Sex: whether talking about it, thinking about it, or doing it, it often seems as though our society is obsessed. But if you paid attention to how sex is depicted in our society, you could be forgiven for thinking it is only the young and beautiful doing it! The reality is that sex is part of life for the majority – including older women. And when a potentially rewarding aspect of life is not working well, it’s time to sit up and take notice.

Older women (in this post, meaning women after menopause) may experience changes in aspects of their sexual life. Sex after menopause can have particular issues. In particular, a natural decline in oestrogen can promote a thinning and ‘’shrinking’’ of the vagina and external genitals, known as ‘’urogenital atrophy’’ or ‘‘vaginal atrophy’‘. This often leads to vaginal symptoms such as dryness, itching, pain with passing urine and pain with sex (although the latter can have more serious causes too, and should be checked by your doctor). An interesting survey run on menopausal women in the United States revealed the following:

  • 22% of women felt uncomfortable with discussing this issue with their partners
  • 57% of women avoided intimacy because of sexual discomfort and 31% of women stopped having sex altogether
  • 64% of women found sex painful and 30% found sex less satisfying due to discomfort
  • 65% of women reported a loss of libido
  • 35% of women no longer felt sexually attractive due to vaginal discomfort
  • 39% of men and women thought the effect of menopause on their sexual relationship was worse than expected.

This shows a pretty significant impact!

(Now – before I go on – I need to make the point that we should not jump to conclusions about the cause. While vaginal atrophy is the most common cause in this age group, other causes to consider include vulvodynia, vestibulodynia, and vaginismus. All of these conditions are treated every day here at Equilibria).

The researchers made the point that the major treatment for vaginal atrophy (a main cause of painful sex after menopause) is vaginal oestrogen cream or pessaries. Less than one-third of women with these symptoms used such a cream or pessary! Of those who did, over half found that it reduced pain with sex after menopause. Although figures are not known for Australian women, it is a point worth thinking about. A simple treatment for this is available and reasonably effective: vaginal oestrogen.

And why not just use vaginal lubricants? While I am a big proponent for vaginal lubricants and moisturisers (and stock the best available here at the practice) they do not address the underlying changes in vaginal atrophy (loss of surface cells, a change to a more alkaline pH, and shrinking of the vagina). Some women will do well with lubricants or moisturisers in conjunction with pelvic floor physiotherapy if there have been changes to muscle function. Some women, however, will notice better improvements through the use of vaginal oestrogen. With the right treatment for pain with sex, sex after menopause can be as satisfying or more then in your younger years.



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