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Help! I’m In Menopause and Sex Really Hurts!

For many women, menopause can be a time of welcome sexual freedom as she can stop worrying about an unintended pregnancy (though, of course, there is still the risk of contracting a sexually transmitted infection if she is not in a mutually monogamous relationship).

But for many women, the normal physical changes that take place in menopause can result in vaginal dryness that can then cause sexual discomfort and loss of interest in having sex.

The purpose of this blog post is to help gain a better understanding of those physical changes and what can be done to help.

Is my sex life over because of vaginal dryness in menopause?

The simple (and reassuring) answer is, “Absolutely not!” Some women may be less interested in sex after menopause because it has become physically uncomfortable. That discomfort from dryness can sometimes feel gradual or seem to happen more suddenly. It can leave a women feeling guilty or inadequate in her relationship with her partner.

What happens in menopause to cause vaginal dryness?

It is normal for many women to experience vaginal dryness in menopause and in the years leading up to menopause.

These changes result from the decrease in hormone levels in our bodies as we age, namely decreased levels of estrogen. Decreased estrogen causes physical changes to take place such as thinning of vaginal tissue, shortening and loss of elasticity of the vagina, and decreased vaginal discharge for lubrication. All these physical changes coalesce to make the vaginal tissue feel more fragile and sensitive.

What are some common symptoms of vaginal dryness in menopause?

Some women report burning or itching, some complain of a friction or tearing sensation with intercourse, and some report feeling an increase in vaginal or urinary tract infections.


What are some options to treat vaginal dryness?

Water-based lubricants are oftentimes helpful to women with mild symptoms only during sex and are available over the counter.

They decrease the sensation of friction to provide temporary relief to the discomfort experienced with sex. Unlike lubricants, vaginal moisturizers are absorbed into the vaginal tissue and are often helpful for women who have mild symptoms of irritation or burning even when they are not having sex.

I tell patients to think of it in the same way as one would moisturize her skin. For many women however, particularly those with more severe symptoms, the use of low-dose estrogen directly in the vagina is even more helpful and is often recommended.

These medications increase blood flow to the vaginal tissue and improve the thickness and elasticity. They come in the form of vaginal creams, tablets or rings and most women will notice an improvement in their symptoms in a few weeks depending on how severe their symptoms are.

Deciding which option is best for a woman is best done in discussion with her health care provider.

If I have stopped having sex for a while, will I be able to do it again?

It’s an unfortunate truth that “If you don’t use it, you’ll lose it.”

Abstaining from sex for a prolonged period of time will make vaginal dryness worse because vaginal intercourse stimulates more blood flow to the vagina, stretches the tissue and increases natural vaginal lubrication.

However, even if you have been avoiding sex for a long time, the use of vaginal hormones can help a woman achieve a more satisfying sex life.

What can I do right now to get help?

Talk to your gynecologist about concerns you may have with painful sex. The North American Menopause Society (NAMS) is also a fantastic and reliable resource to help you navigate through menopause.


About Michele Benoit-Wilson, MD, FACOG

Dr. Michele Benoit-Wilson is a board certified OB/GYN with WakeMed Physician Practices – North Raleigh & Brier Creek. Her clinical interests include: contraceptive management, abnormal bleeding, fibroid management, laparoscopic surgery and both routine and high risk obstetrics. Learn more about Dr. Benoit-Wilson, and schedule an appointment today.