When Pain Becomes an Issue

How low estrogen can lead to painful sex, and what to do about it.

Last week I posted the first of four articles addressing various aspects of low libido, which is a common and often complicated issue both during and after the menopause transition.

Why is it complicated? Because libido can involve biological, psychological and social factors. This means low libido can be the result of a biological issue like low hormones or non-biological factors like chronic stress, lack of connection with an intimate partner, self-esteem issues due to changing mid-life bodies, and today’s topic: pain.

Alright, let’s get into it!

So here’s the deal: you’re unlikely to want sex that’s painful.

If you’re experiencing low desire and unwanted discomfort during sex, addressing the discomfort is a great place to start addressing issues of low desire.

What does menopause have to do with painful sex?

Genitourinary Syndrome of Menopause (GSM) is the medical term for changes to the tissues of the vulva, vagina and urinary tract due to declining estrogen during the menopause transition, and low estrogen post menopause.

Estrogen is lubricating and keeps tissues plump, healthy and happy. As estrogen declines and eventually settles at low postmenopausal levels, our natural lubrication decreases and tissue can become dry, fragile and painful. As a result, sex can become very uncomfortable.

So what can I do to troubleshoot painful sex?

First, make an appointment with a menopause specialist or gynecologist to discuss the possibility of genitourinary syndrome of menopause. Vaginal estrogen cream is inexpensive, safe and effective at restoring vaginal tissues. As one person recently told me: this stuff works miracles. Having used it for the last several years, I wholeheartedly agree.

Second, start using lube every time you have sex.

In addition to making sex more comfortable, studies show lube enhances pleasure and increases the likelihood you’ll orgasm. So it fixes the problem of “sandpaper sex” and can make for a better overall experience.

Not quite convinced? Read this quote from Heather Corinna’s book titled, “What Fresh Hell is This?”

She says,

“In the event you’re not already a lube superfan, and shame has gotten in your way of using a slippery vat of lubey goodness, hear this: Lube is not a bummer or something to be embarrassed about. Lube is gravy on potatoes, pomade on a pompadour, or warm, melty syrup on pancakes for crying out loud. Lube is a glorious thing that can make a potentially already good thing anywhere from a little better to downright magical.”

Okay, I’m sold. What kind of lube should I use?

There are three types of lubricants: water based, oil based and silicone based. What type you prefer is highly personal.

A few things to consider:

According to Dr. Jen Gunter in her book “The Menopause Manifesto”, women with GSM symptoms tend to do well using silicone based lubricants like Astroglide X and Über Lube. But silicone lube can be harder to get out of sheets and isn’t compatible with silicone toys.

Doctor Gunter says water based lubes tend to have more ingredients that you have to worry about. You need to look at both pH and osmolality so that the product doesn’t draw water out of vaginal tissue, causing even more irritation. Sound too complicated? Just go with what Dr. Gunter recommends: Good Clean Love, Yes Baby Vaginal-Friendly lubricant and Yes Water-Based Intimate Lubricant.

Oil based lubes can’t be used with latex condoms but can be a good option otherwise. Some women even use plain coconut oil or olive oil as lube and have found it works well.

With any lube, you want to avoid any products that are scented, warming or flavored which are often irritating to vaginal tissues.

What if sex is still painful?

Using lube and still experiencing painful sex?

Go see your gynecologist or menopause specialist. Again, you may need prescription cream to repair tissues, or you may need to see a pelvic floor physical therapist to troubleshoot the problem.

And if your gynecologist says to just “deal with it” (you wouldn’t believe the stories I’ve heard), find a new gynecologist. Your sexual experience matters, and you deserve to experience as much pleasure as your partner.

Anything else I should know?

Communicating honestly about your sexual experience can feel scary and vulnerable. But open communication is key to developing authentic intimacy with your partner, and that intimacy is an important puzzle piece to feeling a healthy amount of desire.

So if you’re experiencing any pain or discomfort during sex, talk about it and keep talking about it. Sex should be a collaborative experience. Talking about pain is a great place to start working together toward a better, more intimate and fulfilling experience for you both.

xo,
Rebecca

P.S. I can’t believe I just learned this!

P.P.S. Gorgeous painting by one of my favorite artists: John Singer Sargent, Nonchaloir (Repose), 1911, National Gallery of Art, Washington, DC, USA

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