Menopause and Painful Sex: 4 expert tips to prevent painful sex during menopause.

Menopause and painful intercourse!

Among one of the biggest taboos, peri and post-menopause are the topic of painful sex. It’s difficult enough to discuss with your partner, let alone pluck up the courage to discuss it with your doctor.

Why does sex become painful during menopause?

We asked Women’s health physiotherapist, Christien Bird, to share her expert advice.

Christien:  'Vaginas and vulvas are very big fans of oestrogen, one of the reproductive sex hormones that begin to fluctuate during perimenopause and slowly diminish when our ovaries go into retirement.' Oestrogen keeps our vaginas, elastic and moist. So, less of it means thinning of the vaginal walls, and more painful, drier vaginal tissue. The medical term is called ‘vaginal atrophy’, and there’s not a trophy in site!!! Those of you suffering from it, know just how miserable it is.

Vaginal dryness is all about the connective tissue and muscle changes. As oestrogen diminishes, it also changes the PH of the vaginal tissues which can increase the risk of urinary tract infections.

What hormones affect sex in menopause?

Oestrogen and testosterone are the two main sex hormones that play a significant role in our sexual problems during menopause. Christien strongly believes that 'testosterone in women’s health needs a lot more attention than it currently has.'

Testosterone is made in your ovaries and adrenal glands. Christien said ‘testosterone is responsible for your sex drive, libido, your ability to orgasm, and it’s very much your joie de vivre!’ Most women’s levels of testosterone will lower, and very few will experience a rise during menopause.

Christien said ‘to maintain a little bit of testosterone and our joie de vivre, we need muscle and a small amount of fat’. Muscles are our friends in menopause. She advises that you keep up a 'healthy exercise regime, using big muscle groups on a regular basis', using your body weight to stay strong.

So, with all these hormonal changes it’s no surprise that during menopause our sex drive is affected. The Journal of the American Medical Association JAMA Study, on ‘Prevalence of Sexual Complaints in Women’, reported that good sex adds 20% to the quality of a relationship and bad sex drains the relationship by 50-60%. The research highlighted that sex improves relationships and intimacy, and women get a lot of physical benefits from having sex. Christien said ‘this often gets forgotten’. Basically, arousal and orgasm is very good for us!

Why is sex good for women during menopause?

With arousal, more fluid flows through our vaginal tissue and with that comes all the healthy reproductive hormones. Christien says if she 'could order women an orgasm on prescription' she would, it would solve so many sexual problems. When we orgasm, it helps to flush in healthy reproductive hormones through our vaginal tissue. With arousal, and with orgasm, you get a healthy flushing out of hormones.

Apparently, without an orgasm, it can take up to a day to replace those hormones. Whereas following orgasm it only takes a couple of minutes!

An orgasm is a pelvic floor contraction, so, after an orgasm, you can say you’ve done one of your three times-a-day pelvic floor exercises. Take your pick, you can do your pelvic floor exercise three times a day, or have sex. What’s your choice?

Whatever your choice, doing your pelvic floor exercises regularly, will help improve the strength of those muscles. 'You’ll find they get bulkier, improve from a sensory point of view, and you'll get a better sensation, improving arousal and more intense orgasms'. Has Christien sold it to you yet?

It's thought that 40% of women around menopause experience painful sex and most don't seek medical advice. Hopefully, 'pelvic floor strength should improve your confidence and help you to have great sex', says Christien.

Don’t forget your partner

Christien highlighted that sex in menopause affects both partners. As both are undergoing physical and emotional changes, 'it’s important that you talk to your partner, by no means should menopause interfere with the ability to have enjoyable and pain-free sex'. Christien said, ‘although it’s common, you should never consider it’s normal’.

So, what are the solutions to help stop painful sex during menopause?

Christien gave 4 top tips to prevent painful sex during menopause.

Lubrication

These are non-hormonal, water-based and silicone options that bring moisture back into your vaginal tissue. Christien likes Sylk, YesYesYes, & Replens.

Lubricants with the right PH are good for your pelvic floor, not all products will have the right PH (look out for a parabens-free lubricant). Lubricants are available on prescription. ‘It will be trial and error’, Christien says, but 'keep experimenting until you find one which works for you, never give up’. If you have pain further up, you could put some lubricant into a paediatric syringe and squirt it higher. 

Physiotherapy

If you’ve had long-standing painful sex, urinary tract infections, or vaginal irritation, the muscles of your pelvic floor may have a guarding response. Likened it to a fight or flight stress response, a bit like a frozen shoulder in your pelvic floor. Your pelvic floor muscles contract and tighten and do not relax afterwards. When they remain in this contracted state, it reduces the blood flow in this area and can cause more pain.

If this is the case, you may need an internal assessment, physiotherapy could help. You may need some internal treatment to release the muscles. Ask your doctor, if they are not confident, then ask for a referral to a gynaecologist, or to a Women’s Health Physiotherapist, this can be done via the NHS or privately.

Topical Oestrogen

Local, or topical oestrogen may help muscle tissue, and lubrication and contribute towards healthier vaginal tissue helping to prevent the misery of vaginal atrophy. This could be in the form of a small tablet that is inserted into your vagina a couple of times a week, or as a cream. Christien says her patients often see great benefit from this type of local HRT treatment, ‘it has minimal, or possibly no risk, as far as we know’. There are various types on the market, such as Vagifem tablet pessary, or Estriol vaginal cream. 'It’s thought that all women of a certain age could benefit from using topical HRT'. Something to talk to your GP about.

Talk about it!

Christien hopes that you will have the courage to talk to your doctor to seek help, especially if sex is painful. She cannot stress enough that it’s good to talk about the subject of painful sex; talk to your daughters, your mother, your friends, and most of all see a professional. She said we 'should all become ambassadors to talk about the subject'.

The last word from Christien ‘You have to have sex, to have a sex drive. The more you have it, the more enjoyable it will become.’ We say use it or lose it!!!

Watch our vlog with Christien, she gives more practical tips to help prevent painful sex; Menopause & The Pain of Sex!

You can contact Christien Bird at the White Hart Clinic in Barnes.