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Painful Sex?

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Painful Sex?  Talk About It!Menopause.
For many women, the thought of ?the change? has them worried about hot flashes, night sweats, and fuzzy thinking. Other women welcome the relief from managing their ?monthly visitor? and the ability to have sex without the fear of becoming pregnant. It?s true that menopause can be a blessing and a curse. One symptom women don?t expect, and until recently didn?t get a lot of attention in the medical community, is dyspareunia ? pain during intercourse.

Dyspareunia can have a number of causes. Frequently, the disruption of hormone production leading to menopause is the culprit. Estrogen is the necessary ingredient in vaginal health. Without it, vaginal walls thin, muscles around the vaginal opening become less elastic, and the production of vaginal fluid, the necessary lubricant for sex, diminishes. Discovering this unpleasant side effect of getting older can leave women and their partners feeling disappointed, confused, and frustrated.

Symptoms of vaginal atrophy include
(in degrees of worsening order)

  • Vaginal dryness
  • Vaginal tightness upon penetration
  • Soreness or irritation long after sex
  • Painful or burning during urination
  • Pain around the vaginal area especially when touched
  • Pain and/or bleeding during sex
  • Incontinence

However, painful sex can occur because of other medical issues that are unrelated to menopause. Vulvodynia, which is a chronic pain in the external genital area and especially the vulva, is one such example that has nothing to do with menopause. A prolapsed uterus, one that has ?dropped,? can cause painful sex as can endometriosis, a condition caused by uterine tissues growing outside of the uterus. This condition often eases after menopause but can be exacerbated by estrogen supplementation. There are many others. It is important for you to discuss your pain and concerns with a physician so an accurate diagnosis can be made and the appropriate treatment options considered.

If painful sex isn?t addressed, it can cause a vicious cycle whereby the woman, fearing pain during sex, becomes involuntarily tense, which tightens her muscles, including those around the vagina, causing her pain upon penetration. This condition is called vaginismus. Tensing up or stressing over the possibility of painful sex also hinders her arousal ability and reduces the amount of vaginal fluid she can produce. It can truly become a Catch-22.

Many assume that vaginal dryness and tightness is simply a part of ?getting older,? but that cannot be further from the truth. Dyspareunia and vaginismus are treatable conditions. Whether because of embarrassment or fear, women often refuse to discuss it with their doctors. Sometimes believing she is the only one with the problem stops her from saying anything. Yet, according to The North American Menopause Society (www.menopause.org), between 17 and 45 percent of postmenopausal women admit to experiencing painful sex.

There are steps women can take to enhance their sexual experience while reducing the pain of dyspareunia.

Have sex more often. While it may sound counterintuitive, more sex ?reminds? the female body what it?s supposed to do. It encourages blood flow to the vaginal walls and stimulates lubrication. The adage ?use it or lose it? definitely applies.

Try over-the-counter vaginal lubricants. These will not reverse an underlying hormone disorder, but will make sex more pleasurable in the moment.

Utilize longer-acting vaginal moisturizers. These also don?t help the hormonal reasons for vaginal dryness but provide longer relief than short-term lubricants.

Use low-dose vaginal estrogen therapy. These are available in creams, rings, and vaginal tablet form.
Employ higher-dose estrogen therapy. This is full-body hormone therapy typically applied externally via patches and creams or taken by mouth in pill form. These provide relief from other issues such as hot flashes.

If hormone therapy is the best route, women need to understand the implications of ingesting or applying synthetic estrogens. Synthetics don?t mimic what the body needs; they provide a surrogate that may come with a host of unexpected side effects. Meanwhile, bioidentical hormone replacement therapy utilizes hormones formulated to be what the female body expects. Its effectiveness has been well established over decades of use with few side effects.

Pain during sex isn?t normal. Determining the cause and most effective treatment could have you, and your partner, back ?in the groove? in no time. If you would like to discuss treatment options available, please give me a call at (636) 278-6561.

Medicine Shoppe ? 505 Salt Lick Road, Saint Peters, MO 63376 ? 636-278-6561

About Frank Nuber, RPh

Frank Nuber, RPh
Frank Nuber, RPh is a consultant, long term care provider, geriatric medication consultant, women's health and hormone consultant, and experience in clinical and hospital pharmacy.

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