Pain when having sex can affect between 10-28% of women worldwide. It can occur at any time in life but is most common during menopause. This disorder can decrease women's quality of life by inducing stress, anxiety and even relationship problems. However, in many cases it has a solution. If it does not disappear completely, it can improve a lot (Tayyeb & Gupta, 2021). Join us and let's talk about the issue and the options you have to alleviate the pain.

Pain when having sex: possible signs and symptoms

Pain when having sex is known as dyspareunia and can vary depending on the cause. Two types of dyspareunia are described (Conn & Hodges, 2021; Tayyeb & Gupta, 2021):

• Superficial: pain appears at the onset of vaginal penetration. This can be during intercourse, foreplay with sex toys or even during a pelvic examination at the gynecologist.
• Deep: when the pain is concentrated deep in the vagina or pelvic area and only appears when there is deep penetration.

In addition to pain, some women may also experience (Conn & Hodges, 2021):

• Burning
• Cramping
• Urgency to urinate
• Psychological symptoms such as stress, anxiety, depression, embarrassment or negative body image

Causes of pain when having sex

These can be various and include physical and mental problems. Major causes of painful intercourse include (Conn & Hodges, 2021; Spengler et al., 2020; Tayyeb & Gupta, 2021):

Superficial dyspareunia

• Insufficient foreplay
• Lack of lubrication
• Vaginal or genital inflammation or infection
• Urinary tract infection
• Injuries to the genital area
• Allergic reactions or irritation of the genitals
• Vaginal surgery or radiation therapy
• Genitourinary syndrome in menopause

Deep dyspareunia

• Infections of the cervix, uterus, ovaries
• Pelvic inflammatory disease
• Endometriosis
• Uterine fibroids
• Growing tumours in the vagina, uterus, ovaries or fallopian tubes

Dyspareunia and its relationship with the menopause

Now, during perimenopause, menopause and post-menopause, there are many hormonal, physical and mental changes that can also contribute to dyspareunia. These are (Palacios et al., 2019):

• Dryness of the vagina
• Decrease in the capacity of vaginal lubrication
• Thinning of the vaginal walls
• Narrowing of the vaginal opening
• Decreased sexual desire

Recommendations for relieving dyspareunia in menopause

Even with all these menopausal physical changes, you can still have a normal sex life. The important thing is to determine the correct cause of the problem and act on it. The best advice is to see your doctor for a complete check-up of your physical and sexual health. However, there are some very practical recommendations that can be very helpful.

Actions to help relieve pain during sex

These actions are mainly based on improving vaginal dryness, which is a very important disorder during menopause. You can use for this purpose (Laughlin, 2021):

• Vaginal moisturisers that are applied regularly.
• Water-based vaginal lubricants used at the time of intercourse.
• Vaginal creams, tablets or rings with low doses of oestrogen.
• In more severe cases, hormonal or non-hormonal prescription drugs such as ospemifene.

Recommendations to improve your mental state

The mind also plays a key role; anxiety and stress can make the perception of pain worse. To avoid this, there are some interesting recommendations (Conn & Hodges, 2021):

• Practice in your free time activities that you enjoy and help you relax.
• Talk to your partner about pain during sex to avoid misunderstandings.
• Look for activities that increase sexual desire and arousal prior to sex, such as a couple's massage or fulfilling sexual fantasies.
• Try having sexual encounters without penetration. These can also be very pleasurable for both partners and even promote female orgasm.
• Stimulate the intimate area little by little, including the entrance of the vagina to reduce anxiety.

Always remember that you are not alone. Many women like you have had pain when having sex, before, during or after menopause. Also, remember that there are many factors such as infections, irritations and psychological factors that can cause it. Take heart, go to the doctor for a complete check-up and avoid self-medication. A medical consultation and the right treatment can help you enjoy your sex life to the full during menopause.

References

• Conn, A., & Hodges, K. (2021). Genitopelvic Pain/Penetration Disorder. MSD Manuals. https://www.merckmanuals.com/home/women-s-health-issues/sexual-dysfunction-in-women/genitopelvic-pain-penetration-disorder
• Laughlin, S. (2021). Vaginal dryness after menopause: How to treat it? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/vaginal-dryness/faq-20115086
• Palacios, S., Cancelo-Hidalgo, M.J., González, S.P., Manubens, M., & Sánchez-Borrego, R. (2019). Síndrome genitourinario de la menopausia: recomendaciones de la Sociedad Española de Ginecología y Obstetricia. Progresos de Obstetricia y Ginecología, 62(2), 141-148. https://sego.es/documentos/progresos/v62-2019/n2/09-AE_Sindrome-menopausia.pdf Spengler-González,
• L.M, De Dios-Blanco, E., Roque-Ortega, L., & Maurisset-Moraguez, D. (2020). Dispareunia y vaginismo, trastornos sexuales por dolor. Revista Cubana de Medicina Militar, 49(3). http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572020000300015&lng=es&tlng=es.
• Tayyeb, M., & Gupta, V. (2021). Dyspareunia. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562159/