McKesson Clinical Reference Systems: Women's Health Advisor 2002.2

Pain with intercourse (dyspareunia) is common in older women. What may be an occasional problem for the menopausal woman and her partner can become a more frequent and serious problem later if it is not treated.

Causes of Pain with Sex

When a woman has a problem with sexual intercourse, there is usually a health-related reason. A woman might like and want to have sex but avoid it because it hurts.

Sex may cause pain because there is not enough moisture in the vagina. When the vagina does not produce enough moisture in response to sexual arousal, it may be due to a physical cause or psychological factors.

Physical causes include:

• Menopause: The decrease in hormone levels at menopause causes changes in vaginal tissues. They become thinner and less elastic. There is less vaginal wetness even when the woman is aroused.
• Other conditions:
  • endometriosis, in which the tissue normally lining the uterus grows in other places, such as the vagina
  • tipped or prolapsed (fallen) uterus
  • infections of the bladder or urethra (the tube that carries urine from the bladder to the outside)
  • scarring of tissues torn or cut during childbirth, vaginal surgery, or pelvic surgery
  • pelvic inflammatory disease (PID), which is infection in the uterus, tubes, ovaries, and nearby tissues
  • sexually transmitted diseases (STDs) or other infections, such as genital herpes or genital warts or yeast infections
  • intercourse after a long period of not having sex
  • allergic reactions to spermicides or douche solutions
  • growths on the uterus, tubes, or ovaries.

Lack of Sexual Response

Many older people are faced with circumstances that can contribute to a lack of sexual response, including:

• Either you or your partner may be ill or frail. In such cases, sex may not be a priority or may be avoided because of a fear of hurting or being hurt.
• You may lose your partner to death or divorce.
• You may lack privacy and sexual freedom. This may be because you share a home with relatives or are living in a retirement home that does not offer privacy.
• If you are not married, you or your partner may not be comfortable with the idea of sex outside of marriage. (Widows and widowers may be reluctant to remarry because of financial problems, such as a reduction in Social Security benefits.)

Treatment Choices

• Hormone replacement therapy (HRT):

  You can use hormone medicine to replace the natural hormones that decrease after menopause. HRT will reduce or get rid of many of the symptoms of menopause that cause painful sex, such as vaginal dryness.

  HRT may also help reduce the risk of osteoporosis (thinning and weakening of bones due to lack of estrogen after menopause). There are some risks with some forms of HRT. For example, it may increase your chances of getting some forms of cancer. Discuss the benefits and risks of HRT with your health care provider.

  Estrogen cream is available to help with vaginal dryness. While it doesn't help with osteoporosis, as do some other forms of HRT, there is little risk of uterine cancer if you use the cream correctly.

• Vaginal lubricants:

  Your health care provider may recommend use of a vaginal lubricant if you are not using estrogen cream or other forms of HRT. The lubricant can prevent the pain caused by lack of vaginal moisture during sex. You and your partner can use a lubricant in a way that makes it a part of lovemaking. Ask your health care provider what product might be best for you. Benefits of using a lubricant include:

  • less irritation and fewer tears of vaginal tissue
  • less irritation or discomfort for the male partner
  • greater ease of penetration
  • less fear of pain during lovemaking.
• Treatment of other causes:
  • Treat PID, STDs, or other infections of the vagina, bladder, or urethra.
  • Remove or treat fibroids, genital warts, or endometriosis.
  • Remove or repair a tipped or prolapsed uterus.
  • Stop use of spermicides or douches that cause allergic reactions.
• Counseling:

  If the reason for painful sex is psychological, ask your health care provider to refer you to a psychologist, sex therapist, or other counselor for help.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.