Sex is supposed to be fun. We all know that we have sex because of the pleasure it brings. And when our reproductive cycles were active, we couldn’t afford to be as sexually liberated as we wanted. There was the issue of family planning and dealing with all the emotional changes our menstrual cycle brought about. For this, many of us were excited about getting into menopause.
No more worrying about getting pregnant or calculating our period so we do not end up having sex on the day we are bleeding. We don’t even have to worry about the monthly cramps anymore. So it probably comes as a shock for some of us when we feel pain instead of pleasure on one of those nights.
You probably think, “I can handle this!” but the pain only seems to worsen. You chalk it up to a bad day, and you try again on another day, and the same thing happens, but this time even worse than the first day. So you get a bit worried, and you boot up your internet and place a search on Google, and you come across this page.
Well, you are not alone in this, and I mean this. You are probably suffering from a condition known as dyspareunia or painful intercourse. It is a persistent pain around your pelvic region or in your genital area. The severity of the pain varies and can be mild or extremely severe, leaving you crippled during coitus. In some cases, you might not feel this pain until after sexual intercourse, while for others, they start feeling the pain before sexual intercourse takes place.
This condition is not strange to women but is much more common in women than in men. Studies have shown that this condition troubles a lot of post-menopausal women. In menopausal women, this condition is usually caused by vulvar and vaginal atrophy. If you have done some research on menopause, you probably know that most of the symptoms associated with menopause are due to changes in estrogen levels in our body.
Now vaginal atrophy is one of these symptoms. Vaginal atrophy is the thinning, dryness, and inflammation of the vaginal walls caused by a lack of estrogen in the body. Now while there are other causes of painful intercourse, vaginal atrophy is the major reason for painful dyspareunia in menopausal women.
Causes of Dyspareunia
While vaginal atrophy might be responsible for why you can’t seem to enjoy sex anymore, other factors might contribute to this. Knowing the reason behind your condition is the first step in curing it. Let’s take a look at some of the reasons why you might be experiencing pain during menopause.
- Reduced Estrogen
You do not have the same estrogen level as other women. However, there is a commonality among women, and that is the fact that menopause results in a decrease in estrogen levels. Estrogen plays an important role in maintaining blood flow to your vagina. When reduced, the blood flow to your vaginal walls is also affected. It will, in turn, lead to vaginal atrophy, causing your vaginal tissues to become thin and dry. A thin and dry vagina means painful intercourse as lubrication is no longer possible. Your vaginal pH rises as well. This dryness increases the risk of painful genital and urinary tract infections.
- Dysfunction Of Your Pelvic Floor
Besides reduced estrogen levels and vaginal atrophy, painful intercourse can result from problems with your pelvic floor muscles. It can be due to two likely reasons. One of the reasons could be that your body is trying to stop you from having uncomfortable sex. Your body will usually contract the muscles that make up your pelvic walls. And your body does not need your permission to do this. It will do it anyway. When this happens, you might feel your vagina getting smaller upon penetration. Or you could feel intense pains as if your partner is trying to force their way through something close-off to them.
The pain could also be due to a weakening of your pelvic floor. It can cause your bladder or uterus to push against your vaginal walls, and when you have intercourse in this condition, you are sure to experience pain.
- Decreased Arousal
Estrogen is a sex hormone. During menopause, your estrogen levels decrease. It means that you might not be getting aroused as much as you would have under normal conditions. Arousal plays an important function when you are about to have sex. It triggers more blood flow to your vaginal region and causes proper lubrication. Without proper lubrication, you will feel a lot of friction during penetration, which could lead to mild pains in the vagina.
- Psychological And Emotional Factors
Let’s stop for a minute and consider that we have to face other symptoms as menopausal women. Symptoms are not enjoyable and can cause a lot of stress for us. Symptoms like hot flashes, night sweats, and insomnia will surely leave us too stressed to have sex. One very embarrassing situation I had was when I got a bout of heat flashes just moments before I planned to have sex. I still wanted to have sex, but my entire body disagreed with me. Hence I wasn’t properly lubricated, and it was one of the worst sexual experiences. Because emotions are so closely linked to sexual activity, they could have a part in sexual pain. Low arousal and associated discomfort or suffering might be caused by anxiety, despair, concerns about your physical attractiveness, phobia of intimacy, or relationship troubles.
What Does Dyspareunia Feel Like?
But what exactly does this condition feel like? Well, this is mostly a genital problem. The majority of the symptoms would be localized in the vagina. Talking about the vagina, if you have dyspareunia, your vagina will probably show you a few signs. These signs become more common if your condition is chiefly due to menopause. Some of the signs to look out for are
- Your vaginal walls begin to feel rough like sandpaper.
- Tear and bleed easily during sexual intercourse.
- Your vagina feels like it is constantly burning, or you feel the constant need to itch.
- Your vagina feels dry all the time.
- The walls of your vagina get shorter and narrower.
The other symptom to look out for is pain. That much should be obvious as the condition is about pain. Look out for pain when performing activities that should not normally be painful. It could be
- in the vaginal canal, the urethra, or the bladder
- while penetrating
- During or after a sexual encounter.
- During intercourse, deep in the pelvis.
- after a pain-free encounter
- Only in specific situations or with specific partners.
- with the usage of tampons
The pain usually comes with stabbing pain, similar to what you would feel if you were cramping from your periods.
How Do I Know If I Have Dyspareunia?
You will likely have this condition if you show the signs and symptoms I already mentioned. However, you probably won’t be able to say for sure because you do not have a medical degree. So to confirm if you have this condition, you might have to visit your healthcare provider.
When you see the healthcare provider, they will start by taking a history of your sexual and medical life. They will ask you many questions, and I know how embarrassing talking about our private parts and lives can be, but you need to be as truthful as possible when answering these questions. Some of the most likely questions they would ask you include:
- When do you feel the pain?
- Where do you experience discomfort?
- Which partners or situations make you uncomfortable?
- Are there any other activities that bring you pain?
- Is your partner willing to assist with resolving this issue?
- Are there any other issues that could be causing your pain?
After this, the doctor will carry out a pelvic examination. They are checking for specific markers that would indicate dyspareunia. They do this with the aid of a speculum. The speculum is used to inspect the vagina during a Pap test. Your doctor may also use a cotton swab to apply gentle pressure to various parts of the vaginal canal. It will aid in determining the source of the pain. This test is a bit invasive. It would be best to do this with a healthcare provider you trust and someone who will not do a botched job. Your doctor will be looking for the following signs when running this test;
- inflammation or infection
- anatomical problems
- genital warts
- abnormal masses
After your doctor has carried out the initial test, the result of this test might call for further testing. This testing is to further narrow down the underlying cause of the pain you are feeling. There are a few tests your healthcare provider might ask you to run. They are:
- Test for allergies
- Urine test
- Culture for bacterial or yeast infection
- Pelvic ultrasound
- Transvaginal ultrasound
- In some cases, they might also request counseling to determine if the reason behind the pain is psychological.
Is Dyspareunia Curable?
You probably have been waiting for this part. Perhaps, you are on this page for this reason. Is this condition treatable? And if so, what is the best way to treat it.
Well, this is a bit complicated to answer. This condition does not happen in isolation. It occurs mainly as a consequence of other conditions you might have. For most menopausal women, it is chiefly due to lower estrogen levels and the accompanying vaginal atrophy. Nothing screams pain during sex more than a dry, thin vagina. Luckily for us, many of the underlying causes of dyspareunia are due to physical problems that can be treated or managed with adequate medical attention. We will talk about the different ways you can treat this condition. Some of them can be done using home remedies and over-the-counter treatments. I will also tell you when you would need to meet a doctor.
Home Remedies That Can Reduce Dyspareunia Symptoms During Menopause
I have learned over my many years in this life that there are home remedies for almost any condition that you can think about. This condition is not left out too. You can do a few things at home when you start noticing that sex is becoming painful for you.
- Communicate With Your Partner: The first step to handling this condition is communicating with your partner. And I know this can be hard, as it would be very embarrassing to tell your partner about it. But believe me when I tell you that it would be much more difficult to bear the pain again and again, so unless you plan on not having penetrative sex with your partner, they should know that you are in pain during the process.
- Do Not Rush Things: Tell your partner how you feel during sex. Tell them they shouldn’t rush when you need to, and tell them that you feel good. Foreplay that lasts longer can enhance your natural lubrication. Delaying penetration until you’re fully aroused may also help you avoid pain.
- Experiment With Different Styles And Positions: The key here is to find a way to have sex that you would both enjoy. Try alternative positions, such as being on top, if you suffer intense pain while thrusting. You might be able to control penetration in this position to a depth that feels comfortable to you. If that doesn’t work, then try another one. The key here is constant communication. Please do not be shy to tell them exactly how each position feels. Also, both of you should do a bit of research. I am not saying you should crack open the Karma-sutra, but a little knowledge about sexual positions never hurts anybody.
- Prepare For It: As exciting as spontaneous sex can be, I am sorry to tell you that you can’t afford that luxury anymore. Come to bed fully prepared. It means keeping a checklist and making sure the lists are all ticked before you attempt to have sex. You should make sure you are both relaxed. Taking a warm bath helps with that. Then you should empty your bladder before sex. You should also use water-soluble lubricants (we will discuss this later).
- Try Other Means Of Intimacy: Eventually, you might realize that you require other ways of maintaining intimacy in your relationship, and until it becomes less painful to participate in vaginal sex, you might have to try these alternative means of intimacy. Alternatives to intercourse like sensual massages, kissing, and mutual masturbation may be more comfortable, gratifying, and enjoyable than your typical routine.
- Over-The-Counter Pain-killers: This could also help. I mean, what better cure for pain than pain relievers. Try taking them before having sex and see if they help with the pain.
Vaginal Lubricants And Moisturizers, Their Benefits And Side Effects
I already mentioned that the basis of treating this condition is by treating the underlying cause. For menopausal women, this is mostly due to vaginal atrophy consequent upon reduced estrogen levels. The most common treatment used for this condition in menopausal women is the topical use of vaginal lubricants and moisturizers.
The major symptom of vaginal atrophy is vaginal dryness. It is this dryness that makes sex painful for women going through menopause. That is where lubricant and moisturizer come into play. They serve as non-hormonal treatments for vaginal dryness. They have proven to be quite productive in reducing the friction that leads to pain in vaginas with thin walls.
The two might serve the same function, but that doesn’t mean they are the same.
You see, a lubricant is meant for instant release and is meant to be used shortly before or during sexual intercourse to reduce pain. On the other hand, moisturizers demand a little more consistency than that. They work by rehydrating your vaginal tissues. Use them over a long period, and you should be consistent. It has a cumulative effect, so the best practice would be to rub them on your vaginal walls a few times a week.
Side-Effects Of Using Vaginal Lubricants and Moisturizers
Using these products is relatively harmless. They do not generally threaten your health, but like most medications, they have side effects. Some of the side effects include:
- Skin irritation, as a result of your skin reacting to an ingredient in the product, is a common side-effect.
- Allergic reactions are also quite common, so when looking to get these products, it would be better to check if they have an ingredient you are allergic to.
- Yeast infection
- Some vaginal lubricants also tend to dry quickly, creating a constant need for reapplication and might lead to a further decrease in libido.
For menopausal women, artificial lubricants do not address the fundamental problem of clinical vaginal dryness. They do not affect estrogen levels or weaken vaginal tissue. As a result, you may discover that these products do not completely fix the problem.
Estrogen creams may be a helpful option for those who do not find relief from vaginal atrophy when using commercial lubricants. However, because of the risks associated with these, it would be best to talk to your doctor before you start using them.
Receiving Counseling for Dyspareunia in Menopause
Apart from vaginal atrophy, there are plenty of reasons why you might be experiencing menopausal pain. For people like this, the cause of your pain might be more psychological than you think. These cases may require you to address the psychological issue before your life returns to normalcy.
There are counseling methods that have been developed to help you with this.
- Desensitization Therapy: Desensitization therapy teaches you pain-relieving vaginal relaxation techniques such as Kegel exercises. Consistent use of these techniques and exercises will help reduce your pain during sexual intercourse and improve your sex life.
- Sex Therapy: This is also known as sex counseling. Even after treatment, if sex has been uncomfortable for a long time, you may maintain a poor attitude to penetrative sex. You may require assistance if you and your spouse have avoided intimacy due to painful sexual activity. You may need to enhance communication and re-establishing the sexual connection. These concerns are resolved by speaking with a counselor or sex therapist.
- Cognitive Behavioural Therapy: Cognitive-behavioral therapy is a form of therapy that aims to change the way you think and react to help you manage your difficulties. This kind of therapy has also shown promise in the treatment of dyspareunia.
When Should You See A Doctor?
You may start feeling severe pain during intercourse, and home remedies or over-the-counter treatment do not seem to be working. The best thing you might need is to contact your healthcare provider for proper diagnosis and treatment.
Yes, this condition is a very common issue among menopausal women like you and me. However, you don’t have to stop having sex or put up with the discomfort. Ignoring your symptoms may worsen the longer you’ve been through menopause. If you’re unsure what’s wrong with your vagina, consult your doctor. They can assist you in determining the cause of your discomfort and treating it. Stay safe, stay happy.