You say you’ve had painful intercourse for a few years, and were hoping it would pass. You tend not to want to have sex because the perception of pain outweighs the perception of pleasure. No surprise! And you’re not at all alone, for whatever comfort that gives you.
Once a woman transitions through menopause, she will be postmenopausal for the rest of her life. That means there is no source of estrogen, which results in what we call chronic and progressive vaginal atrophy. The effects of this are increasing vaginal dryness and thinning and narrowing of the vagina. This is not something that will reverse itself over time; without treatment, it only progresses. (I know! This is not something our mothers prepared us to expect!)
The majority of postmenopausal women who want to continue to have intercourse need to compensate for the loss of estrogen. The Premarin vaginal cream you refer to using is one option for treatment; it’s a long-term treatment, not a “cure.” It replaces the estrogen your body used to produce, directly in the area where it can have positive effect. This localized hormone treatment is preferred for women whose only issue is painful intercourse. There are fewer risks associated with it than with systemic hormone therapy (called HT or HRT, for hormone replacement therapy), which introduces hormones to more systems in your body.
If your painful intercourse isn’t adequately treated with the Premarin cream, there may be a secondary cause of pain, like vaginismus or vulvodynia. It is important to give feedback to your health care provider to be sure that the sources of pain are properly identified and treated.
It may be that your tissues are now healthy, but because you’ve avoided intercourse you could now benefit from vaginal dilators. Regular use of dilators will gradually stretch your vaginal tissues so that intercourse is comfortable again.
Alas, the sexual enjoyment that came so easily, with so little effort, is now a different story. But I hope you find the efforts of regaining sexual comfort worth the time and energy! I’m privileged to hear from patients about their successes, so I know it can happen!
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.