feel fine, yet on other days I'm moody and get hot flashes. My periods are
becoming erratic, too.
Sex with my husband used to be pleasurable. But ever since I started going into
menopause, it has become quite uncomfortable and even painful. And I find
myself fearing it—or worse, avoiding it—because, frankly, the pain it causes
takes away any pleasure.
I think it's interfering with my relationship. I no longer feel sexy or desirable.
Although my husband is sweet and seems to be understanding, I think he's
losing
patience with me, and I don't want to give up this important part of our
relationship and let this problem come between us.
I've heard the term "vaginal atrophy," and people talking about how the vagina
"shrinks." Is that what's going on here?
Signed,
Want Sex But Afraid
Sex shouldn't hurt, nor does it need to. But you're not alone. For many women,
sex can become painful and difficult around menopause.
The main culprit is estrogen loss, making the tissues of the vagina dry and
thinner. Without moisture, the friction of sex can certainly cause pain. The
vagina
also loses some of its elasticity, which can make it feel tight and make
penetration painful.
This condition used to be called vaginal atrophy, but in the last few years was
updated to genitourinary syndrome of menopause, or GSM, because the changes
that happen encompass more than just the dryness, irritation and burning of your
vagina. They also include urinary symptoms, too. Learn more about what
happens to your vagina during menopause.
But let's get back to your question of painful sex. The timing of your question is
good, because there was an informative article just published in The New York
Times called "Treating the Incredible Shrinking Vagina."
In it, the author, Dr. Jen Gunter, says that while these symptoms are distressing
for many women, they can almost always be treated. So, there's hope here.
Dr. Gunter writes that besides loss of lubrication during sex, women may
experience "an uncomfortable sandpaper-like sensation, pain, difficulties
achieving orgasm and even tearing of the vagina or vulva." Your risk of urinary
tract infections can climb, too, during this time and under these conditions.
Estrogen, which declines around menopause, is crucial to maintaining the
bacterial colonies of the vagina. Changing levels can also affect the type of
bacteria in your vagina and the typical odor of it, she writes.
During perimenopause—the period leading up to menopause—up to 15 percent
of women deal with GSM, with that number climbing to about 50 percent by
three years after menopause. (Menopause is defined as when you have gone 12
consecutive months without a period.)
Conversely, some women might never feel any symptoms at all. It is variable for
everyone.
But, for women who experience problems, there are treatments to help—both
over-the-counter and prescription products.
comfortable. Some data suggests that a silicone-based one will be more effective
than one that is water-based. If your partner uses a condom (yes, you can get
pregnant during perimenopause!), beware that some oil-based lubricants can
degrade condoms.
A moisturizer, used two to three times a week, can ease a dry vagina by
mimicking the actions of vaginal fluid. One example is Replens, but there are
many on the aisle of your drugstore.
And then there are prescription options. Vaginal estrogen is considered to be the
gold standard to replace your missing estrogen after menopause. It's available as
estradiol or conjugated equine estrogen and comes in different formulations
including vaginal tablets, gel caps, creams or in a vaginal ring. This type of
estrogen is low-dose and considered very safe. It is not associated with risks like
breast cancer or stroke when used as prescribed.
There's also a newer option called intravaginal DHEA, which is a hormone that's
converted in the vaginal tissues to estradiol and testosterone. Because it is
newer, it hasn't been as well-studied as vaginal estrogen, so you might want to try
the other options first. Keep in mind that some women might find it messy,
because it requires daily application.
Then there's a pill, called Osphena, which contains the drug ospemifene, which
acts like estrogen on the lining of your vagina (as well as your bones). While it
doesn't seem to have the potential harmful effects of estrogen on your breasts or
uterine lining, be aware that it can cause hot flashes and has a potential risk of
stroke and blood clots, according to the Mayo Clinic.
Besides these treatments, it's recommended that you give your vagina some
special care during this time. Wash your vulva with an unscented cleanser rather
than soap, which can be drying and aggravate the already-dry vagina you're
dealing with.
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