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Vaginal Pain

Mar 23, 2017

What can you do about post menopausal vaginal pain? While the average age of menopause is 51, normal menopause can occur anytime between ages 40 and 60. Menopause is defined as no period for a full year. Many women start experiencing the symptoms of menopause for years prior to the completing of menopause (no period for one year). These years just before and the two or three years after the last period are called the peri-menopause.

Some women never have any symptoms of menopause but many women will start to experience vaginal dryness or vaginal pain during this time. My patients will often complain of vaginal dryness during intercourse. Some of them tell me that it feels like "something is being hit" or even that "something is tearing" during vaginal penetration.

The changes in the vaginal mucosa (the lining of the vagina) that occur during menopause and peri-menopause are due to the loss of estrogen. During our normal menstruating life, estrogen stimulates the vaginal mucosa to remain thick and lubricated. The cells of this very important skin form thick layers that make the vaginal mucosa sturdy--able to withstand tampon use during periods, friction from vaginal penetration during sex and even the severe stress of delivering a baby. Estrogen keeps these layers thick and strong. Estrogen allows the mucosa of the vagina to stay lubricated and slippery so that penetration is not painful. Estrogen also allows this skin to remain flexible--stretchy enough to withstand penetration or childbirth. Both the lubrication and the flexibility of the mucosa allow it to remain uninjured and healthy when used.

During and after menopause, the lack of estrogen often results in the lack of lubrication. Lubrication is easy to restore. We can apply a thin layer of vaseline, olive oil, coconut oil or whatever lubricant we prefer after showering. Lubricants such as Astroglide or KY jelly can be used with condoms during intercourse. If you are in a monogamous relationship or do not need to worry about pregnancy and are not using condoms, you can use olive oil, coconut oil or vaseline for lubrication during sexual activity as well.

The flexibility and strength of the vagina are a little bit harder to restore because lubrication alone does not always make sex comfortable or enjoyable. However, replacing the lost estrogen restores the vagina so that it remains sturdy and flexible. Estrogen can be restored through systemic (pills, patch, gel or ring) estrogen or hormone replacement therapy for those women who wish to have systemic hormones. For those women who do not want to use systemic estrogen or who have contraindications like breast cancer or severe cardiac disease, local estrogen can still be used. There are numerous studies showing that vaginal estrogen use does not result in health risks. Vaginal estrogen can be used by women with breast cancer and by women with cardiac disease safely. The only real contra-indication would be allergy or local sensitivity to the medications.

Vaginal estrogen can be used by using one of the vaginal creams (Estrace or Premarin), a vaginal tablet (Vagifem) or a vaginal ring (Estring). They are all equally effective so the choice of which to use is up to patient preference. The creams, the tablet and the ring are all highly effective at restoring elasticity, flexibility, strength and lubrication to the vagina. Each will take about four to six weeks to restore vaginal health. Many women find that sensitivity and pleasure are restored with consistent vaginal estrogen use as well. Often times chronic bladder problems (infections or frequency of urination) that occur with menopause and lack of estrogen will be resolved as well.

Local vaginal estrogen therapy is time tested, safe and effective for the elimination of painful intercourse and vaginal dryness due to menopause. There is no need to suffer!

Unfortunately, I often find that my patients come back to me still suffering with painful intercourse or worse, avoiding intercourse altogether due to the pain because they are afraid to use the local estrogen therapy or simply do not want to use any medication. Most of these women tried the estrogen and found that it worked! But they still are unhappy with this as the only option.

Now there is another option! Vaginal laser therapy, the Mona Lisa Touch can be used to restore the lubrication, flexibility and strength of the vaginal mucosa. Highly effective, it is an alternative for those women who just do not want to use vaginal estrogen. Three treatments given six weeks apart restore vaginal health within eight to twelve weeks. A once yearly “touch up” treatment keeps the vagina healthy over time. This treatment is not covered by insurance so women will need to speak to their doctor about cost and whether it is the right choice for them.

The bottom line is that vaginal estrogen is the preferred treatment for painful intercourse and vaginal dryness after menopause. But for those women who cannot or do not want to use estrogen, there is no need to suffer any more. The Mona Lisa Touch provides hormone free treatment to restore lubrication and elasticity to the vagina. The Mona Lisa Touch is one more option for women who want to remain sexually active and healthy throughout menopause.

As always, you should discuss your options with your doctor. For menopausal concerns, it is best to make sure you have a doctor who is a menopause specialist.


For more information on The Mona Lisa Touch: