How to Be Intimate When You Have Vaginal Atrophy

If you have vaginal atrophy (also known as genitourinary syndrome of menopause), you likely know its symptoms all too well. The condition, which is marked by the thinning of vaginal tissue as well as dryness, often makes sex uncomfortable or painful. And if you’ve feared getting it on with the condition, you wouldn’t be the first woman to feel that way. In fact, a survey in Menopause found that 58% of women with VA avoided intimacy. But there are things you can do to boost your confidence with the condition. Here how’s to be happier in the bedroom—and beyond.

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Take Time Together as a Couple (And Cuddle!)

Intimacy can come in many forms, not just sexual. “Couples must create opportunities to reinvigorate love and affection,” especially with a condition like VA, says Oz Harmanli, M.D., chief of urogynecology & reconstructive pelvic surgery and professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine in New Haven, CT. So plan a weekend getaway. Take an online cooking class. Spend Saturday afternoons together after a busy week. Even just snuggling can help build a strong relationship via the production of the hormone oxytocin, sometimes called the “cuddle hormone,” which happens when you hug and touch.

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Get Help From the Professionals

The symptoms of vaginal atrophy are varied and can include irritation, itching, burning, pain on urination, urinary tract infections. “But they typically don’t get better without treatment,” says Stephanie Faubion, M.D., professor and chair of the department of medicine at Mayo Clinic in Jacksonville, FL, and Penny and Bill George Director of the Mayo Clinic Center for Women’s Health. That’s why it’s important that you don’t go it alone. Talk to your doctor about your symptoms to find the best treatment for you, including estrogen treatments or other therapies.

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View Sex in a Positive Light

Upping your sexual activity may sound counterintuitive to those feeling pain during intercourse, but increasing it—while focusing on what feels good to you—may actually help. In fact, a research review in the American Journal of Obstetrics and Gynecology concluded that “there is a positive link between sexual activity and maintenance of vaginal elasticity and pliability as well as lubricative response to sexual stimulation.” While you might think of sex in a negative way—we get it, pain can certainly do that!—try not to turn away from it. Because there are ways to safely approach it, like…

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Have the Right Products Ready

Since dryness is the major symptom of vaginal atrophy, lubricants are a common recommendation. Make sure you have them on hand before having sex so you’re not caught without them because they can help tremendously, says Dr. Faubion. Look for either water- or silicone-based formula that are free of glycerin or parabens. “People tend to react to those,” she says. Feel free to experiment until you find one you like. One note: Don’t use Vaseline/petroleum, even though it might seem like a good idea—it can increase your risk of yeast infections, according to the Cleveland Clinic.

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Add Vaginal Self Care to Your Daily (or Weekly) Routine

Making sure you take care of down there is important. You can do so by using bioadhesive moisturizers on the regular—some daily, others less frequently. They help reduce day-to-day dryness, as opposed to lubricants, which add moisture only at the time it’s applied to the skin. “I tell women it’s like face cream for the vagina. They irreversibly bind to the cells and just lock in water, and most are fairly effective,” Dr. Faubion says.

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Focus on Romance

“Women cannot have the best sexual experience without romance,” says Dr. Harmanli. By getting the night started early—before you even head to the bedroom—it can help set the tone for relaxing, bonding, and, yes, sex. Taking time to unwind together can get overlooked, but he says, “in established relationships, especially with the stress and physical exertion from work and daily activities, it may not be as easy to focus on this essential ingredient for better sexual satisfaction.”

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Talk, Talk, Talk

It’s important to keep communication open with your significant other so he or she doesn’t feel hurt by your fear of sex, or lack of interest in it, if you’re working on getting back to it after a VA diagnosis. Let your partner know what you’re going through and how he/she can help you feel more comfortable. “Being transparent is the key,” Dr. Harmanli says. He assures his patients that any initial worry about bringing it up with likely go away as you connect, reminding them, “There is nothing embarrassing about sex. Especially with the [right] partner.”

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Don’t Jump Straight into Sex

Making out is a great tip for those with VA. Foreplay means more stimulation, which increases moisture in your vagina. Talk to your partner about taking it slow and increasing the time spent in anticipation of intercourse. Build up to it! You might find getting intimate easier. After all, says Dr. Faubion, “enjoying the moment is going to help a lot [because] if you’re very fearful that it’s going to hurt, your pelvic floor muscles tense up. It can just compound the whole thing.”

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When You Do Have Sex, Try That New Position

Being open to trying different positions and types of touch can have a huge benefit when pain strikes. Says Dr. Harmanli, “Every person has different needs for better sexual satisfaction. It may take some time in any relationship to identify what works the best.” His advice: Be specific with your partner as to how it feels best to be touched and where.

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Use Pelvic Floor Exercises to Your Advantage

Some doctors recommend pelvic floor therapy to help the muscles in the area. A 2019 review in Drugs and Aging concluded that targeted toning and strengthening exercises “may be useful for the treatment of non-relaxing or high-tone pelvic floor muscle dysfunction triggered by painful sexual activity related to GSM.” You'll want to work with a pelvic-floor specialist before you jump in...certain moves like Kegels can sometimes be counter-productive for certain VA symptoms. Your doctor can hook you up.

Beth Shapouri
Meet Our Writer
Beth Shapouri

Beth Shapouri is an award-winning beauty, health, wellness, and lifestyle freelance writer whose work has appeared in Glamour.com, Elle.com, Health Monitor, Magnolia Journal, Marie Claire, RealSelf.com and more. Career highlights include a multi-year stint as Lead Beauty Writer for Glamour.com and contributing to a New York Magazine package on circumcision that received a National Magazine Award for service.