At the time of menopause, women who had previously enjoyed sex may develop vaginal dryness and pain with intercourse. They may also experience difficulty achieving orgasm. A milder version of this can occur in perimenopause, the time interval that precedes menopause. Perimenopause can last for three months or as long as ten years before menopause. The age at which natural menopause occurs tends to be similar to that of your mother.
Sexual dysfunction occurs because of declining levels of estrogen and testosterone. Left untreated, the vaginal dryness can progress to vaginal atrophy as these tissues literally start falling apart. In an older menopausal woman who has never taken postmenopausal estrogen, her vagina may shrink down to that of a pre-pubertal girl!
It’s important for young women to know that a similar type of vaginal dryness can occur in young women taking birth control pills or other forms of contraceptives. If the young woman is not sexually active, the problem may not be apparent to her. However, when she has her first sexual encounter and it’s painful, she may mistakenly think it’s “normal” for sex to hurt! When you consider that birth control pills are prescribed to millions of females as young as twelve, it’s probably a common problem that goes undetected. That’s because young women may be hesitant to report sexual complaints to their doctor. However, when the brain associates sex with pain instead of pleasure, this can program her to develop a low sex drive leading to disinterest in sex. No matter how much you may love your partner, if your brain always connects pain with a particular activity, your brain tells you, “Don’t do that, dummy!”
A Patient Named Mary
I remember a patient named Mary, who had previously enjoyed a healthy, sexual relationship with her husband. Mary started on birth control pills (BCPs) when her husband enrolled in dental school. Within six months of starting BCPs, Mary was having excruciating pain with intercourse. They both knew it wasn’t normal, but didn’t associate it with the BCPs. Even after stopping the BCPs, her sexual dysfunction had continued. It wasn’t until I prescribed a short course of vaginal estrogen, that she finally returned to normal. Once her tissues had healed, because her normal ovulatory menstrual cycles were producing estrogen, she did not require ongoing treatment.
In menopause, however, even after starting estrogen replacement, women may continue to experience vaginal dryness and painful sex. This problem usually subsides after a two-week course of vaginal estrogen. Menopausal women usually need to continue long-term maintenance treatment of twice weekly vaginal estrogen, to prevent recurrence of symptoms.
Sex is important in an intimate relationship between you and your partner. If it’s painful, talk to your doctor about ways to treat it.