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Women, vagina owners, and birthing persons report having pain with sex,frequently. And it can happen at different parts of the lifespan but for the same reason. Do you know why?
Estrogen! Or lack thereof.
How your hormones are affecting your sex life.
Here’s the deal: The tissues that surround the vaginal opening and the tissues of the vulva are very estrogen-dependent. That is, they love estrogen, and they have tons of little hormone receptors within the tissues that bind to estrogen. Estrogen helps make the tissue robust, plump, lubricated, and soft. When we don’t have enough estrogen floating around, the receptors have nothing to bind to, and we see effects in the localized tissue.
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The labia (aka the outer and inner external folds of your vulva) become thinner, more dry, fragile, and the vaginal opening and canal can become “atrophied,” which means smaller. This creates more dryness, itchiness, and pain when something is trying to enter the vaginal canal. There is a medical term for this called atrophic vaginitis (AV) or vaginal atrophy, and this can even cause small micro-tearing in the tissues as they try to accommodate a penis or something else in the canal. Symptoms of AV include dyspareunia (pain), dryness, changed vaginal pH, and urinary and genital changes.
The decrease in serum estrogen level after menopause is a main cause for these symptoms. AV has potentially negative effects on quality of life and can be related to secondary diseases such as increased urinary tract infections.
What makes your estrogen levels drop?
So why does this happen? Two common culprits: breastfeeding and menopause.
People who are lactating and breastfeeding usually don’t have regular periods since the body is trying to suppress ovulation so you don’t get pregnant again. (Disclaimer: You can still get pregnant if you’re breastfeeding in the absence of a period!) The body’s job is to make milk to feed the baby, not get pregnant again quickly.
That’s why most people who have a baby have similar vaginal tissues to a person in menopause: atrophy; dryness; pain; pale color; less lubrication; and thinner, more fragile tissue. In a study of 832 first-time moms, nearly half of the women (46.3%) reported a lack of interest in sexual activity, 43% experienced a lack of vaginal lubrication, and 37.5% of women had dyspareunia (painful sex) six months after birth.
The same goes for menopause. Menopause is the cessation of menstrual cycles, and no more ovulation occurs. Estrogen fuels ovulation, so when estrogen drops and ovulation stops, we have a systemic result. Without estrogen flowing through the body due to menopause, the tissues of the vulva and the vagina are affected. In fact, anywhere from 17 to 45% of postmenopausal women report painful intercourse, and AV appears in approximately 45% of postmenopausal women, according to research on dyspareunia.
1. Get a pelvic floor physical therapist.
Pelvic floor physical therapists can help you decrease pain, show you specific exercises to help release the pelvic floor and vaginal muscles, and help you get back to a sex life you enjoy, no matter where you are in your life. Hormones play one part, but pelvic floor muscle dysfunction and tightness may be another cause as well, as everything needs to be addressed and working properly.
2. Consider estrogen creams.
Talk to your provider to see if topical estrogen is safe for you to use: Sometimes a small amount of estrogen cream applied to the vulva and vaginal opening can make a huge difference. This helps make the tissue a bit more plump, robust, and lubricated.
Try a high-quality water-based lube (my favorites are Good Clean Love and Coconu), and apply it on the outside of the vaginal canal. If your partner or whatever is going into the vagina, apply inside the vagina as well. Reapply copious amounts as needed throughout. You can never use too much lube! (Here’s mbg’s roundup of the best natural lubes.)
4. Consider moisturizers.
There are some over-the-counter products that are not hormone-based that help lubricate and soften the skin on the outside of the vulva. There are some that also are internal. Luvena is an over-the-counter (OTC) suppository specifically designed for postmenopausal women and helps to lubricate and moisturize. Other options are coconut oil and Aquaphor, applied externally to help protect the tissues.
Remember this: If you are experiencing painful sex, although it is common, it is not normal, and you don’t have to live with it. Ask your OB-GYN for a referral to a pelvic floor PT, try good-quality lubrication and moisturizers, and get a program in place to help you live the life you want to be living.