Hot flashes, weight gain, and difficulty sleeping – these are all commonly discussed issues that women encounter during perimenopause and menopause. Painful intercourse is something women may be a bit more hesitant to discuss, but it shouldn’t be because it’s a problem that many women start to experience during this transitional time in their lives.
As we age, our skin collagen decreases, which can lead to less cushioning between the skin and our pelvic bones and a decrease in lubrication. Our skin also thins and is more easily irritated. These changes can cause discomfort with vaginal penetration and sometimes external friction during sexual activity.
The good news is that there are several ways to help decrease pain during intercourse and improve your satisfaction:
- Maintaining regular sexual activity with a partner or through self-pleasure is essential for promoting adequate blood flow to the genital area. More activity, therefore, can actually help decrease discomfort and maintain function.
- Moisturizing lotions designed specifically for the vagina can help improve skin health, and there are many different types available at your local pharmacy or grocery store. Similar to facial and body moisturizers, vaginal moisturizers are best absorbed after a shower or bath and can be used as often as needed. Hyaluronic acid products have been studied and have had good effects. Some just use coconut or vitamin E oil.
- Vaginal lubricants can help decrease friction which can cause pain during sexual touching and penetration. There are three main types of lubricants, and many different options are available within each type. Experimenting and finding the one that works best for you is important.
- Water-based lubricants feature easy clean-up from sheets and clothing and a low chance of skin irritation, although different additives like preservatives may irritate some people. Water-based lubricants can dry out and require additional water (or saliva) to reconstitute.
- Silicone-based lubricants are the most slippery; therefore, only small amounts are needed, and you are less apt to need additional applications. Note that silicone-based lubricants should not be used with silicone vibrators because they can cause a reaction that will deteriorate the vibrator.
- Oil-based lubricants are the most likely to be irritating to sensitive skin, but many women enjoy using plain old olive or coconut oil or ghee that they have on hand in their kitchen cabinets.
If these at-home remedies don’t work, it’s time to consult your primary care provider or gynecologist, who can perform a careful examination to rule out other causes of pain, including infection, non-hormonal skin problems, or pelvic floor muscle injuries. Your provider may recommend a prescription for vaginal estrogen to help rebuild some vulvar and vaginal skin pliability and natural lubrication. These come in the form of creams, pills, or rings, and your provider can discuss these options with you.
Some people require pelvic floor physical therapy or work with vaginal dilators to rehabilitate the vagina after menopause. Women who have never had a vaginal delivery tend to have more problems with a shrinking vagina after menopause.
For women experiencing physical challenges that interfere with their quality of life during menopause, Atrius Health offers Menopause Consultation Services to our patients at our Kenmore and Chestnut Hill/West Roxbury practices, and virtual visits are also available.
