My friends have been talking about their menopausal symptoms for years. I've been with them when a hot flash strikes. They have lamented their night sweats and sleepless nights. I have expressed empathy to them, while inwardly thanking my lucky star that I wasn't having these bothersome indicators of "the change."
Yet, the reason I was asymptomatic wasn't my menopausal status; it was due to taking oral contraceptives, which mask the symptoms of menopause. I recently stopped taking birth control pills when a blood test confirmed what I suspected: I am post-menopausal. I braced myself for night sweats and sleepless nights; none came. I braced myself for hot flashes; none came. I concluded that I was one of the fortunate women who glide through menopause without the common symptoms that so many suffer.
But, then a symptom struck: Painful intercourse. The technical term for this is dyspareunia. According to a study, published in the Journal of the American Medical Association in 1999, 25% of post-menopausal women have some degree of dyspareunia. A more recent study found that 49% of menopausal women suffer from painful intercourse. This same study found painful intercourse to be a taboo topic; few discussed it with friends. No wonder my own confidants never mentioned this when bemoaning their night sweats and hot flashes.
Sadly, according to the Mayo Clinic website, many women also never mention this to their doctors. As Joan Price explains in her book, Naked at Our Age, "...many kinds of vulvar and vaginal pain are medical issues with a cause that requires a medical intervention." Joan therefore recommends that women see a doctor if they are experiencing genital pain. I concur. Reading this brief bog is unlikely to resolve your problem if you have genital pain. I hope, however, that this blog does let you know that you are not alone and that effective treatment exists. Seek it.
I did. I called my trusted gynecologist who explained that the most common cause of painful intercourse among post-menopausal women is lack of estrogen. Reduced estrogen levels can cause shrinkage of the vaginal mucosa. This shrinkage results in narrowing of the vaginal opening called the vestibule. This condition is called vaginal atrophy. Commonly, this narrowing of the opening causes pain during initial penetration that usually subsides once the penis is deeper inside. My gynecologist prescribed an internally-applied estrogen cream. The doctor also recommended using a water-based personal lubricant during foreplay and intercourse, warning me to avoid glycerin-based lubricants because they can result in further dryness for menopausal women.
Ellen Barnard also recommends either water-based lubricants (such as Liquid Silk) or silicone- based lubricants (such as Pink), as part of her Vaginal Renewal Program. As described on her website, this is a program "for women who are currently sexually active with vaginal penetration, and are experiencing dryness and discomfort or pain during intercourse that is either diffused throughout the vagina or burning or tearing at the vaginal opening." It is chock-full of good advice---and is bound to educate and assist any post-menopausal woman suffering from painful intercourse. Another excellent resource is Our Bodies, Ourselves: Menopause.
Vaginal dryness and painful intercourse are as much a part of menopause as hot flashes and night sweats. Break the silence, and tell your friends about it. Also let them know that information and help is just a mouse click and phone call away.
Note: Premenopausal women with vaginal or vulvar pain should see their doctors. Another good source of information is www.nva.org