Painful Sex After 50

There are lots of reasons why sex might be painful after you turn 50. For many women, as estrogen levels decline during midlife, their vaginas become much drier and don't have the same elasticity—the ability to stretch.

What you might notice 

• Skin around the labia and vagina feels dry when you wipe
• More irritation with tight clothes
• A slight odor—from sour to fishy
• Feeling that the vaginal opening can't stretch enough for a partner or a toy to enter
• Pain if the skin is being stretched and possibly tearing if it's pulled too far
• Normal ability to lubricate has disappeared
• Pain in the area after sex

You're not alone! In fact, about half of women over 35 need to use a lubricant when having sex.

Why this happens

You may be surprised to learn that your genital area has a ton of estrogen receptors. As they get thirsty for more estrogen than your body is making, the skin gets dry, loses some of its elasticity and can shrink.

In addition, without the estrogen to keep the vaginal ecosystem in balance, the normal healthy bacteria that live in the vagina, known as lactobacilli, will go away. These lactobacilli keep the pH slightly acidic, which prevents the overgrowth of yeast and bacterial infections.

All this adds up to a vagina that's drier, less able to lubricate and more prone to infections.

Unlike hot flashes and night sweats in menopause, this condition does NOT get better over time. In fact, it gets worse. So, if you're experiencing any of these symptoms, talk to your health care provider.

What you can do

There are great resources available from the North American Menopause Society, including a link to help you find a health care provider who is familiar with this.

Here are some tips that may work for you:

1. Use lubricants. Try a lubricant made especially for vaginal use, such as Sliquid, SYLK, K-Y and many more.  There are lots of great options. Some lubricants are flavored for more fun with oral sex. There are also longer-acting vaginal moisturizers. These include Replens, which can deliver moisture for up to three days; Emerita, a natural product that can be used daily; and Lubrigyn, which includes a lubricant and a moisturizer. 

2. Talk to your health care provider about vaginal estrogen. Guess what? Using small amounts of estrogen in the vagina does NOTincrease the risk of breast cancer. Really, it doesn't because it's all absorbed in the vagina and cannot be detected in the blood. This helps restore vaginal estrogen, which better enables the skin to stretch and lubricate. It also encourages the lactobacilli return, reducing the risks of infection.

3. Consider using Intrarosa. This is a new steroid vaginal suppository, approved by the U.S. Food and Drug Administration, to treat moderate to severe dyspareunia (painful sex). The steroid—dehydroepiandrosterone or DHEA—converts to estrogen in the body, helping to restore vaginal estrogen. This improves the elasticity and lubrication of the skin and may allow for lactobacilli to return, reducing the risks of infection.

4. Consider using Osphena. This is an oral medication that acts like an estrogen in the vagina. It helps restore the vaginal estrogen, which makes the skin better able to stretch and lubricate and also helps restore lactobacilli. 

My book, The Hot Guide to a Cool Sexy Menopause, has a lot more information on all aspects of menopause.

Disclosure: I do not work for or with any of the products listed here. All of the proceeds from the sale of my book go to FAME Hospital in Tanzania.

This blog originally appeared on Nurse Barb's Daily Dose. Barb Dehn is a women's health nurse practitioner, award-winning author and nationally recognized health expert. She practices with Women Physicians in the Silicon Valley of California.