How can women expect their sex life to change after menopause?
A 2008 study showed that more than 40 percent of women in their fifties and sixties report some type of sexual problem, like low libido and difficulty with arousal. However, only one-third of these women were actually bothered or distressed by it. The key words here are bothered and distressed. If these issues aren't affecting the quality of your relationship or aren't bothering you, then these issues don't necessarily require any treatment. Some women report better sex lives after menopause, and others report no change at all. For many couples, there are a number of other issue at play besides hormones, like depression, side effects of cancer treatment, medication, and emotional connection.
However, one of the most common menopause-related issues is pain with vaginal penetration, often caused by vaginal atrophy, more commonly referred to as vaginal dryness. This can occur in 50 to 60 percent of women, and is due to the drop in estrogen levels that occurs during menopause. Women's vulvar and vaginal linings are very sensitive to this drop, and can become dry, irritated, and occasionally bleed, just like any skin that becomes thin and fragile. Women often report feeling irritation, less lubrication, and pain with intercourse. It's not uncommon for this to develop into a vicious cycle of avoiding sexual activity and put a strain on the relationship.
Vaginal atrophy can also cause the vaginal opening to shrink, which can cause pain with not only intercourse, but also with gynecologic exams. If you're experiencing pain or bleeding with vaginal penetration, it's worth seeing your gynecologist or primary care physician about to rule out other causes.
What are some over-the-counter remedies for vaginal dryness?
I often recommend trying a good quality water or silicone-based lubricant with sexual activity. Water-based lubricants are relatively inexpensive, can be used with all adult products, and are easy to clean. Silicone lubricants are more “slippery” but also more expensive, and require soap and water to clean. Also, silicone lubricants should not be used with other silicone products, including silicone toys, vaginal estrogen rings, and certain pessaries, as these lubricants may melt the silicone product. It's important to pay attention to the ingredients in these lubricants, as some include ingredients like propylene glycol, herbal extracts, and numbing medications, which could cause allergic reactions.
Another over-the-counter option for treating vaginal dryness is vaginal moisturizers. These are liquid or gel-based moisturizers that can be used two to three times per week to prevent dryness. While they are helpful for some women, others don’t like the messiness of it.
If vaginal dryness or pain persists, it may be worth getting an evaluation with your gynecologist or primary care physician. If the problem is more complex, or the usual treatments don’t work, then your doctor might then refer you to a specialist.
How can women talk to their partner about these issues?
I think the first thing that needs to happen is for women to really slow down, and pay attention to these changes in their bodies, and decide if it’s bothersome, or affecting their ability to be intimate with someone. And, if the answer is yes, then let your partner know that. For example: “Sex hurts now…I think it’s because I’m going through the change. Our sex life is important, so I’m going to the doctor to see what can be done.”
This is a good start to open communication, as many partners are relieved to discuss the elephant in the room, and it makes it easier for partners to enjoy sexual activity without worrying about causing pain in the process. It's important for women and their partners to know there are absolutely treatment options available.
Main Line Health's Menopause and You program offers support to women during menopause, including an archive of women's health articles and videos. To schedule an appointment with a specialist at Main Line Health, call 1.866.CALL.MLH (1.866.225.5654) or use our secure online appointment request form.