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Painful sex during menopause? Know your options

Karen Hawthorne is a health and lifestyle writer and producer in Toronto, Canada. Her work has appeared in print and online for publications including Glow, Homemakers, BestHealthMag.ca and the National Post.

Menopause: Managing painful sex

Results from a recent HealthyWomen survey show that the vaginal and sexual symptoms of menopause can have a negative impact on postmenopausal women’s sexual health, yet women are generally too embarrassed to address the symptoms with their doctor or partner. There are treatment options – women can enjoy sex without discomfort. Here’s our Q&A with survey consultant Dr. Michael Krychman from the Southern California Center for Sexual Health and Survivorship in California.

Woman with menopause in bed

Dealing with menopause

SheKnows: Women equate menopause with hot flashes and night sweats. Were you surprised that only 48 percent of survey participants were aware that painful intercourse is a symptom?

Michael Krychman: Although vaginal changes like painful intercourse are a common symptom of menopause, experienced by almost half of all postmenopausal women, many women do not associate them with menopause. Although this lack of awareness is unfortunate, I'm not surprised. I've found that many women are often too embarrassed by painful intercourse to speak to their health care professional about it so they never make the connection. Many times, women think painful intercourse and vaginal dryness are just a normal part of the aging process and they can't do anything about the changes they are experiencing, so instead of seeking information, they just choose to deal with these conditions the best they can. It is unfortunate that women are suffering in silence when there are safe effective treatments available that can diminish their symptoms.

Speak up! Vaginal dryness can be treated

SheKnows: Why is vaginal dryness symptomatic of menopause?

Michael Krychman: During menopause, women no longer produce as much of the hormone estrogen. Decreases in estrogen levels may cause tissues of the vulva and the lining of the vagina to become thin, dry and less elastic - a condition known as atrophy. Vaginal secretions also diminish, resulting in decreased lubrication. Without treatment, the problem may worsen, and the vaginal tissues can become inflamed, a condition called atrophic vaginitis. Additionally, women who are not sexually active may be bothered by vaginal dryness and itching, and these symptoms can become more severe as time passes.

SheKnows: Over-the-counter lubricants can help, but do they only lessen dryness temporarily?

Michael Krychman: Depending on a woman's individual treatment goals and risk profile, a health care professional may recommend over-the-counter vaginal lubricants and moisturizers or prescription estrogen therapy. Water-based vaginal lubricants may decrease friction and temporarily ease discomfort during intercourse, and vaginal moisturizers act directly on tissue to relieve dryness. However, they don't treat the root cause, which is estrogen depletion and associated tissue morphological changes. By supplying topical estrogen locally to the vaginal tissue, prescription estrogen therapy treats the underlying cause of painful intercourse and restores vaginal tissue.

Hormone therapy addresses root cause

SheKnows: There are prescription hormone therapy creams and treatments, but women are afraid of the risks.

Michael Krychman: As with all medications, there are certain things women must be aware of when considering prescription estrogen therapy cream. The same risks of hormone therapy use are found with all estrogens. Women should know that using estrogens may increase the risk of certain conditions, including cancer of the uterus, stroke or blood clots, and dementia (based on a study of women 65 years or older). The decision to take hormone therapy should be made in consultation with a health care professional based on an individualized assessment of treatment goals and personal health risks.

SheKnows: What is the best option for someone who wants a low-dosage, convenient method of treatment?

Michael Krychman:  There is no one-size-fits-all approach. There are a variety of products on the market including minimally absorbed local vaginal estrogen tablets, creams and rings. A frank discussion with your prescribing health care professional about the symptoms you are experiencing is necessary so that he or she may tailor your treatment plan to your individual needs and lifestyle. Assessment and choosing a product should also include a discussion about benefits and risks of each product, and your personal individual risk factors and family history.

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