#55 Painful Sex After Menopause

The medical term for painful sex after menopause is menopausal dyspareunia. It’s not a matter of either you have it or you don’t. It’s a matter of what degree of pain you may have. Between 20 and 40 percent of menopausal women have some level of pain with intercourse.

If you are having pain with intercourse, you should make an appointment with your doctor for a pelvic exam. Your physician may recommend an ultrasound. Conditions such as cancer of the vulva, vagina, uterus, ovary, or bowel may be associated with painful sex after menopause. These conditions are less common causes for the pain, but more dangerous.  These cancers are often hard to diagnose but are serious and treatment should not be ignored or overlooked.

Cancer of the vulva begins with few symptoms except for the possible presence of itching or burning. As the vulva shrinks, a benign but troublesome disease called lichen sclerosis can develop. However, a small area as little as less than half an inch in diameter could be vulvar cancer. So I recommend you see your doctor for any itching or burning of your vulva.

The value of pap smears has been downplayed in recent years, but although pap smears are no longer done routinely in the yearly physical exam for women, the rate of cervical cancer in increasing. The pap smear also can detect vaginal cancer.

Once your doctor has ruled out cancer, your physician can move on to a common cause of painful sex after menopause, vaginal dryness.  In menopause, the outside layer of your ovaries stops making eggs—and estrogen. The estrogen is responsible for keeping your vagina soft and stretchy.

The thinning and shrinking of your vagina which occurs when estrogen levels fall can be diagnosed with a pelvic exam. The whole conversation around hormone replacement theraphy has become very complex with many options, depending upon your symptoms. The Mayo Clinic has a good discussion of the many varieties of hormone replacement therapies.

Vaginal estrogen cream has become popular for treating menopausal symptoms. The big problem with them is the expense. A tube may cost as much as $300. There are over-the-counter alternatives made from yams, plants which contain estrogens. These creams will be weaker than the prescription vaginal creams, but they can be effective, especially if you start treatment early before the dryness has a chance to become more severe.