Sandpaper. That is what my patients tell me about how their vagina feels during sex after menopause.  There’s good news though--you don’t have to live that way.  There are several things you can do to reinvigorate “down there”.

 What is menopause?

 When your ovaries stop releasing eggs each month, you have entered menopause.  Without the ovulatory cycle, your ovaries are not making estrogen and progesterone like they used to.  Testosterone is also decreasing.  These hormones play a large role in sexual function.

 Vaginal changes after menopause

 We call the changes to the vagina vaginal atrophy which is part of the genitourinary syndrome of menopause (which includes changes to the urinary tract).   Vaginal atrophy doesn’t usually appear until about 5 years after the last menstrual period.  Many women don’t realize that vaginal dryness is due to menopause.  They feel like something is wrong with them when sex hurts. Many times, their partner is concerned because they don’t appear to be lubricated or aroused and the couple is unaware that this is a normal change of menopause.

 Lack of estrogen causes some major changes to the vagina.  Before menopause, estrogen  makes the vaginal walls thick, moist and stretchy.  There is good blood flow to the vagina and plenty of nerves (just ask anyone who has had a baby!).  There are small folds (rugae) in the vagina that allow the vagina to stretch so a penis can fit into it or a baby can come out of it.  All of this leads to pleasurable sex. But after menopause, the vaginal walls become thin and dry.  They lose their rugae, stretchiness and they don’t naturally lubricate during sex.  This loss of elasticity combined with lack of natural lubrication can lead to painful sex.

 4 things you can do about vaginal dryness.

Lubricate:  There are several types of vaginal lubricants: water based, silicone based and natural oils like olive oil.  If you are menopausal and have vaginal dryness, throw away the water based lubes. Although they sound “natural”, water based lubes pull moisture from the vaginal tissues and make dryness worse. Pick a silicone based lube like Uberlube or Wet Platinum.  Water based lubes do not affect the integrity of a condom but some silicone based lubes do.  If you are using condoms, the silicone based Uberlube is a good choice because it does not affect the condom.  Put some on the outside of the vagina, which is called the vulva, and before sex, put some on your partner too.  This will help things glide a lot more smoothly.  

Moisturize

Just like you put lotion on your hands, you can also moisturize the vagina.  There are a variety of products on the market for this, like Lubrigyn or Hyalo Gyn.  I tend to recommend coconut oil (solid) or wait for it. . . .Crisco.  You can use as little or as much as you want.  You can put some on the vulva morning and night, or every time you pee.  You can even freeze chunks in an ice cube tray and then insert them into the vagina with your finger.  This does not increase your risk of infection.  

 Low dose vaginal hormones

 Low dose vaginal hormones replace what the vagina is lacking during menopause- estrogen.  Before you say no to hormones, remember that low dose vaginal hormones do NOT increase your risk of breast cancer, blood clot, heart attack or stroke.  Vaginal hormones restore the elasticity to the vagina, allowing it to stretch without pain and return its ability to lubricate itself again. Sex becomes pleasurable again as there is more blood flowing to the vagina allowing for more sensation and engorgement. 

 Vaginal laser

There are some several studies evaluating vaginal laser for the treatment of genitourinary syndrome of menopause.  Thus far, they show some promising results.  Vaginal laser breaks down old collagen and your body replaces it with new healthy collagen and elastin. After laser, the tissue appears more like premenopausal tissue with more superficial cells and women report less dryness and less pain. 

Go ahead, reinvigorate the vagina! No need to have painful sex when there are so many treatment options.  You will be so pleased with your results!

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Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click here to schedule.