DEAR MAYO CLINIC: I’m a 64-year-old girl, fortunately married for over 30 years. My husband and I’ve at all times had a wholesome intercourse life. Nonetheless, a number of years in the past, I started experiencing ache throughout intercourse. My physician stated I’m postmenopausal and in wonderful well being in any other case. The ache makes me wish to keep away from intimacy. Is ache throughout intercourse a traditional a part of getting older? What can I do, as I nonetheless wish to get pleasure from this a part of our life collectively?
ANSWER: I’m so glad you’re asking this query. Many individuals, together with clinicians, don’t at all times join menopause and sexual well being. So many ladies I see assume ache with intercourse is regular for ageing. I’m right here to inform you that isn’t the case. You shouldn’t have ache with intercourse.
Because of the modifications in hormones, nonetheless, postmenopausal ladies are vulnerable to growing one thing known as genitourinary syndrome of menopause, or GSM. Sometimes, GSM signs begin about two years after the ultimate menstrual interval, so that they lag behind different menopausal signs like sizzling flashes and night time sweats. GSM is the place there are modifications to the pores and skin of the vagina and the vulva that may end up in dryness after which ache with intercourse as a result of an absence of lubrication. These signs are sometimes the results of falling estrogen ranges. GSM can also enhance your danger of urinary urgency, in addition to your danger of urinary tract infections. Your clinician can diagnose GSM with an examination of the vulva and vagina. It’s important to endure an examination by a skilled clinician as a result of typically different issues could cause vulvovaginal signs and ache with intercourse, and your clinician can diagnose them.
The nice information is that there are a lot of protected and efficient therapies for GSM. Low-dose vaginal estrogens work exceptionally properly for girls with vaginal signs corresponding to dryness and urgency. These are very efficient and protected regardless of what you will have learn. Many sufferers ask in regards to the danger of estrogen because the Meals and Drug Administration features a warning for all estrogen merchandise, together with low-dose vaginal estrogen. Nonetheless, revealed analysis research point out that these merchandise is not going to enhance your danger of coronary heart assault, stroke, blood clot or breast most cancers.
Older ladies even can contemplate beginning a low-dose vaginal estrogen and proceed utilizing it indefinitely, not like systemic hormone remedy, which isn’t really useful to start after age 60.
The FDA-approved low-dose estrogen choices for GSM are:
- Estrace (estradiol) or Premarin (conjugated equine estrogen): A vaginal cream that you just insert into your vagina with an applicator.
- Estring: A vaginal ring that treats vaginal dryness for 3 months at a time.
- Vagifem: A suppository pill that’s routinely inserted into the vagina.
- Imvexxy: A capsule that you just insert into the vagina twice weekly along with your finger.
An alternative choice is intravaginal DHEA (prasterone), which is extra just like an androgenlike testosterone, which will be useful with vaginal atrophy. This product is offered in a vaginal pill and is inserted with an applicator nightly. Oral ospemifene, a selective estrogen receptor modulator, can be used to deal with GSM.
Recognizing your need to stay intimate, I like to recommend investing in a superb high quality over-the-counter lubricant, which will help relieve discomfort attributable to vaginal dryness throughout sexual activity. Additionally, a nonhormonal, over-the-counter vaginal moisturizer can be utilized often outdoors of intercourse to assist with consolation and supply moisturizer.
You could think about using a vibrator to assist restore the blood and nerve provide that may be impacted as a result of GSM modifications. In case you are undecided the place to start out so far as buying, attain out to a ladies’s well being specialist who can information you to protected, high quality merchandise that may be bought on-line by way of a medical provide retailer.
Keep away from douching as this may worsen dryness and irritation. And ensure you keep hydrated.
Lastly, chances are you’ll want to contemplate searching for out a pelvic flooring therapist. Usually, those that expertise ache with intercourse discover that their pelvic flooring muscle groups are influenced, so pelvic flooring remedy will be useful. Your clinician can consider this on examination and supply suggestions. Some {couples} additionally profit from intercourse remedy with a skilled psychologist if GSM has considerably impacted their intercourse life.
Getting older and going by means of menopause doesn’t need to be the top of your intercourse life. As soon as you discover the correct remedy, it is best to be capable to resume a satisfying intercourse life freed from ache. Discuss to your major well being clinician, gynecologist, or ladies’s well being specialist to study out there choices. And if you don’t discover the knowledge you search, don’t hesitate to ask for a second opinion. — Juliana (Jewel) Kling, M.D., Ladies’s Well being Middle, Mayo Clinic in Arizona
(Mayo Clinic Q & A is an academic useful resource and doesn’t exchange common medical care. E-mail a query to MayoClinicQ&A@mayo.edu. For extra data, go to www.mayoclinic.org.)
©2023 Mayo Basis for Medical Training and Analysis. All rights reserved. Distributed by Tribune Content material Company, LLC.