I collaborated with AMAG Pharmaceuticals to create this post. All opinions are my own.

Recently I was invited to speak to a group of postmenopausal women who were all 50+ (plus) to discuss some of the concerns that we’re encountering from how to deal with wrinkles and weight gain to sleep and yes, we talked about one of my favorite topics – Sex!

Many admitted that talking about sex was something they learned early on as girls was a taboo topic, too personal and private to disclose, even with their closest friends. I’ve heard this at every talk I’ve given, so I asked everyone to close their eyes and then asked them to raise their hands if they had a concern about painful sex after menopause. I’m sure you can image what happened next. Over half of the women raised their hands! Over half!

Then I asked these brave women to open their eyes. After the nervous laughter died down, we realized that surprise, surprise – we’re not alone. An estimated 32 million postmenopausal women in the United States suffer from vulvovaginal atrophy, also known as VVA, and while experiences vary, painful sex is one of its symptoms! I get it, for most of us, it’s a lot easier to have sex, than to talk about it.

I just don’t know where to start

One courageous woman said, “Look, this is a very personal and private issue and it’s embarrassing. Sometimes I feel like it’s easier to just ignore it and focus on other aspects of my life, but then I think, ah, am I really ready to give up my sexuality and the intimacy in my relationship? But, I just don’t know where to start.”

I saw a lot of women in the audience nodding their heads. What I’ve found is that once we open the door to this topic, women rush in and are eager and willing to have the conversations, and let me reassure you, they don’t have to be Painfully Awkward.

What is going on?

What I heard that night and what I hear from my patients every day are these questions:

• Why does sex hurt?
• Why is my vagina so dry?

The Low Down

After 50 and sometimes a little earlier, our bodies experience shifting hormone levels that can lead to hot flashes and night sweats and eventually impact the vulvar and vaginal tissues. They become thinner, drier and less able to stretch. This collection of symptoms is known as Vulvar and Vaginal Atrophy or VVA and can cause pain with sex, also known as dyspareunia.

Unlike hot flashes and night sweats which often improve over time, VVA just gets worse. That’s right, without treatment, these symptoms generally will not improve over time. Some women relate that just wearing tight workout clothes or using certain soaps leads to vulvar and vaginal irritation. Others say that the tissue is so dry that no amount of lubricant makes reduces the pain associated with intimacy. Many have tried various remedies from their pantry to help things slide and glide but find those are just as irritating and they’re not making a lot of progress.

(Images courtesy of AMAG Pharmaceuticals, Inc.)

Don’t just accept this

One of my patients said what many others have expressed. “We get started, and I’m a little nervous, but willing to try again. But then, as soon as we try, it hurts and then poof, the mood vanishes and I’m done. I feel bad for me and for my husband. This is not fun!” She wondered out loud if she should just give up on having sex. And, the answer to that is NO! Do NOT give up on your sex life. You don’t have to put up with this and there’s a lot that can be done. Women deserve to have a sex life after 50!

Treatment options

There are many treatment options available. This video from my friend Dr. Sheryl Kingsberg explains why you deserve better if you’re experiencing pain with sex. https://www.pausesexpain.com/dyspareunia-treatment

Finding a Health Care Provider

Unfortunately, many health care providers are so busy talking about when to have a mammogram and getting cholesterol and diabetes testing that they don’t bring up any aspect of sexual activity, let alone painful sex. Some haven’t been trained to talk about sex and honestly, don’t know how to start the conversation with you. But that doesn’t have to stop you or discourage you from finding a health care provider with whom you are comfortable talking about sex and who has the knowledge and experience to help you find treatment options. Do talk to your friends, read reviews and consider going to the North American Menopause Society’s website, Menopause.org for more information and if you want to find a certified Menopause Practitioner in your area.

Preparing to Talk to Your Health Care Provider

Now that you’ve found a provider to talk to, here are a few questions to jot down.

• Can you help me understand why my vulva and vagina are so dry?
• How can you help me have more comfortable sex that doesn’t hurt?
• What kinds of over the counter treatment options are available?
• What kinds of estrogen and non-estrogen treatments do you prescribe and why?
• Are there any other benefits from treating my vaginal and vulvar dryness than less painful sex?

Talking to Your Health Care Provider

Now that you’re prepared, don’t let embarrassment prevent you from living life and enjoying sex. You can visit www.PauseSexPain.com to learn more.

Though there are undoubtedly people who are born with “The Happy Gene” and are natural optimists, I’ve seen many people choose to be optimistic and not give in to their negative self-talk. Here’s what I use with my patients:

1. Imagine The Worst – Nothing squashes optimism like fear, except if you have a plan for what you’re most afraid of. Instead of being overwhelmed by events or possible situations, I ask my patients to talk about the worst case scenario and then we work back from there imagining how they would cope with every single challenge to optimism. Once people have a blueprint for coping, it’s much easier to feel safe and optimistic, that things will work out, no matter what.
2. Fake It Til You Make It – Optimism is all about confidence. Confidence that Life is Good, that you can handle whatever comes your way. But sometimes, people don’t really feel that way for a variety of reasons. Until you can feel that way, train yourself to act, speak and interact with others with an optimistic, open, hopeful heart, because inevitably you will find that people react more positively to you.
3. Ignore Grumpy, Negative People – Don’t give them any of your energy, or time. Save your energy for people who are positive and for experiences that fulfill you.