Transcript
Dr. Jill Liss: Hi, I'm Dr. Jill Liss, a board-certified gynecologist, Menopause Society Certified Practitioner, and an advisor for Versalie. Today we're going to talk about a common issue in menopause that's not talked about enough, painful sex. Let's get into it.
Ambassador: So, I'm 51 years old and sex has started to hurt. Is this related to menopause?
Dr. Liss: That's such an important question. Painful sex, also called dyspareunia, is a very common symptom that happens in menopause. It is common, but that does not mean it's normal, or that you should suffer through it. The most common cause of painful sex during menopause is something called genitourinary syndrome of menopause, and that's the umbrella term that defines the changes related to the loss of estrogen in the genital and urinary tissues.
With the loss of estrogen, we have less elasticity and less lubrication due to decreased collagen, as well as blood flow in the vaginal and vulvar areas. We see structural changes that are permanent, and they do progress over time in the absence of estrogen. We also see changes in the pH and shifts in the microbiome, which can impact susceptibility to infections and UTIs can become more common.
While genitourinary syndrome of menopause and estrogen loss are typically the drivers of pain with sex, there are other causes that need to be evaluated and ruled out. Some of these include dermatologic conditions of the vulva, like lichen sclerosus, as well as pelvic floor disorders, including pelvic floor prolapse or high-tone pelvic floor dysfunction. Other contributors can be psychosocial factors like anxiety, depression, and stress.
Having a skilled gynecologist sort these things out for you and offer treatment options is the best way to move forward. There are lots of safe and effective options to treat these things.
Ambassador: Do you have any tips for dealing with painful sex during menopause?
Dr. Liss: The good news about painful sex during menopause is there are several available and effective treatments that are safe to use for nearly everyone.
The first category would be over-the-counter lubricants and moisturizers. A lubricant is something that somebody uses when engaging in penetrative sex. Whereas the moisturizers are used on a more routine and regular basis to retain moisture in the vulvar and vaginal tissues.
There are also several safe and effective prescription options, including vaginal estrogen. The great thing about local estrogen is that it's absorbed locally at the tissues where you need it, but not systemically. Thus, it doesn't carry the same risks as you might hear about in using systemic hormone therapy. There are several ways to deliver it, and truly they are safe for nearly everyone.
Another significant driver of pain with sex is related to the complex muscles and nerves that surround the genital tissues. We can treat estrogen loss, but if the muscles and nerves are also needing therapy and rehabilitation, we can't achieve a good outcome. One of the ways we can really help the muscles and the nerves of the pelvis is via pelvic floor physical therapy. These are people who are specifically trained in pelvic floor and can help with rehabilitation.
The best results typically come from people who approach symptoms with a multimodal approach from multiple angles. So, pelvic floor physical therapy together with local therapies can lead to complete relief or majorly improved symptoms. Talk to your doctor, which could be your gynecologist or your primary care doctor, about what options might be right for you.
Ambassador: So if I'm feeling discomfort and I'm not sexually active, should I still go to the doctor?
Dr. Liss: Yes. Genitourinary symptoms can affect more than just sex, so it's important to seek out help if you're experiencing discomforts or other impacts.
Ways that people might feel uncomfortable include tenderness with wiping, dryness or irritation with sitting or prolonged walking, as well as with activities that were not previously bothersome, like cycling, that are now painful or not sustainable. If you're experiencing any of these discomforts, there's benefits in treating your genitourinary symptoms to improve your comfort.
There's also benefit in that urinary tract infections can become more prevalent, and this can be an important and serious health outcome. Treating genitourinary symptoms with things like local vaginal estrogen can decrease your risk of infection, decreasing the rates of hospitalization, and serious outcomes.
Ambassador: At what point do I need to reach out to my doctor in regards to painful sex during menopause? Is it caused by menopause?
Dr. Liss: As you approach the menopause transition, it's never too early to be proactive about your vaginal and sexual health. Whether or not you're sexually active, your comfort matters, both at rest as well as with sexual activity. So if you have any symptoms at all, do not wait until they're severe to reach out for help. Talk to your doctor if you're experiencing any symptoms of discomfort with sex, vaginally irritation or dryness with sex or without sex, emotional distress related to these changes, or if you're having more frequent urinary tract infections.
But the changes related to estrogen loss are to some degree inevitable, but that doesn't mean that your symptoms or painful sex are. Reach out early, get the help you need, and be proactive about it. These are not things you need to suffer through, and they're really important to your overall health.
Painful sex after menopause is so common. I see it every day, multiple times a day, when I'm in the office seeing patients. Patients are struggling with painful sex, discomfort, but it's one of the things that I feel most empowered to help with. We have so many treatment options that are safe and effective for nearly everyone.
So if you're struggling, don't just live with it. Reach out to your doctor for help and see what treatment options will be right for you. You do not need to be alone and suffering. Help is available.