Menopause, Painful Sex and a New Solution

Menopause.  What is the first thing that comes to mind when you hear that word?  Chances are good you think of hot flashes.  Certainly, hot flashes are part of the mid-life change and for some women, they can be quite bothersome.  However, there is another condition associated with menopause that can be even more bothersome and quite painful.  It is vulvovaginal atrophy, which causes burning, itching and at times, bleeding.  Unfortunately, many women are too embarrassed to discuss this matter with their health care providers.  Ladies, let’s turn this around. There is no need to suffer!

Painful sex in and around the time of menopause is often due to the natural decline of estrogen, which makes vaginal tissue thinner, drier and less elastic.  The result?  For many women, sex becomes uncomfortable and sometimes impossible.  Insufficient lubrication can cause tearing of vaginal tissues during intercourse.  Anxiety and frustration may also take its toll and cause future arousal difficulties or a halt to sex altogether. It is estimated that 20%-45% of middle-aged and older women are affected by these symptoms.

Prescription remedies are available in the form of vaginal estrogen rings, tablets and topical creams.  The estrogen used in these products is low dosage and a much lower risk than estrogen pills used in hormonal replacement therapy. There is a low rate of absorption into the bloodstream. For those who prefer a nonhormonal alternative, an over the counter lubricant like K-Y Jelly, or moisturizer such as Replens, can be helpful.

Recently, the FDA approved Osphena, the first nonhormonal pill, taken once a day to treat moderate to severe sexual pain.  This drug mimics estrogen on some tissues and is in a class of medications called selective estrogen receptor modulators, or SERMS.  In the vagina and uterus, it acts like estrogen and can relieve sexual discomfort

Yes, there are side effects with Osphena as with all medications.  They include vaginal discharge, blood clots and stroke.  It is always important to check with your doctor, be honest, ask questions and weigh the risks.  For those who want a non-estrogen alternative and prefer swallowing a pill over the messiness of applying a cream, Osphena may the right answer for you.

It is always important to talk with your doctor and get regular checkups. Remember, good health starts with you.  A comfortable and happy sexual relationship is part of the total package!

About Dr. Renee Horowitz

Dr. Renee Horowitz is a fellow with the American College of Obstetrics and Gynecology and a member of the American Medical Association, the American Medical Women’s Association, and the International Society for the Study of Women’s Sexual Health. She also is affiliated with the William Beaumont Hospital in Royal Oak, Michigan, and DMC Hospital in Detroit, Michigan.

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