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Up to half of women find sexual intercourse painful after menopause, but a new medication promises to relieve painful sex.

Many women suffer moderate to severe pain during sexual intercourse after they have reached menopause. Termed dyspareunia, this condition causes recurrent pain before, during, and/or after vaginal sex. Dyspareunia may cause:

  • Pain that only occurs during sexual penetration.
  • Pain that occurs during any kind of penetration, even putting in a tampon.
  • Deep pain during thrusting.
  • Burning pain, aching pain, or throbbing pain that can last for hours after intercourse.

Dyspareunia may bring severe pain "out of nowhere," even when sex previously had been pain-free. It is not a condition that necessarily occurs with vaginismus (a spasm of the muscles surrounding the vagina), vulvodynia (chronic or constant burning or stinging pain in the vulva without a known cause), interstitial cystitis ("bladder pain syndrome" that often occurs with dribbling or urine retention), endometriosis (the appearance of tumors in the lining of the uterus that shrink and expand with a woman's menstrual cycle; during the years leading to menopause the first half of a woman's period usually gets shorter, and the tumors expand during the second half of her period, so she has more pain more often), or vulvar itching (itching caused by drying as estrogen levels lower). 

Dyspareunia isn't a simple problem. It has many causes, and there are many relatively simple interventions that can bring relief even if they don't cure the whole problem:

  • Insufficient lubrication Women at any age become more "lubricated" during longer foreplay. Simply spending more time in foreplay before sex can help with vaginal pain. Women who have past menopause (or who are breastfeeding) have lower estrogen levels, which makes the problem of insufficient lubrication worse. 
  • Certain medications increase vaginal dryness and vulvar itching. These include antihistamines, antidepressants, high blood pressure drugs, sedatives, and birth control pills that emphasize progestin. Women can work with their doctors to find prescription drugs that don't aggravate sexual difficulties.
  • Certain illnesses usually make sex painful for women. These include endometriosis, hemorrhoids, pelvic inflammatory disease, cystitis, uterine prolapse, retroverted uterus, uterine fibroids,irritable bowel syndrome, and ovarian cysts.
  • Vaginal, vulvar, or cervical trauma can make sex painful. This includes female circumcision, episiotomy (cut made in the birth canal to assist in delivering the baby), accidents, or pelvic surgery.
  • Skin disorders like eczema are sometimes the problem.

Psychological factors may come into play. Pain during intercourse is almost never "all in your head," but a history of sexual abuse can contribute to pain. Most women who have dyspareunia do not have psychological issues causing the pain.

There isn't a lot that doctors can do for dyspareunia. A prescription medication called ospemifene (Osphena) can be used to deliver estrogen directly to dry tissues in the vagina. Because it is applied topically, it is much less likely to cause the kinds of undesirable side effects associated with ordinary estrogen replacement therapy.

Some women benefit from Kegel exercises or pelvic floor training that helps them control muscle tension. Others try natural remedies for dyspareunia ranging from water based lubricants and baby oil to yoga and acupuncture. One of the newest medications for the problem is actually a nutritional supplement that has been around for over 50 years.

Continue reading after recommendations

  • Labrie F, Archer DF, Koltun W, Vachon A, Young D, Frenette L, Portman D, Montesino M, Côté I, Parent J, Lavoie L, Beauregard A, Martel C, Vaillancourt M, Balser J, Moyneur É
  • VVA Prasterone Research Group.Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause. 2016 Mar.23(3):243-56. doi: 10.1097/GME.0000000000000571. PMID: 26731686.
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