The “painful” truth about menopause is that it causes a change in estrogen levels that can cause sex to hurt after menopause. There’s actually a name for this—it’s called the Genitourinary Syndrome of Menopause.
What’s Going On Down There
The vaginal canal is rich in estrogen receptors. Estrogen secreted by pre-menopausal ovaries binds to the receptors keeping the tissues there plump, elastic, moist, and well lubricated. Estrogen also helps keep the microbiome of the vagina rich in beneficial Lactobacillus flora. These guys produce lactic acid that keeps the pH low, which helps reduce pathogenic microbial growth, candidiasis, bacterial vaginosis, and urinary tract infections.
As we go through menopause, the production of estrogen from our ovaries declines and eventually stops. The vaginal tissue starts to thin and breakdown. It can become dry, inflamed, and less elastic. You may experience itching, pain, or burning with urination. Many women even experience a dryness and tearing sensation during sex, which may result in spotting. The pain during sex after menopause can be so significant that you don’t want to have sex anymore.
Here’s What You Can Do to Help
Non-hormonal topical lubricants can provide relief during intercourse. They come in a liquid or gel and prevent pain by reducing friction. You apply them to your vagina or your partner’s penis right before you have sex.
Moisturizers also reduce friction during pain with sex after menopause. And when used consistently they can improve the health of vaginal tissue and provide relief. I recommend choosing water-based, paraben-free products that are made with a pH similar to the natural vagina secretions.
Many of my patients have found relief from using vitamin E vaginal suppositories that can be purchased over the counter to soothe and heal the inflamed tissue. These options are especially helpful if you have a personal or family history of breast cancer or just don’t feel comfortable using hormonal options.
If you’re open to hormonal options, restoring estrogen to the vaginal tissue greatly improves the health of the tissue and provides relief. I have seen great success in many patients using compounded estriol inserted into the vagina as a cream or a mini insert suppository typically given daily for 2 weeks and then 2-3 times a week as needed.
Vaginal Tissue Rejuvenation Therapy
Depending on the severity of symptoms, vaginal tissue rejuvenation therapy using a laser can help improve blood flow to the vaginal mucosa and stimulate new collagen growth to provide relief.
Platelet Rich Plasma Treatment
Platelet-rich plasma (PRP) treatment to the vaginal wall and clitoris is another option. With PRP, your blood is taken out of your vein, spun down to increase the concentration of platelets, and then injected into your tissue. This triggers stem cell multiplication and healthy “younger” tissue growth. This can help tighten and lubricate the tissue in the vagina and clitoris to help reduce discomfort and increase arousal.
If you experience frequent infections such as urinary tract infections, candida, or bacterial vaginosis, probiotics taken orally as well as probiotic suppositories inserted vaginally have provided preventative benefits in many of my patients.
Shatavari, also known as Asparagus racemosus, a traditional root used in Ayurvedic medicine, is known to reduce inflammation, moisten dry tissues, and increase libido. I recommend a capsule dose of 500 mg to 1000 mg 1–2 times daily.
Sea buckthorn oil has also been shown to improve vaginal health at a dose of 3 grams daily over 3 months.