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Heather Jeffcoat on Livestrong.com
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image depicting why sex can be painful after menopause
Image Credit: Zinkevych/iStock/GettyImages
When Emilia Benton reached out to me for an article she was working on for Livestrong, her intent was to give a brief overview of why sex can be painful after menopause and the various treatment options being offered. Of course I was glad to put in my two cents for pelvic floor physical therapy as a big piece of the puzzle.

Heather Jeffcoat, DPT

Learn Why Sex Can Be Painful After Menopause - And What You Can Do About It

First we had the Baby Boom, and then the Menopause Boom. Since then we've learned a lot about what menopause is all about, but as happens with any time of change in our lives, there are still a number of questions to be answered. One of the more common ones concerns why sex can be painful after menopause.

Some of the answers to this question will be familiar to any woman who has experienced insufficient lubrication for any number of reasons, often to the point where they either cannot enjoy sex to the fullest - or cannot even do it at all due to the pain and discomfort. But during the fertile period of a woman's life, these issues can often be corrected depending on the cause.

But the vaginal dryness that can accompany menopause is often treated with a more long term approach, since the issue is seen as "here to stay", so to speak. Everything from hormone replacement therapies to laser treatments are sometimes touted as quick fixes for what is really just a natural part of every woman's life cycle. Here at Femina PT we prefer to treat issues related to menopause with a whole body approach, rather than just blaming these issues only on a lack of hormones - or a lack of laser light exposure!

What Causes Menopause?

From the article:

During your younger years, hormone levels — particularly estrogen, progesterone and testosterone — are high, explains Barbara Hannah, MD, an ob-gyn in the Detroit area and author of ​A Hot Mess: Tips, Tricks and Truths About Menopause and Perimenopause​. These hormones are needed for menstruation, childbearing and childbirth, but their levels naturally shift once menopause sets in.

"During the aging process, there is a significant decline in hormone production, and as a result there are a number of changes in the body," Dr. Hannah explains. "These changes occur from the top of the head to the bottom of the feet and not one single body system is spared."

When most people think of the effects of hormonal changes on the body and how they might affect one's sex life, many people's minds go straight to the psychological effects such as lowered libido and lack of sex drive, but in fact hormones - or the lack thereof - play a signficant role in a physical sense as well.

What Causes Painful Sex After Menopause?

During youth, the hormone estrogen is responsible for keeping the vagina moist and lubricated during sexual intercourse," Dr. Hannah explains. "The youthful vagina has folds called rugae that help to add pleasure to the sexual experience, and the thicker vaginal skin is resistant to damage and tearing."

"With aging and the decrease in estrogen, the vagina thins and dries, which leads to frequent infections, tearing of the tissue and, unsurprisingly, painful intercourse, which can make having sex almost impossible for some people, Dr. Hannah says. Additionally, the vagina becomes shorter and narrower with the decrease in the hormone estrogen.

The average age most women hit menopause is 51. It's important to lead a healthy lifestyle and avoid excess use of things that can accelerate aging such as alcohol, tobacco, and fast foods, to name just a few. Staying hydrated with clean filtered water is always a good call, and leading an active lifestyle will help make sure your body stays in tune and wards off the effects of aging.

The article lists 6 potential remedies for painful intercourse after menopause, which include:

1. Moisturizers - We've got lots of good info here.
2. Lubricants - One of our most popular articles is "Could Your Lube be Hurting You?"
3. Prescription Medications - Hormone replacement therapies are a common topic, see here
4. Eating Phytoestrogen Foods
5. Laser Treatments - Lasers And My Vagina?!?
6. Pelvic Floor Physical Therapy - This is where we come in!

The article seems to imply that making Pelvic Floor Physical Therapy your last option is a good idea, but of course we hope you will make it a priority in case it's all that's needed!:

If the prescription or over-the-counter products you've tried aren't bringing you relief, it may be worthwhile to consider seeking out pelvic floor physical therapy or rehabilitation, says Leia Rispoli, MD, an interventional pain management specialist and physiatrist specializing in pelvic floor pain and dysfunction in Newport Beach, California. This can include pelvic floor exercises, manual therapy or biofeedback using stimulation by various tools.

"If those interventions still fail to improve symptoms, the patient may require a further workup and treatment options from a pelvic pain management doctor," Dr. Rispoli says.

My take:

Sex doesn't have to stop after menopause, but what makes you comfortable and how you experience pleasure may need to change," adds Heather Jeffcoat, DPT, a pelvic floor physical therapist, owner of Femina Physical Therapy in Los Angeles and author of ​Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve​. "Incorporating a pelvic floor physical therapist and learning how to keep the tissue flexible and allow it to stretch without experiencing pain can make the difference between abstinence due to pain and being able to engage in a pain-free sex life."

Can You Prevent Painful Sex After Menopause?

One Answer Aside From Hormone Replacement - Have Frequent Intercourse!

File this under "Use it or lose it!" - like any other part of the body, underuse can lead to atrophy.

Frequent intercourse helps to keep the vagina stretchy and healthy," Dr. Gersh adds. "Use it or lose it is the motto of the day."

This might be the best advice you can get, but if you just can't get there yet and need some help, use this form if you would like to see one of our trained therapists.

You can also use this link for the complete story at Livestrong on why sex can be painful after menopause.

More Media Coverage

What Our Patients Have to Say

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Testimonial by S.P., Age 26

I would like to start off by thanking Heather Jeffcoat for educating me and curing me of Vaginismus. I had been married for almost three years before I was referred to Heather. I never knew about Vaginismus until almost three years into my marriage. I knew something was wrong when I went on my honeymoon and came back a Virgin. I had always imagined how magical my first night would be but boy was I wrong.

Read more: Testimonial by S.P., Age 26

Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

Testimonial by S.P., Age 26

I would like to start off by thanking Heather Jeffcoat for educating me and curing me of Vaginismus. I had been married for almost three years before I was referred to Heather. I never knew about Vaginismus until almost three years into my marriage. I knew something was wrong when I went on my honeymoon and came back a Virgin. I had always imagined how magical my first night would be but boy was I wrong.

Read more: Testimonial by S.P., Age 26

Testimonial by R.S.

I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

-- R.S.

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by R.D., age 38

"I had a severe tear during childbirth that was not stitched together correctly and therefore healed poorly. Even after having a surgery a year later to remove the scar tissue, I was still having pain, and no one could explain why -- there was no overt 'reason' to explain the pain. I had tried other 'specialists' and even saw another physical therapist who had me do hip / leg stretches -- what a joke! I was about to give up and just 'live with it' until thankfully I kept searching online and found Heather.

Read more: Testimonial by R.D., age 38

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