We hear from many women who are struggling with painful intercourse. It has been our experience that the number one concern of older women who contact us is painful intercourse related to vaginal atrophy. Vaginal atrophy is a surprisingly common condition.
Denise (age 68)
Truly enjoyed her sexual relationship with her first husband. After he passed away, her sex life disappeared. Now remarried, she was looking forward to reigniting that part of her life. Unfortunately, things are not going well.
Lee (age 33)
Undergoes chemotherapy and radiation for breast cancer. These treatments cause her to enter early menopause. Sex is no longer pleasurable.
Danielle (age 54)
Has been told she better ‘use it or lose it’. But it hurts too much!
Estrogen is a group of hormones primarily responsible for “maintaining the collagen, elastic fibers, and vasculature of the reproductive organs and urinary tract that is essential for its structural and functional integrity. It also maintains vaginal PH and moisture levels”.³ Estrogen is produced in the ovaries, along with progesterone and testosterone.
What is Vaginal Atrophy?
Vaginal atrophy (atrophic vaginitis) is a medical condition characterized by the inflammation of the vagina due to diminishing estrogen levels and is usually brought on by menopause. It results in thinning and shrinking of the vaginal walls as well as reduced lubrication. The pelvic floor muscles, urethra, and vagina (the entire urogenital tract) may all be affected by the reduction of estrogen production.
- vaginal dryness, itching, burning
- discomfort and/or painful sexual intercourse
- slight spotting/bleeding during intercourse
- thinning pubic hair
- increased frequency of UTIs
- increased vaginal infections
- increased vaginal PH levels
When & Why Does This Happen?
Vaginal atrophy can develop whenever there is a prolonged reduction in the amount of estrogen a woman’s body produces. This drop in estrogen could be due to the onset of menopause, treatment for cancer, surgical removal of the ovaries, or following giving birth. Although most commonly seen in older women, it does affect younger women as well.
Did You Know?
Menopause Facts: Defined as 12 months since a woman’s menstrual cycle; average age 51.3 yrs., not a single event, symptoms last on average 3.8 years.³
- Menopause – Vaginal Atrophy is a common symptom of menopause. It has been estimated that over 50% of menopausal women will develop atrophy.¹ Some estimates are even higher at 75-90%.²
- Cancer treatments – Cervical, Ovarian, Breast, Uterine
- Both chemotherapy and radiation therapy can cause ovarian failure. With little to no estrogen being produced menopause is brought on. Vaginal atrophy can also be a side effect of treatment for cancers that are not specifically located in the pelvic region.
- Surgery – Surgical removal of the ovaries immediately brings the onset of menopause and can cause vaginal atrophy to develop.
- Following childbirth and while breastfeeding some women experience a drop in estrogen levels causing vaginal dryness.
What is Vaginismus?
Vaginismus is a condition where there is involuntary tightness of the vagina during attempted intercourse. Reacting to the anticipation of pain, the body automatically tightens the vaginal muscles, bracing to protect itself from harm. Sex becomes uncomfortable or painful, and entry may be more difficult or impossible depending upon the severity of this tightened state.
Vaginal Atrophy & Vaginismus
When vaginal atrophy goes undiagnosed and a woman continues to attempt to engage in intercourse, vaginismus may develop. It is important in these situations to address both the vaginal atrophy and vaginismus. Both problems will need to be treated to ensure full resolution. Without addressing the vaginal atrophy, it will be difficult to resolve the vaginismus as it may continue to be triggered by pain from the atrophy condition.
Questions to Ask Yourself if You Suspect Vaginal Atrophy
- Has sex become increasingly uncomfortable?
- Does your vagina feel like ‘sandpaper’?
- Do you have vaginal dryness, itching, and/or burning?
- Have you noticed a decrease in your natural lubrication?
- Have pelvic/gynecological exams become uncomfortable?
- Have there been changes in the outer appearance of the vagina? Shrinking folds of skin? Less pubic hair?
- Is there a reason you may be experiencing a drop in estrogen production – approaching menopause, cancer treatment, etc.?
Solutions For Vaginal Atrophy
If you suspect you may have vaginal atrophy see your physician or a gynecologist for a consultation. She/he will take your personal history and likely do a pelvic exam to examine your vagina. Based on the assessment, a course of treatment will be recommended and will take into account your personal history, symptoms, and severity.
The course of treatment for vaginal atrophy may include use of personal lubricant, estrogen supplements, vaginal dilators, and/or pelvic floor therapy (physical therapy).
Why Dilators are Recommended
Vaginal dilators are used to slowly increase the size of the vagina, restoring length, shape, and elasticity. They are used to gently massage and stretch the vaginal tissue making penetration more comfortable. This is especially effective due to the narrowing of the vaginal canal.
Personal lubricants help make the vaginal canal more slippery so there is less dryness and friction during penetration.
Vaginal moisturizers help alleviate ongoing vaginal dryness (examples – Replens, olive oil, coconut oil).
Kegels are pelvic floor exercises that help to draw blood flow to the vagina, increase elasticity, and strengthen the pelvic floor muscles. They also help to improve control over the vaginal muscles.
Estrogen is primarily used to help rebuild the tissue or lining of the vagina. This leads to increased lubrication. There are many different options in using estrogen ranging from vaginal cream, suppositories, or rings, and hormone replacement therapy (HRT). Be sure to discuss any and all hormone-based treatments with your physician.
Professionally trained physical therapists can provide pelvic floor therapy for the treatment of vagina atrophy as well as any accompanying vaginismus.
For women with vaginal atrophy and no accompanying vaginismus, regular and consistent use of vaginal dilators is often suggested. Typical protocol follows inserting a lubricated dilator, leaving it in for a period of time each day, then gradually increasing the size of the dilator inserted.
- Notelovitz, M (1997). Urogenital aging: Solutions in clinical practice. International Journal of Gynecology & Obstetrics, 59, (1 Suppl.), S35-S39.
- Corio, L (2011). http://blogs.webmd.com/womens-health/2011/05/a-for-atrophy.html.
- Eden & Wylie (2009). Quality of sexual life and menopause. Women’s Health (Lond Engl), Jul:5(4): 385-96.
- Sex & the Mature Woman
- What is dyspareunia? What is the connection between dyspareunia and vaginismus?
- What is the difference between primary vaginismus and secondary vaginismus?
- Is there a difference between the treatment for primary and secondary vaginismus?
- Do you recommend working with treatment professionals?