Many women experience pain before, during, or after sexual intercourse – the medical name for this is dyspareunia. This common problem can erode sexual desire and pleasure, strain relationships, and impact quality of life. For postmenopausal women, in particular, it can suddenly bring up issues of ageing and body image. Often women suffer in silence because they are embarrassed or don’t know who to talk to about treatments.

There are a variety of causes of painful sex:

  • Hormonal changes (particularly perimenopause, postmenopause, but also postpartum (after childbirth), while breastfeeding or when taking some hormonal contraceptives)
  • Vaginismus (spasm/overactivity of the muscles)
  • Gynaecological conditions (genital infections, benign or malignant growths, endometriosis)
  • Neurological conditions (vulvodynia, nerve pain, chronic pelvic pain)
  • Skin diseases (dermatitis, lichen sclerosis, psoriasis)
  • Emotional issues, anxiety, depression, relationship issues
  • Combinations of the above causes

Commonly several of these are to blame concurrently. The decrease in estrogen levels at menopause can thin the surface lining of the vagina, resulting in dryness, pain and burning. Another cause is vulvodynia or vestibulodynia, a chronic pain syndrome that leads to discomfort with any kind of touch or pressure in the area around the vagina. Psychological factors may be involved, especially in women who associate the vaginal area with fear or injury.

 

Assessment:

Due to the numerous causes for painful sex it is important to have a thorough assessment with a doctor to ascertain which diagnoses are present. This will most likely include a physical examination if you are comfortable to proceed.

 

Treatment Options:

FEMTOUCH

The newest treatment available for painful sex due to postpartum and postmenopausal changes is FEMTOUCH – a vaginal laser procedure.  This CO2 laser is applied to the surface 0.5mm layer of the vaginal lining to stimulate new cell growth, increase elastin, improve the number of blood vessels, and increase lubrication.  The procedure is done in the doctor’s office and the actual laser part takes 5-10 minutes. It is not painful. Three sessions are required, spaced 1 month apart.

Geelong Veins, Skin and Laser are pleased to be able to offer you FEMTOUCH.

Low-dose vaginal estrogen and HRT.

These are common treatments for painful vaginal changes related to menopause. They can also help in some cases of vestibulodynia and vulvar skin problems. Vaginal estrogen has less risk of side effects than oral estrogen. Daily or weekly dosing is required.

Pelvic floor physical therapy.

A women’s health physiotherapist can assess pelvic muscle issues and urinary problems, offering specific advice. Women can learn exercises to help strengthen pelvic floor muscles, which may have been weakened by aging, childbirth, hormonal changes, and certain physical strains. Relaxation training and bladder training are other techniques.

Counselling.

Issues such as anxiety and poor communication in a relationship can contribute to painful sex, and painful sex can put stress on a relationship. Talking with a mental health professional or sex therapist may help.

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