- Women’s Health
- Healthy Living
- Health Conditions
- Nurse Barb
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:
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!
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.
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:
Source: ACOG, Committee Opinion. April 2013 (reaffirmed 2015), number 557.
A Woman’s Normal Anatomy
PALM – Structural causes of AUB
P – Polyp
A – Adenomyosis
L – Leiomyoma (fibroids)
M – Malignancy/Hyperplasia
COEIN – Non-structural
C – Coagulopathy
O – Ovulatory
E – Endometrial
I – Iatrogenic
N –Not Classified
Source: Established by FIGO – Fédération Internationale de Gynécologie et d’Obstétrique (the International Federation of Gynecology and Obstetrics)
Many women I speak to are surprised to learn that they can take birth control pills in their 40’s and early 50’s as long as there are no contraindications.
Many women who are in Perimenopause, that is the time when there are a lot of menstrual irregularities, the start of hot flashes, night sweats and vaginal dryness, will benefit from taking a low dose birth control pill to help with their symptoms as well as provide contraception.
Fertility after 40
While fertility rates do decline after 40, if a woman is still having her period, even if it’s irregular, she can become pregnant. Contraception is advised if a woman does not want to become pregnant.
If you’re asking this question, you’re not alone. If you’re under 30 about 1/3 of women use something slippery (lube or lubricant) to help everything glide and slide with sex. If you’re in your 50’s or beyond, it’s more like 50- 75%.
Which lubricant is best? Well that depends. Most of the manufacturers of lube have several different varieties for any situation. Here are some guidelines:
– These include Good Clean Love, KY, Sliquid, Aloe Cadabra, Sylk, Yes
– These can be used with any toy made out of anything
– Ok with all condoms
– Available in sugar-free flavors
– If you’ve used a water based lubricant and it’s feeling a little dry, instead of applying more lubricant, you can use a little bit of water to rehydrate the lubricant. (hint- your saliva will also work)
– Won’t stain the sheets and rinses off with water
There’s lots of reasons why sex might be painful after you turn 50. For many women as estrogen levels decline during midlife, their vaginas become much more dry and don’t have the same elasticity or ability to stretch.
What you might notice
If you or someone you care about is concerned that they may have herpes, then you know that it can be a very worrisome time with a long list of questions. What makes it even more difficult is that you might be hearing conflicting and confusing information.
Several types of Herpes
What makes it more confusing is that there are several Herpes Simples Viruses (HSV), including the type that causes Chickenpox and Shingles.
Testing for Herpes when symptoms are present
If there are visible or active symptoms, such as sores, small bumps, crusted over lesions or small tears in the skin, then a healthcare provider can do a swab of the area and send it out for a PCR (Polymerase Chain Reaction ) evaluation. This is the most accurate way to test because it looks for the viral DNA, which is present even after a few days of symptoms. We don’t use cultures any more because they are not as reliable.
I hear from a lot of women who are suddenly ready to have a baby. They want to be pregnant as soon as possible. Others are considering pregnancy and trying to get prepared.
Stop All Birth Control
It may sound obvious, and that’s because it is! If you’re ready to become pregnant, then the first thing to do is to STOP using any birth control.
With most birth control methods once you stop using them, your menstrual cycle will start up again. It may take a few weeks to see a period return, but the process that leads to your period resumes as soon as you stop birth control.
Has the switch flipped and you’re starting to think about becoming pregnant? Have you started to notice more pregnant women everywhere you go?
Does it seem like there’s a new mom pushing a stroller on every street corner? Do you see Dads with little ones in carriers? If so, you just might be starting to think about becoming a mom yourself. This is sometimes known as the pre-contemplative phase where ideas take seed and start to grow in your mind.
Questions to consider
Every woman approaches this process from their own unique perspective. Here’s some questions to consider:
Meet my friend Trisha. She loves to fly so much that when she’s not a private corporate jet pilot, she can be found winging her way across the country working as a flight attendant.
Trisha is a healthy woman in her 40’s who is passionate about staying in shape. She loves to walk or bike to the beach and then swims in the ocean to stay in shape. She is energetic and enthusiastic and loves new adventures.