Delighted to Have Sex Again

Whether in person in my office or by email from the MiddlesexMD website, I hear variations on this story more often than you might think: A woman who’s been without a partner for years—often as many as 10—has found someone new. While she’s happy to have found a partner with whom to be intimate, she finds that sex is uncomfortable or even painful.

I celebrate the new relationship with each woman! While it’s perfectly possible to be happy on our own, it’s also lovely when we find a “right person” with whom we can share our lives and experiences—and intimacy, too.

When we find that right person after menopause, sometimes physical changes take us by surprise. Pain with intercourse is typically associated with vulvovaginal atrophy, which is the effect of the loss of estrogen. Women notice that they have less natural lubrication, and vaginal dryness makes friction painful. And the vaginal tissues are less elastic; the vaginal actually can shrink.

Both dryness and loss of elasticity can be addressed most simply with a lubricant. Silicone lubricants (our most popular is Pink) provide the most glide and last longest. Vaginal dilators can be helpful if, after a period of sexual inactivity, tissues need some gentle stretching.

Providing estrogen to the tissues is another option. There are prescription products that supply estrogen only to the vaginal tissues: Estrace cream, Premarin vaginal cream, Estring, and Vagifem are all localized options. Osphena is a non-hormonal option for treatment of vaginal and vulvar pain.

Some women describe a burning sensation on penetration, which may be caused by vulvodynia. Estrogen is part of the solution then, too, and a thorough medical exam would be helpful to determine exactly what treatment is needed.

Women who are sexually active after a hiatus also sometimes report the first urinary tract infections of their lives! There’s a movement to replace the term “vulvovaginal atrophy” with “genitourinary syndrome of menopause.” Both terms are a little clumsy, but the latter more accurately represents the reality of the effects of menopause: that there is a urinary as well as a genital component. Again, anything that improves vaginal health is a plus for the urinary tract; adding localized estrogen may be necessary. If bladder infections are recurring, using an antibiotic each time you have sex can be helpful to preventing them.

And! If you’re not in a relationship right now, whether or not you’re looking for one, be mindful of your body’s changes. If you’d like to keep your options open for the future, create your own maintenance plan; with some ongoing care, you can avoid the need to undo the effects of time.

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