MENOPAUSE – IF SEX TURNS FROM PLEASURE TO PAIN
Did you know that pain with sex – dyspareunia, is one of the most frequently reported symptoms of menopause? If sex is painful, women commonly have a reduced desire for sexual intimacy or reduced arousal too. Many women accept this as part of aging and just avoid having intercourse. However, there are ways to improve dyspareunia and to start enjoying sex again.
Why can sex become painful after menopause?
A common reason sex can become painful after menopause is due to the drop of the hormone Oestrogen. Oestrogen is important in the vagina and vulva to keep the tissues soft, lubricated and elastic. When Oestrogen lowers, the tissues can become more fragile and dry, this sometimes causes too much friction during vaginal penetration and the tissues get irritated. In some women, the pelvic floor muscles that surround the vagina and the vaginal opening tighten as a protective response to try and prevent further penetration. This tightening response can cause further discomfort, and if the muscles stay tight they can become sore from being over-active. If this continues women can develop anxiety or fear about having intercourse (sometimes this occurs on more of a subconscious level) and the nervous system can also become sensitised.
If you have pain during intercourse it is essential that you consult with a doctor familiar with women’s health problems so that any other causes of pain such as infection, skin conditions and irritations can be checked. Your doctor may also prescribe a local oestrogen treatment to help improve the integrity of the vagina and vulvar tissues.
What can physiotherapy do to help?
A physiotherapist will collect a thorough history and perform an assessment to help determine why you are experiencing pain. The physiotherapist may also provide education and treatment including:
- Advice on vulval care such as avoiding using soaps and scented personal items on the vulval tissues
- Use of lubricants
- Advice about sexual positioning and building arousal and desire again
- Desensitisation of the tissues and the nervous system
- Education on pain science and why your pain may be persisting
- Teach relaxation – whole body and of the pelvic floor muscles
- Help gently release tight pelvic floor muscles
- Provide you with self-management strategies
- Refer you to other appropriate health care practitioners
PAINFUL SEX IS NOT OK
There are so many reasons why sex can hurt, but none of them are OK! Painful sex, also known as ‘dyspareunia’ or ‘genito-pelvic pain penetration disorder’ affects up to 1 in 5 people – you are not alone. The impact on desire, intimacy, relationships and one’s own self-esteem can be significant but it is also a very treatable condition and not something that should be put up with!
Some of the common causes of painful sex include:
- Skin conditions impacting the vulva (the skin outside the vagina) such as thrush or dermatitis.
- Low levels of vaginal lubrication, either due to hormonal changes associated with menopause or breastfeeding, or due to lower arousal.
- ‘Vaginismus’; a condition where the pelvic floor muscles spasm in response to any attempts at vaginal penetration (e.g. during sexual intimacy or with tampon use), ‘blocking’ the vaginal opening and making it impossible or painful for anything to enter the area.
- ‘Vulvodynia’; a condition that involves increased sensitivity in the tissues and nerves surrounding the vaginal opening, also commonly impacting the activity of the pelvic floor muscles.
- Other medical conditions which cause increased pain in the pelvic and tension in the pelvic floor muscles, such as endometriosis or adenomyosis.
If sex causes pain, it is natural response to want to avoid it and for your libido to drop, this results in little or no desire to participate in sexual intimacy. Often people find they start to withdraw from all types of intimacy with their partner, and this can place great strain on the individual suffering from pain and the relationship itself.
Often pain begins with a physical cause, such as a thrush infection, but even when this original cause resolves, the pain can persist because of changes in the brain, and the way the muscles and nerves function.
As with all of the pain conditions discussed, a visit to a GP with a special interest in women’s health to rule out causes in the vulvovaginal tissues (such as infection) is the first step. Once you have a diagnosis, your physiotherapist can work with you, and often a team of other health professionals (which may include your GP, a gynaecologist, a dietitian and/or a sexual counsellor or psychologist with a special interest in pain and sexual health) to treat the sexual pain. This involves treating the sensitive tissues in the body (not just the skin, but the nerves and muscles surrounding the area), but also working with the brain to refresh the sensitised nervous system by exploring your thoughts and beliefs about sex and the cause of the pain. Physiotherapy works to retrain the nerves, relax the muscles and reduce anxiety that occurs with sexual intimacy and vaginal penetration.
There is strong evidence to support the role of women health physiotherapists with additional training in women’s and pelvic health to treat a number of conditions across all life stages – from more commonly known pelvic health issues affecting women such as incontinence and prolapse, to pelvic and sexual pain concerns and also for helping children and adolescents with bed wetting or other bladder/bowel control concerns.
We hope the information in this blog has been useful and should always be considered in conjunction with an individual assessment with your physiotherapist and/or other health care provider skilled in the area such as a GP or gynaecologist.
We would love to help you manage your concerns and get you back achieving your goals worry –free!