Menopause and painful sex

Menopause is the time in a women’s life when they she will have their her final period, marking the end of the reproductive cycle. Ovulation no longer occurs, there is a decline in oestrogen and progesterone, and this displays in various ways. Most women in Australia will be menopausal by the age of 51 and perimenopause can last for many years prior to this.

There are three main phases to menopause:

• Perimenopause: the time prior to menopause where a woman may notice a change in her periods (shorter, longer, or more irregular) as well as other symptoms such as hot flushes, brain fog and weight gain

• Menopause: The last menstrual bleed

• Post menopause: starts when a person has had no menstrual bleed for 12 months.

There are many different effects that can occur on the body (you can read more about menopause here) and this can include the vagina and sexual function.

Vulvovaginal atrophy (also called Genitourinary Syndrome of Menopause – GSM) refers to symptoms that occur in the vaginal canal primarily due to a decrease in oestrogen. These symptoms are reported in 50-70% of postmenopausal women to varying degrees.

Symptoms include:

Genitals:

• Vaginal dryness

• Irritation/burning

• Vaginal/pelvic pain and pressure

• Vaginal Vault Prolapse

Sexual:

• Pain with intercourse (Dyspareunia)

• Reduced lubrication

• Post-intercourse bleeding

• Decreased arousal

• Decreased/loss of libido

• Pain with orgasm (Dysorgasmia)

Urinary:

• Pain with Urination (Dysuria)

• Urinary Urgency

• Leakage with coughing/sneezing/exercise (Stress Urinary Incontinence)

• Recurrent urinary tract infections

• Urethral prolapse

Menopause and post menopause is a common time for pelvic floor symptoms to worsen, with up to 40% of post-menopausal women reporting urinary incontinence and up to 31% reporting symptoms of pelvic organ prolapse. Most symptoms are reported around age 60-65 years old. Oestrogen assists with keeping muscles and tissues strong and flexible which is why there can be such profound symptoms occurring to the pelvic floor and vaginal tissue.

Treatment options:

If you are experiencing painful intercourse, then you have a number of options and going to see your trusted health care provider is the first step. 

• Topical vaginal oestrogen or hormonal replacement therapy (HRT):your doctor may recommend topical vaginal oestrogen or HRT if you experiencing symptoms related to Genitourinary Syndrome of Menopause including vaginal dryness and painful sex. This is not suitable for everyone and is always prescribed by your medical professional.

• Using a good quality water based gel/lubricant to assist with vaginal dryness during intercourse. This can help to keep the vaginal tissue lubricated to prevent any unwanted friction which can increase pain and pelvic floor tension.

• If you are experiencing vaginal stenosis/narrowing or getting skin splitting at the vaginal entrance then something like dilators may be appropriate. Vaginal Dilators allow the vaginal tissue to gradually stretch over time which can restore some flexibility and length to the tissue and can be effective at treating painful intercourse.

• Seeing a Pelvic Floor Physiotherapist to address bladder and bowel function, work on your return to pain free intercourse and ensure that there is not something besides vaginal dryness or narrowing that is causing your pain. Other reasons for pain with intercourse may be a prolapse or pelvic floor tension – that is, the inability of the pelvic floor to relax!

To find out more about menopause, your pelvic floor and how we can help, click here.

References:

• Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020 Apr 8;12(4).

• Rosenbaum, T.Y. (2005) Physiotherapy Treatment of Sexual Pain Disorders. Journal of Sex & Marital Therapy, 31, 329-340.