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Painful intercourse—when menopause is the gift that keeps on giving
The menopausal transition is not easy. Hot flashes, night sweats, brain fog, weight gain, and irritability are discussed quite a bit among friends, in the media, and recently on a popular TV show! However, I’ve found that it’s rare for my patients to bring up one particularly troublesome symptom—painful intercourse. Knowing how common it is, I try to ask patients about painful intercourse before they bring it up with me.
Women in perimenopause often don’t express concerns about painful intercourse, which is a symptom of genitourinary syndrome of menopause, because it generally doesn’t become an issue until after the menopausal transition. At the time when women are experiencing hot flashes, night sweats, and other symptoms of perimenopause, painful intercourse isn’t on their radar. By the time many women experience this, their menopausal transition was many years ago. I commonly hear, “I went through menopause many years ago, so how could this be menopause?”
The answer is that although some symptoms occur immediately as the menopausal transition occurs, other changes continue the longer we lack estrogen. As time goes on, some symptoms improve, while others get worse. Estrogen in the vagina and on the vulva maintains blood flow, collagen development, lubrication, protects the tissue from infection, and balances the pH. Therefore, a lack of estrogen leads to severe negative effects, including a loss of elasticity, thinning skin, and dryness inside and out. These symptoms often lead to painful intercourse, vaginal irritation and infections, and bladder irritation and infections. These are all symptoms of the genitourinary syndrome of menopause and may cause us to have a decreased libido, problems with intimacy, and stress in relationships.
These symptoms can occur during premenopausal years as well. Hormone changes during the postpartum period and while breastfeeding, different surgeries, cancer treatments, and certain medications can be responsible for the same reduction in collagen prior to perimenopause.
Luckily, we have many options to help with these symptoms. Different hormones, like estrogen and DHEA, in addition to nonhormonal options like hyaluronic acid suppositories, pelvic floor physical therapy, and MonaLisa Touch, a nonsurgical fractional CO2 laser, are all treatment options. Sometimes one therapy is enough to help, but in some cases a combination of therapies is needed.
So, if these symptoms sound like what you are experiencing, then be sure to share your concerns with your physician. At Premier Women’s Care of Southwest Florida, we are here to help guide you through the menopausal transition and through the years that follow.