleeding during sexual intercourse or even a pelvic exam. Over time, especially in the absence of regular intercourse, the vagina may also become slightly shorter and narrower. The resulting discomfort can intensify to the point where sexual intercourse is no longer pleasurable or even possible.

Not only does the physical act of intercourse become a challenge, the increased emotional stress can be a double whammy for a healthy sexual relationship.

The Partners’ Survey, which is a part of a larger global survey called CLOSER Research (Clarifying Vaginal Atrophy’s Impact OSex and Relationships) sponsored by Novo Nordisk, revealed that 65% of men worried that sex would be painful for partners, and almost a third of both men and women reported that they discontinued having sex with their partners as a result of discomfort.

This survey, which included 4,167 post-menopausal women ages 55 to 65, found that 57% of women avoided being intimate, and 65% said they lost their libido.

The good news is the majority of the 4,174 men in the survey were concerned about what was going on with their partner. Unfortunately, this taboo subject has partners turning off the lights at night rolling over, confused and frustrated.

Margery L.S. Gass, MD, NCMP, NAMS Executive Director says,

“This topic is so sensitive that, according to the International Menopause Society, 70% of women say their healthcare professionals have only rarely or never raised the subject with them.”

James A. Simon, MD, NCMP, FACOG, Clinical Professor of Obstetrics and Gynecology at The George Washington University School of Medicine in Washington, DC, says,

“In my experience treating patients, most women are not comfortable talking about vaginal symptoms, especially related to pain and discomfort. The word ‘vagina’ is somewhat taboo, so it’s no wonder no one talks about vaginal atrophy.”

Taboo or not, vaginal dryness is manageable and treatable.  The North American Menopause Society recommends:

  • Vaginal Lubricants: Decreases friction during intercourse.  There are many over-the-counter (OTC) water and silicon-based options. Water-based lubricants are popular and easy to wash off. Silicon-based lubricants tend to last longer, but are not as easy to wash off.
  • Vaginal moisturizers: Non-hormonal OTC, generally used twice a week.  Moisturizers are absorbed by the skin and adhere to the vaginal lining, keeping it moist.
  • Regular sexual stimulation: Intercourse promotes blood flow to the genital area, helping to maintain vaginal health.
  • Developing expanded views of sexual pleasure: If vaginal penetration (intercourse) is difficult or uncomfortable, consider so-called “outercourse” options such as extended caressing and massage.
  • Local prescription therapy: For vaginal dryness and discomfort that does not respond to over-the-counter lubricants and moisturizers, low doses of local vaginal estrogen therapy are very effective and safe. Local estrogen increases the thickness and elasticity of vaginal tissues, restores a healthy vaginal pH, increases vaginal secretions, and relieves vaginal dryness and discomfort with intercourse.
  • Systemic prescription therapy. Low doses of systemic estrogen in the form of a pill or skin patch or gel used to treat hot flashes are also effective for treating vaginal dryness, although some women might benefit from adding local treatment to their systemic treatment to relieve discomfort. If only vaginal symptoms are present, local therapy as described above is recommended.

During my menopause transition, I was very aware that vaginal dryness was a common symptom and assumed this was a natural part of aging.  I made assumptions that if my skin was aging, why would my vagina be any different? Then, I became aware of the many options for treatment.

I started out using OTC silicon-based lubricants and that worked for a few months.  It solved the friction problem, but not the pain.  Then, I tried vaginal moisturizers and the pain was relieved for a few more months. However, since vaginal dryness tends to be a progressive condition, the situation only got worse for me.

Per the Partners’ Survey, 56% of women and 57% of men whose partners used local estrogen therapy reported that sex was less painful.  This was true for me.  Painful sex disappeared once those vaginal cells were plumped up with local estrogen therapy, restoring my love life.

Recently, I asked Wen Shen, MD, Assistant Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, about the safety of vaginal hormonal treatment:

“Vaginal estrogen comes in very low doses, as light as ten micrograms used twice a week.  There have been premarketing studies that show women who use vaginal estrogen do not increase their systemic estrogen levels above the post menopausal level.  After treatment, the levels actually go back down again to really low levels.

The vaginal skin and bladder are very well treated with vaginal estrogen, and they have more elasticity and thickness, so that the vagina can serve as a sexual organ again and the bladder can be less irritated.”

It is important to discuss vaginal dryness with your healthcare provider to confirm that you are not suffering from a vaginal infection.  If left untreated, it can lead to long-term complications in some women.

According to Dr. Shen:

“Vaginal dryness is one of the easier symptoms of menopause to treat that carries the least amount of risk.”

I was so happy there was a solution to vaginal dryness that I started talking about it with my girlfriends.  Many confessed that they too suffered from extreme dryness during intercourse and were losing interest in sex, leaving their partners feeling confused and distanced.

My friends and colleagues in the menopause community started calling me “Vagina Girl” because I always asked, “How’s your vagina?” It was perfect when asked to join the GLAM TM (Great Life After Menopause) team to bring awareness to vaginal dryness.

My message to woman, and to the men who love them, vaginal dryness is treatable. Talk to your healthcare provider. If you are menopausal or suffering from hormonal changes, you don’t have to suffer in silence.

Vaginal health is more than sexual health – it is good women’s health.

By Staness Jonekos, Co-Author The Menopause Makeover

Medical reviewer: Wendy Klein, MD, FACP

Disclosure: I am a member of GLAM™ (Great Life After Menopause), a women’s health initiative sponsored by Novo Nordisk.

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