Help! It Hurts When I have Sex

There are many reasons why women over 50 might be experiencing pain with sex. The number one reason is that the vagina gets very dry and loses the ability to lubricate naturally. The tissue also thins out and doesn’t stretch and expand the way it used to.

All of this occurs because of the hormonal changes your body is going through. Yes, that means menopause. Sorry. But, unlike hot flashes and night sweats, which may go away and not bother you anymore, vaginal dryness only gets worse as we get older.

What you might notice:

  • The skin around the labia and vagina feels dry when you wipe
  • More irritation with tight clothes
  • A slight odor – from sour to fishy
  • Feeling that the vaginal opening is just too small
  • That the skin doesn’t stretch enough for a partner or a toy to enter
  • Pain and frustration when trying to insert anything – and it just won’t go in
  • No natural ability to lubricate
  • A need for more and more lubricant for sex
  • Pain during and after intercourse

You’re not alone! In fact about half of women over 35 need to use a lubricant when having sex. (link to post on lubricant)

Why this happens

You may be surprised to learn that your genital area has many estrogen receptors and as they get thirsty for more estrogen than your body is making, the skin gets dry, loses some of it’s elasticity and can shrink.

The Vaginal Biome

In addition, without the estrogen to keep the vaginal ecosystem in balance, the normal healthy bacteria that live in the vagina, known as lactobacilli, will go away. These lactobacilli keep the pH slightly acidic, which prevents the overgrowth of yeast and bacterial infections.

More Urinary Tract Infections?

All this adds up to a vagina that’s drier, less able to lubricate and which is more prone to infections both in the vagina and in the urinary tract. That’s the right! Because the urinary opening (urethra) is right above the vaginal opening, those problematic bacteria from the vagina have a tendency to migrate to the urethra and up to the bladder. So if you’ve suddenly started having more bladder infections after 50, you might need some vaginal estrogen to prevent more from recurring.

This Only Gets Worse

Unlike hot flashes and night sweats in menopause, this condition does NOT get better over time, in fact it gets worse. So if you’re experiencing any of these symptoms, do talk to your provider.

What you can do

There are great resources available from the North American Menopause Society, including a link to help you find a health care provider who is familiar with this.

  1. Do use lubricants – From Olive or coconut oil to Sliquid, KY and Sliquid, there are lots of great options out there. Don’t forget, some are flavored for more fun with oral sex. (link to blog post on lubricants)
  2. Do talk to your provider about vaginal estrogen – Guess what? Using small amounts of estrogen in the vagina does NOT increase the risk of breast cancer. Really, it doesn’t because it’s all absorbed in the vagina and we can’t detect it in the blood. This helps restore the vaginal estrogen, which makes the skin more able to stretch and lubricate. It also helps the lactobacilli return reducing the risks of infection.
  3. Do talk to your provider about vaginal DHEA – There is a new vaginal suppository with DHEA. Once inserted the vagina converts it to estrogen. This helps restore the vaginal estrogen, which makes the skin more able to stretch and lubricate. It also helps the lactobacilli return reducing the risks of infection.
  4. Consider using oral medication – There is an oral medication that acts like an estrogen in the vagina. This helps restore the vaginal estrogen, which makes the skin more able to stretch and lubricate. It also helps the lactobacilli return reducing the risks of infection.

If you decide to use any of the prescription medications it will take about 2 – 6 weeks to see improvement in the tissue. It’s important to keep using these medication or the vagina will revert back to being dry and uncomfortable and more prone to both vaginal and urinary tract infections.

My book, The Hot Guide to a Cool Sexy Menopause has a lot more information on all aspects of menopause.

Disclosure: I do not work for with any of the products listed here. All of the proceeds from the sale of my book go to FAME Hospital in Tanzania.

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