Your vagina does dry up
It’s true that some 68 to 86.5 percent of women have problems with sex after menopause, according to a review of medical studies in the journal Obstetrics & Gynecology, but there are treatments that work. “These are extremely common problems, and unfortunately they’re not often addressed by the patients or by the physicians, so we have a lot of very unhappy ladies out there,” says Mary Jane Minkin, MD, director of the Sexuality, Intimacy, and Menopause clinic at Yale New Haven Hospital and founder of the women’s health website MadameOvary.com. The root of the problem with sex post-menopause? It stems from lack of estrogen, which can wreak havoc on the vagina. “The vaginal walls do become thin, they do become dry, and they do lose a lot of their elasticity,” says Lauren Streicher, MD, author of Sex Rx: Hormones, Health, and Your Best Sex Ever, and medical director of the new Northwestern Medicine Center for Sexual Health and Menopause in Chicago. “Between 50 to as high as 70 percent of women experience these changes.” You may not notice them unless you’re having sex—or try to have sex for the first time in a while. Here’s what else your vagina wants to tell you.
You may have to work to make sex pain-free
The vaginal drying many postmenopausal women experience can make friction during sex hurt, and studies show that up to 45 percent of women have painful sex after menopause. But remedies for this problem are as close as the nearest drugstore. The first course of action is an over-the-counter lubricant to ease the friction, but not all lubes are not created equal. “The better lubricants are silicone-based, which are very slippery and last longer than water-based,” Dr. Streicher explains. “Replens Silky Smooth is a really good one, and Wet Platinum is another.” You could try a home remedy like olive or coconut oil, but they can increase the risk of infection and weaken condoms, which could be an issue for sexually transmitted infection prevention if you’re with a new partner. Another option is an over-the-counter vaginal moisturizer, which you would used regularly to increase water content in the skin. If OTC products aren’t enough, talk to your doctor about prescription for a local vaginal estrogen. Creams as well as rings or tablets are available. “The amount of estrogen that’s absorbed through the vagina is miniscule,” Dr. Minkin says. Non-estrogen options are an oral prescription pill called Osphena, a SERM (selective estrogen receptor modulator) that turns on estrogen receptors but does not increase estrogen itself; or a recent FDA approved suppository called Prasterone, which uses the hormone DHEA. Finally, a pain-free laser treatment is available that “restores lubrication and elasticity to the vaginal and vulvar tissues,” Dr. Streicher says. She recommends the Mona Lisa laser, but it’s not covered by insurance. The FemiLift is another popular CO2 laser. Talk to your doctor to figure out which option is best for you.