Vaginal changes and sex
Foot Notes
- King D et al. Turning back the clock: adopting a healthy lifestyle in middle age. The American Journal of Medicine 2007; 120 (7): doi.10.1016/j.amjmed.2006.09.020.
- US Department of Health and Human Services. Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General, 1989. Rockyville, Maryland: Public Health Service, Centers for Disease Control, Office on Smoking and Health, 1989.
- Prescott et al. BMJ 1998;316:1043-1047.
- Bonita R et al. Passive smoking as well as active smoking increases the risk of acute stroke. Tob Control 1999; 8:156-160.
- Aldoori MI et al. Smoking and stroke: a causative role. Brit Med J 1998; 317: 962-3.
- www.americanheart.org/womenheartdiseaseandstroke
- Strategic Perspectives: Female Sexual Dysfunction; Datamonitor, 08/2002.
Changes to the vagina: atrophic vaginitis / vaginal atrophy
- After the menopause, due to lack of oestrogen, the vagina becomes shorter, less elastic and dryer. These changes are referred to as 'atrophic vaginitis / vaginal atrophy'. Common symptoms are vaginal dryness, itching, burning, soreness of the vagina and pain during intercourse (dyspareunia).
- Changes in vaginal flora may result in more frequent bacterial of fungal vaginal infections.
- Approximately 30% of women experience vaginal symptoms during the early post-menopausal period, and up to 47% of women have them during the later post-menopausal period1.
1. NHS Direct: Health Encyclopaedia - 2008 http://www.nhsdirect.nhs.uk/
Vaginal therapy
- Vaginal therapy includes vaginal tablets, creams, rings and suppositories which are inserted into the vagina to help relieve the vaginal symptoms of the menopause. These deliver oestrogen directly to the tissues of the vagina.They are easy to use and easy to stop. They are sometimes referred to as 'local therapy'.
- For women who have only vaginal symptoms, it may be worth trying one of these local preparations.
- If menopausal symptoms are more general, a form of treatment which circulates throughout the whole body (known as "systemic treatment" which is most commonly applied by tablets taken by mouth, or skin patches) may be more appropriate.
Tips to help yourself
- Avoid bathing with soap, shower gels, and bubble bath as these have a drying effect. Instead there are many soap-free products available that are as effective at cleaning.
- If you use non-prescription vaginal lubricants or vaginal moisturisers to decrease friction and discomfort during intercourse, make sure you only use lubricants approved for vaginal use. Don’t use scented moisturisers, baby oil, or petroleum based products as these could cause irritation and make dryness and irritation worse.
- You may benefit from vaginal therapy – ask your doctor.
Sleep disturbance
Sleep disturbance can be part of various psychological symptoms wich many women experience during the menopause. Other psychological symptoms are e.g. mood swings, tearfulness, and feeling depressed.
Sleep can also be disrupted by night sweats and urinary problems, leading to tiredness, irritability and even to exacerbation of depression.
Vaginal changes
The hormonal changes and sleep disturbance at menopause can themselves affect mood and depress libido. Unfortunately, their effects may be compounded by psychological factors. In middle age some women can view the loss of fertility and changes to skin, hair and shape as signs that they no longer have sex appeal. This can become a self-fulfilling prophesy if they cease to care about their sexuality and avoid intimacy. If they also experience vaginal dryness and painful intercourse, loss of libido may increase further.
Low oestrogen causes the normal cells lining the vagina to be replaced by different ones that create a much thinner lining. This leaves nerve fibre endings close to the surface of the vagina and vulnerable to stimulation from friction during penetrative sex. Normal bacteria that live in a healthy vagina disappear as it becomes less acid so that infections become more common.
Symptoms include vaginal dryness, painful intercourse (dyspareunia), itching, burning, soreness, and urinary infection. Within three years of menopause almost half of women experience vaginal dryness to some extent. Currently very few – only around one in three or fewer - either seek medical help or receive advice and treatment to resolve the problem.
Female sexual dysfunction
In addition to the changes during menopause that lead to vaginal dryness and painful intercourse, you may experience other problems such as loss of libido, frequent urinary tract infections, and weak bladder that impact on sex drive.
Classic symptoms are lack of interest in sex, lack of arousal, and difficulty with orgasm7.
Fatigue, stress, and lack of sleep can contribute to lack of sexual desire. It is important to try to sleep well and eat a well balanced diet for energy.
Making time for sex is important – going to bed early or remaining in bed in the morning. Massage, caressing, and relaxation techniques can help to stimulate sexual desire.
If problems do arise due to vaginal dryness it is important not to get frustrated or to force sexual intercourse. It is important not to lay any blame on either partner. Try again later.
Some women find psychological counselling helpful, to discuss difficult issues with a third party or to openly discuss any issues together with their partner.
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