Pain with Sexual Relations in Older Women

Pain with intercourse is common in older women. At first it may be a problem just once in a while. If it is not treated, it can become a more frequent and serious problem. A woman might like and want to have sex but avoid it because it hurts.

The medical term for painful intercourse sex is dyspareunia.

How does it occur?

You may feel pain at the opening of your vagina or on the vulva, which is the area around the vaginal opening. Even a gentle touch in this area may cause pain. When you have a problem with pain during sexual intercourse, there is usually a health-related reason.

Sex may cause pain because there is not enough moisture in the vagina. When the vagina does not produce enough moisture in response to sexual arousal, it may be due to a physical cause or psychological factors.

Some of the physical causes of pain during sex are:

• Menopause: The decrease in hormone levels at menopause causes changes in vaginal tissues. They become thinner and less elastic. There is less vaginal wetness even when the woman is aroused.
• Other conditions:
  • endometriosis, which is growth of uterine tissue outside the uterus, such as in the vagina
  • tipped or prolapsed (fallen) uterus
  • infections of the bladder or urethra (the tube that carries urine from the bladder to the outside)
  • bowel problems (diverticulitis)
  • scarring of tissues torn or cut during childbirth, vaginal surgery, or pelvic surgery
  • sexually transmitted diseases (STDs) or other infections, including pelvic inflammatory disease (PID) or yeast infections
  • a swelling of a gland at the vaginal opening called a Bartholin's cyst
  • intercourse after a long period of not having sex
  • a problem called vaginismus, which is a tightening of the muscles at the opening of the vagina because of spasms
  • irritation by spermicides, soaps, or other chemicals
  • growths on the uterus, tubes, or ovaries
  • injury of the vaginal area
  • warts
  • previous sexual assault
  • arthritis
  • sexual dysfunction

Many older people are faced with circumstances that can contribute psychologically to a lack of sexual response, such as:

• Either you or your partner may be ill or frail. In such cases, sex may not be a priority or may be avoided because of a fear of hurting or being hurt.
• You may have lost your partner to death or divorce.
• You may lack privacy and sexual freedom. This may be because you share a home with relatives or are living in a retirement home that does not offer privacy.
• If you are not married, you or your partner may not be comfortable with the idea of sex outside of marriage. (Widows and widowers may be reluctant to remarry because of financial problems, such as a reduction in Social Security benefits.)
• You may be on medications that can affect your libido (sex drive), such as blood pressure medications.

How is it diagnosed?

Your healthcare provider will ask about the pain. You may have a pelvic exam and tests to look for infection or other problems.

How is it treated?

Your treatment depends on the cause of the pain.

• Vaginal lubricant:

  Your healthcare provider may recommend use of a vaginal lubricant. The lubricant can prevent the pain caused by lack of vaginal moisture during sex. You and your partner can use a lubricant in a way that makes it a part of lovemaking. Lubricants can be purchased at a drugstore. Ask your provider what product might be best for you. Benefits of using a lubricant are:

  • less irritation, pain, and fewer tears of vaginal tissue
  • less irritation or discomfort for the male partner
  • greater ease for the penis to enter the vagina
  • less fear of pain during lovemaking
• Hormone therapy:

  You can use hormone medicine to replace some of the estrogen hormone that decreases after menopause. Hormone therapy may reduce or get rid of many of the symptoms of menopause that cause painful sex, such as vaginal dryness. There are some risks with hormone therapy. For example, it may increase your chances of getting some forms of cancer or heart disease. Discuss the benefits and risks of hormone therapy with your healthcare provider.

• Treatment of other causes:
  • Treat infection of the vagina, bladder, or urethra with medicine.
  • Remove or treat fibroids, genital warts, or endometriosis.
  • Remove or repair a tipped or prolapsed uterus.
  • Stop use of spermicides or douches that cause allergic reactions.
  • Treat vaginismus with dilators of the vagina and Kegel exercises.
• Counseling:

  If the reason for painful sex is psychological, ask your healthcare provider to refer you to a psychologist, sex therapist, or other counselor for help.