Making Intimacy Playful, Not Painful With Vaginal Atrophy
What’s that sound? Is that “Let’s Get It On” by Marvin Gaye playing in the background? Yep, that’s right, we’re talking about sex. And if you’re experiencing vaginal atrophy (VA), or the newer term, genitourinary syndrome of menopause (GSM), this might be a sore subject—literally—since vaginal dryness can make intimacy a painful experience you want to avoid. If that hits home, keep reading—we’ve got tips straight from the experts to help you feel better and put the playfulness back into your sex life, because that’s what you deserve.
First Up: Get Treatment
Here’s the thing: You need to address the physical symptoms of VA that are making sex painful in the first place, says Evelyn Mitchell, M.D., an obstetrician and gynecologist (OB-GYN) with Keck Medicine of the University of Southern California in Los Angeles. And don’t delay—talk with your doctor about hormonal and nonhormonal treatment options that can help you feel better ASAP. “Getting treatment first is key so when you have sex, it’s not something you dread, and it’s not uncomfortable,” she says. “If something is not pleasurable physically, then mentally you don’t want to go there anymore.”
Communicate With Your Partner
We get it—sometimes talking about sex with your partner can be awkward. But open, honest communication is majorly important with VA. “Sometimes it’s not easy to talk about the fact that you’re not satisfied,” says Dr. Mitchell. “But sex should be equally pleasurable for both partners.” Sharing what’s working and what’s not with your partner can open the door for changes that lead to a more fulfilling—and comfortable—sex life for both of you. Plus, you can flirt while you do it! Remember: You should feel empowered to explore your sexuality, Dr. Mitchell says.
Change the Focus From Orgasm to Pleasure
Orgasms are great (understatement of the year!). But taking the pressure off the need to have one each time you have sex can help you lean deeper into pleasure. “There are so many important variables that go into sexual satisfaction,” says Susan D. Reed, M.D., an OB-GYN and program director of the Women’s Reproductive Research Program at University of Washington Medicine in Seattle. Learning what you like through masturbation can be helpful, too. Dr. Reed agrees: “Does sexual stimulation feel better if you’re self-stimulating or having sex with a partner, and if self-stimulation is better, how can you replicate that experience with a partner?”
Don’t Skimp on Foreplay
Similarly, focusing on foreplay and other forms of touch and intimacy—kissing, massage, oral sex, mutual masturbation, sexting, and more—can help take pressure off the act, especially when intercourse itself is painful due to VA. “Foreplay is extremely important with a condition like atrophy,” says Dr. Mitchell. And if intercourse itself is uncomfortable, you may start to anticipate pain, making sex all the more unappealing. So get creative, and break out of your routine by turning foreplay into the main event. “You can even use an oil called Zestra to increase arousal, and make foreplay fun again,” she says.
Experiment With Sex Toys
Not only can sex toys spice things up in the bedroom, but they can also offer ways to be intimate beyond strictly intercourse, which can be painful if you have VA. “There are all kinds of sex toys available from reputable stores that can be helpful,” Dr. Reed says. Integrating toys like vibrators into your sex life can also be a key part of foreplay if you have bothersome symptoms related to VA. “The nerves in this area move more slowly than they did when we were younger, and the blood flow is not as good, so devices that help with foreplay may be important,” she adds.
VA often means vaginal dryness—and that can make sex uncomfortable and in some cases lead to bleeding. Yikes. Thankfully, lubricants can help—not to mention, it can be fun to try different products and add an extra something-something to your sexual routine. Look for hypoallergenic lubes or try plant-based options like coconut oil, suggests Dr. Reed. But a quick note: While spicing things up is good, don’t take that so literally when it comes to lube if you have VA—“spicy” or “tingling” products may increase discomfort on the thinner vaginal tissue, says Dr. Reed.
See a Sex Therapist
Talking about your VA and less-than-stellar sex life may feel awkward, and you may not know where to start to improve intimacy when it’s physically uncomfortable. In addition to getting treated by your doctor, Dr. Mitchell recommends sex therapy. “Going to a sex therapist either alone or with your partner can help you find ways to bring intimacy back and keep it going,” she says. “You can explore what about sex is important to you. Sex therapy allows freedom for women to openly talk about this with their partners and have a voice in this conversation.”
Remember That Some Changes Are Normal (and OK!) With Age
In a society arguably way too focused on anti-aging, it can be difficult for people (women especially—thanks, patriarchy) to accept the changes that come naturally as you grow older. Educating yourself about how sexual function evolves over time can be helpful if you’re facing intimacy issues and open the door to try new things, like different sex positions and ways to reach orgasm that are comfortable and work for your body, says Dr. Reed. “It’s helpful to learn about what sexual function should be as we age and what is normal,” she says.
It’s Not Just Women
Is your sexual partner male? Newsflash: Men’s bodies change as they age, too! And yes, that can impact sex, just like your VA can. In fact, as many as half of men in their 50s have some level of erectile dysfunction, says Dr. Reed. “If the partner is unable to have as firm an erection, with a dry vagina, you’re in for trouble—so trying to remain intimate and have open discussions around this is really important.” Work to build an ongoing conversation about improving intimacy as a team, rather than placing the blame on one partner’s body or the other.
Don’t Give Up Hope
If VA is making sex uncomfortable or painful, know that you don’t have to accept this as your new normal. “There’s always hope, and there is professional help for this. A good health care provider can help guide you,” says Dr. Reed. As hormones diminish around menopause, it’s natural that sex may start to look different than it once did—but different doesn’t have to be a bad thing. In fact, this could be the perfect time to increase communication with your partner, get creative, and try new things in the bedroom—and soon enough you might just be seeing fireworks.
Vaginal Atrophy Information: The Cleveland Clinic. (2020.) “Vaginal Atrophy.” my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy
Sexual Health Problems FAQ: American College of OB-GYNs. (2019). “Your Sexual Health.” acog.org/womens-health/faqs/your-sexual-health
VA Treatment Options: Contemporary OB-GYN. (2018). “Genitourinary Syndrome of Menopause: Underdiagnosed and Undertreated.” contemporaryobgyn.net/view/genitourinary-syndrome-menopause-underdiagnosed-and-undertreated
Symptoms: Cureus. (2020). “The Genitourinary Syndrome of Menopause: An Overview of the Recent Data.” ncbi.nlm.nih.gov/pmc/articles/PMC7212735/