Painful intercourse can be a common problem after menopause. The condition, known as dyspareunia, affects about 40 percent of postmenopausal women, according to research.
Yet most women don’t seek help for the problem or even realize that help exists. That’s a shame, says Lisa Masterson, M.D., a former host on “The Doctors” daytime medical TV show and current host of the weekly “Health in Heels” podcast and website. The condition can affect your sex life, your relationship, and your self-image.
“Dyspareunia is caused by decreased estrogen levels after menopause, which affects the vaginal tissue, leaving it thin, inflamed, and dry,” says Masterson, a practicing gynecologist in Southern California. “And unlike hot flashes after menopause, the condition won’t just go away.”
Can lead to UTIs
In fact, left untreated, the condition may get worse because the tissue can be easily irritated after intercourse and may even bleed. The overall condition is known as vulvovaginal atrophy, and it’s also associated with an increased risk of urinary tract infections, overactive bladder, and bladder leakage.
In the Vaginal Health: Insights, Views, and Attitudes (VIVA) study published in 2012, researchers surveyed 3,520 postmenopausal women age 55 to 65 living in the United States, Canada, Denmark, Great Britain, Finland, Norway, and Sweden. Fifty-eight percent of women with vaginal discomfort told the researchers that they didn’t realize it was a symptom associated with menopause.
And in the Revealing Vaginal Effects At midLife (REVEAL) study, 80 percent of the women who reported discomfor during sex said that they had simply learned to live with dyspareunia, and many continued to have sex despite the pain.
Over-the-counter and prescription treatments
To ease the discomfort, at least temporarily, you can try over-the-counter solutions. Personal water-based lubricants like Astroglide or K-Y Ultragel can make intercourse more comfortable, and they are safe to use with latex condoms and wash off easily with soap and water. But they tend to evaporate faster than other types, so frequent reapplication may be necessary.
Vaginal moisturizers, such as Replens or Vagisil Prohydrate, mimic the vagina’s natural secretions and can hydrate the vagina for two to three days.
To address the underlying problem of estrogen deficiency in the vaginal tissue, your doctor can prescribe vaginal or oral estrogen therapy. Vaginal creams, rings, and tablets are very effective, and low-dose vaginal estrogen therapy is safer than systemic therapy (pills or patches).
Many women hestitate to use oral hormones because of concerns about developing cardiovascular disease or breast cancer. But a study published in September 2017 in the Journal of the American Medical Association, which followed more than 27,000 women who took oral hormone therapy for an average of five to seven years and continued to follow the participants — now for a total of 18 years — concluded that the use of hormone therapy was not associated with increased or decreased death rates.
Another, newer option is a nonhormonal, once-daily pill called Osphena (ospemifene), available by prescription, which acts on estrogen receptors in the vagina and thickens the tissue there. Osphena is a selective estrogen receptor modulator (SERM) in the same class of drugs as the breast cancer agents tamoxifen and toremifene. Studies before and after its approval in 2013 show that daily use of the drug is well tolerated and effective in reducing the severity of painful intercourse. On the downside, Osphena may increase the risk of stroke, blood clots, and uterine cancer.
An emerging option is laser therapy, which in studies to date has shown promise for reducing dyspareunia, restoring the vaginal tissue to its premenopausal state, and improving a woman’s quality of life.
Getting the courage to talk to your doctor
Surveys show that many women are reluctant to talk to their doctors about painful intercourse. They may be embarrassed, believe nothing can be done to help them, or think their sex life is private and not an appropriate topic to discuss with health care providers.
Many say they wish their doctors would bring up the topic so they don’t have to. “Doctors should ask about it,” Masterson says, “but if they don’t, bring it up yourself. It’s a very common problem, and your doctor won’t be surprised by the question.”
And she adds this food for thought: Because women can expect to live 40 percent of their lives after menopause, "it’s worthwhile to have a conversation with your doctor about dyspareunia. It can have a big impact on your life, your relationship, and how you feel about yourself, and you want to find a treatment that is the right fit for you.”