It’s true that as a woman’s estrogen level declines during menopause, sex drive and sexual pleasure often change. Yet sex after menopause can be rewarding and fulfilling if you prepare for the changes.
A pivotal event during menopause is the loss of estrogen, which causes the vaginal tissue to become thinner, dryer, and less elastic. This vaginal dryness, also known as atrophic vaginitis, along with the shift in the vaginal pH from acidic to alkaline, increases a woman’s risk of inflammation, swelling, and infection, which are accompanied by itching, redness of the vulva, excessive discharge from the vagina, an unpleasant odor, and pain or discomfort during sexual intercourse.
Treating Vaginal Dryness
The traditional treatment for vaginal dryness for menopausal and postmenopausal women has been hormone replacement therapy (HRT), a combination of estrogen and progestin. But results of the Women’s Health Initiative, which studied more than 16,000 postmenopausal women over more than five years before the study was terminated, showed that HRT increases the risk of breast cancer, stroke, pulmonary embolism, and coronary heart disease among these women.
Fortunately, there are several other strategies to prevent and treat vaginal dryness and ward off inflammation and infection.
- Have more sex. Regular intercourse helps promote blood flow to the vagina and maintain vaginal tone and elasticity. However, always use some type of vaginal moisturizer (see below), especially if you have extended intimacy sessions, to avoid irritation and inflammation.
- Avoid using performed soaps, bath additives, douches, feminine sprays, or similar products. They can destroy the vaginal pH, which is necessary for vaginal health.
- Wear cotton panties rather than nylon and pantyhose with a cotton crotch. Cotton allows air flow and helps prevent infection.
- If you use spermicidal foams or creams, you may need to experiment to find a brand that does not cause irritation, as some women are allergic to these products.
- If you use condoms, also use a moisturizer or lubricant, as a dry condom may cause tears in vaginal tissue.
Using Vaginal Lubricants or Moisturizers
You can choose from a variety of vaginal lubricants and moisturizers to improve the health of your vaginal tissue.
- Water-based lubricants and gels: These are available over-the-counter (OTC) and treat the symptoms but not the cause of vaginal dryness. The effects are not long-lasting, so you need to reapply each time you have intercourse. Because they contain chemicals they may irritate the vagina.
- Vaginal moisturizers: These are absorbed into the vaginal tissue and increase moisture. Also available OTC, they may not provide enough lubrication during intercourse and so lubricants may be needed.
- Vaginal creams: These contain estrogen and are by prescription only. The creams build up estrogen levels in the vagina and may affect breast and uterine health. They may also contain irritants such as propylene glycol.
- Vaginal Tablets: These contain low levels of estrogen and are by prescription only. Tablets are inserted into the vagina where they help thicken the vaginal walls but the estrogen is not absorbed into the bloodstream.
Many women find that once the worries about menstruation, menopause, and contraception are gone, and they address vaginal dryness, sex after menopause can be very emotionally and sexually satisfying–even better than before!