Are Your Hormones Making Sex Less Enjoyable For You?

Estrogen! Or lack thereof.

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.

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.

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 dyspareunia2.

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.

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.)

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.