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Painful sex after menopause is common and treatable, from the Harvard Women’s Health Watch

Millions of women experience pain before, during, or after sexual intercourse—a medical condition called dyspareunia. This common problem can sap sexual desire and pleasure, strain relationships, and erode a woman’s quality of life. For postmenopausal women, in particular, it can bring up issues of aging and body image. Many women suffer in silence because they’re embarrassed or can’t find a doctor who specializes in problems of this nature. The May 2012 issue of the Harvard Women’s Health Watch describes how dyspareunia can be treated, and guides women to get the help they need.

Painful intercourse has many possible causes, including hormonal changes, medical and nerve conditions, skin diseases, and emotional problems such as anxiety and depression. Often, several are at work. The decline in estrogen production at menopause can thin vaginal tissue, resulting in dryness, burning, and pain. Another culprit is vestibulodynia, a chronic pain syndrome that causes discomfort with any kind of touch or pressure in the area around the vagina. Psychological factors may be involved, especially in women who associate the vaginal area with fear or injury.

Treatment often requires a multifaceted approach that includes medications and other therapies as well as self-care practices. These are some frequently prescribed strategies for managing dyspareunia:

Low-dose vaginal estrogen. This is the main treatment for painful vaginal changes related to menopause. It can also help in some cases of vestibulodynia and vulvar skin problems. Vaginal estrogen has less risk of side effects than oral estrogen.

Pelvic floor physical therapy. This relatively new technique hasn’t undergone rigorous study yet, but experts consider it safe and effective. A physical therapist uses hands-on techniques such as massage and gentle pressure to relax and stretch tightened tissues in the pelvic area. Women also learn exercises to help strengthen pelvic floor muscles, which may have been weakened by aging, childbirth, hormonal changes, and certain physical strains.

Counseling. Issues such as anxiety and poor communication in a relationship can contribute to painful sex, and painful sex can put stress on a relationship. Talking with a mental health professional or sex therapist may help.

Self-care. Treat vulvar skin gently. Wash with mild soap or plain water and pat dry. Avoid perfumed products such as bubble bath and douches. Choose cotton underwear, and avoid tight clothing.

Read the full-length article: "When sex gives more pain than pleasure"

Also in this issue of the Harvard Women's Health Watch

  • In the journals: Compression stockings after deep-vein thrombosis: Knee-highs or thigh-highs?
  • Ask the doctor: Does mangosteen have any health benefits?
  • Ask the doctor: Are sunless tanning products safe?
  • Ask the doctor: Why should I limit my dairy intake to one to two servings a day?
  • When sex gives more pain than pleasure
  • Managing osteoarthritis of the knee

More Harvard Health News »

About Harvard Health Publications

Harvard Health Publications publishes four monthly newsletters--Harvard Health Letter, Harvard Women's Health Watch, Harvard Men's Health Watch, and Harvard Heart Letter--as well as more than 50 special health reports and books drawing on the expertise of the 8,000 faculty physicians at Harvard Medical School and its world-famous affiliated hospitals.