Women's Health: Painful sex related to menopause: common and curable

MAKING A POSITIVE CHANGE: Women's Health Painful sex related to menopause: common and curable By Dinah Olson, PA

Sex, like so many issues life brings us, can be complicated. It can be fun, relaxing and so many other great things.

But physical changes associated with menopause commonly cause sex to become uncomfortable or painful. Fortunately there are treatments available.

Before we look more at the physical changes of menopause, it’s important to acknowledge how complicated sex can be. A lot goes on ‘above the belt.’ Sexual health, personal experiences, level of interest, enjoyment all vary wildly across people.

For some people their sex lives hold a place of high importance. For others it plays a much lesser role. And that role will likely change over the course of our lives. Our attitudes about sex, feelings about our sexuality, body image, physical health, emotional stressors all change over time.

And then there are relationships issues. We may have long term sexual partners, brief relationships or sometimes no relationship at all. Even in a healthy longstanding relationship challenges come and go. Stressors related to finances, jobs, children, health concerns occur and these issues invite themselves into the bedroom.

The point is that sex is complicated because so many factors are at play.

That said, there are very common, purely physical changes that may result in decreased enjoyment of sex and sexual function that occur as women age. These changes occur around the time of menopause when a woman’s ovary function decreases and results in decreased levels of the hormone estrogen. Changes associated with lower levels of estrogen are usually noticed gradually. Some women may start to notice changes as early as their early 40s and others may not notice changes until their late 50s. Some women are severely affected and others may experience mild symptoms.

The physical changes that occur with lower estrogen levels can significantly impact how you feel about and experience sex. The desire for sex, known as libido, may fall. The tissue that lines the vagina may become thinner, less lubricated, more easily irritated and even tear. Women may experience sensations of vaginal dryness, burning or itching. This can make sex or masturbation very uncomfortable. The skin of vulva (the area outside the vagina) may similarly become less robust and women may experience increased irritation or itching in that area as well. Our lower urinary tract (the bladder and urethra) may also be affected by lower estrogen levels. Some women experience urgency of urination, leakage of urine, painful urination or increased frequency of urinary tract infections. It is not surprising that these changes can make sex less enjoyable or downright painful. These physical symptoms associated with lower estrogen levels are now referred to in the medical literature as genitourinary syndrome of menopause (GSM). The good news is GSM is a

treatable condition. The first step is to talk to your healthcare provider about your symptoms and concerns. Some primary care practitioners are quite comfortable evaluation and treating these issue. Some women preferto see someone specializing in women’s health. Your healthcare practitioner will help you be sure there are no underlying conditions that need to be evaluated and treated. Once this is done, treatment for symptoms can be recommended.

There are many products available over the counter that may provide relief of symptoms of GSM. These include lubricants and vaginal moisturizers. Lubricants provide short term relief of vaginal symptoms and are typically used during intercourse or masturbation. You may find them labeled personal lubricants, sexual lubricants or lube. They are available in as water-based, silicone-based and oil-based products. Water-based lubricants are widely available and safe to use with condoms and vibrators or sex toys. Silicone-based products tend to stay moist longer than water-based lubricants. They are safe to use with condoms but could damage vibrators or sex toys made from silicone. Oil-based lubricants are more commonly recommended for external use such as massage. They have a tendency to remain in the vagina for days. They can also damage condoms or vibrators. If you wish to use an oil based lubricant in the vagina, consider trying natural oils such as coconut or almond oil.

Also available without a prescription are vaginal moisturizers. These are longer lasting than lubricant products and generally used two to three times weekly. Vaginal moisturizers may provide relief from general discomfort associated with vaginal dryness. They can also decrease discomfort with sex and may be used in conjunction with lubricants. They are available as creams, gels, suppositories and oils. Some people use natural oils such as coconut or almond oil as vaginal moisturizers.

When moisturizers or lubricants are not sufficient, prescription medical treatments are available. Vaginal estrogen creams, vaginal estrogen tablets and vaginal estrogen rings all provide excellent relief of symptoms of GSM. There is also one oral medication currently available to treat painful sex associated with menopause. See your healthcare provider to see which would be the most helpful for your unique situation. Help for this common problem is available!

If you would like to learn more, these resources may be helpful: https://middlesexmd.com https://www.menopause.org https://www.womenshealth.gov/menopause/menopauseand-sexuality SWM

Dinah Olson is a physician’s assistant at OCO Centers for Reproductive Health.