Vaginal dryness, often the first signal of vaginal atrophy, is a common obstacle to comfortable sex for midlife women.
It is most often the result of the changes we all experience with menopause.
When young women are sexually aroused, vaginal lubrication flows easily from the vagina's blood vessels through its tough, elastic lining. Plenty of estrogen and testosterone in our systems kept these tissues strong and healthy, and made this process automatic, if we were lucky. As estrogen levels decline, the vaginal lining changes, becoming less stretchy and more delicate (much like all the rest of our skin). Blood vessels, muscles, and surrounding tissues all become less responsive over time, and result in vaginal dryness.
As we age, our testosterone levels drop too, making sexual desire and drive half as strong as they used to be. At age 50, we have about half as much testosterone as we did at 25, our peak. When lack of desire and painful penetration reduce the number of sexual encounters, the vagina responds by losing its elasticity and responsiveness even faster.
Vaginal Atrophy and Painful Intercourse after Menopause
Vaginal dryness can progress to vaginal atrophy, the thinning and weakening, shortening and tightening of the vulvo-vaginal tissues. It's the most common cause of painful intercourse after menopause, experienced by more than half of us. In addition to vaginal dryness, it can give us vulvar pain, discharges, pain or stinging with penetration, tearing or bleeding of increasingly delicate skin, and a variety of issues with urination. Yes, that's right. If you don't use it, you lose it.
The net effect: We can pretty quickly lose our ability to lubricate our own vaginas, which can become quite sensitive and prone to tearing, leading to painful intercourse after menopause. Ouch!
Fighting Menopausal Vaginal Dryness
If you enjoy sex, and want to have it as part of your life, then keeping your vagina well moisturized and in good condition is just one more piece of your body maintenance routine. You cleanse and moisturize your face. You work out to maintain your strength and agility. Your new best friends in fighting menopausal vaginal dryness will be lubricants and moisturizers, lubricants to use during sex, and moisturizers to use between sexual encounters to keep your vagina moist.
When we stop having penetration with sex, vaginal changes happen more quickly. We're more likely to have tiny abrasions from friction, causing the walls of the vagina to stick together or even close in some places. Regular sex, including penetration, either alone or with a partner, increases blood flow to the vagina and surrounding tissues.
What Not to Do
A word about what not to do: Do not use packaged douches to treat vaginal dryness. These will make matters worse by robbing your vagina of its healthy flora. Do not use hand lotions, vinegar, or yogurt as moisture replacements. They're not effective moisturizers and may contain ingredients that will work against your healthy pH level. If you prefer to use alternative therapies, by all means, explore them, but please get your advice from a qualified provider who has experience in vaginal therapies.
When Dryness During Intercourse Persists
If your symptoms of dryness during intercourse progress, or you are experiencing dryness all the time, we encourage you to talk to a gynecologist or menopause specialist you trust and feel comfortable with. Sometimes thinking it through and developing a plan with another person can really help.
One extra note about your most critical sexual organ -- your mind. When you're not actually in the mood for sex, or you are not aroused enough for sex, all the lubricants and moisturizers in the world won't make the experience pleasurable. Our bodies, at any age, must open to the experience before we can enjoy penetration or even clitoral stimulation. At midlife, that will usually take longer than it did when we were young. Give yourself time, and ask for time from your partner to allow both your mind and your body to engage before sex.
Learn about the actions you could take, listed at right, to address this condition or see other conditions that could affect you.
First published 01/13/2010 Last updated 07/26/2013
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