A happy, healthy sex life is an important part of mental, physical and emotional health. But when intercourse becomes painful, it can cause emotional and other issues for couples.
Pain with sex is more common for women after menopause. Estrogen therapy is an option for most, but not for women with a history of breast cancer. A central goal of cancer treatments is to have no estrogen in the system.
Health care providers have long thought that vaginal atrophy was causing the pain during sex. But from my experience treating vulvar pain, I believed that the location of pain was the inner vulva, outside the vagina, and that the problem is a pain condition, not a dryness condition. I had the opportunity to research my theory thanks to funding by the Center for Women’s Health Circle of Giving research grant awarded in 2011.
I studied 46 women with severe pain with penetration related to lack of estrogen. I focused on the area of the vulva just outside the vagina—a place where a woman can easily apply topical therapy herself. Patients used liquid lidocaine compresses for three minutes just before sex. We also provided a silicone lubricant.
We found that 90 percent could then have comfortable, enjoyable penetration. Male partners did not note any numbing, and women had no pain—and could enjoy intimacy again.
I believe that even women who can use estrogen should also be shown how to focus on the entryway location, rather than inside the vagina, if they are using local, topical therapy for such pain. And if that therapy is not enough to reverse the tenderness, liquid lidocaine is an option.
Learn more about the options we offer at the Center for Women’s Health Vulvar Health Program, or talk to your own health-care provider. Because a fulfilling happy sex life is key to everyone’s overall well-being.
Dr. Martha F. Goetsch is an OB/GYN at the Center for Women’s Health specializing in vulvar health.