Vaginal changes

One of the most common symptoms of the menopause is vaginal dryness. This and other similar symptoms occur due to a fall in oestrogen levels during this transition which can impact upon a woman’s sex life.

Many women find that they experience painful intercourse during and after the menopause which affects their relationships.

If this has happened to you then you are probably reluctant to have intercourse due to the pain and discomfort caused by these changes.

What are vaginal changes?

This term encompasses vaginal dryness, irritation and soreness. This may appear to be a minor symptom but women who experience this find that it has a dramatic effect upon their lives.

There are women who feel a sense of failure and guilt which often leads to depression.

The medical term for vaginal dryness is ‘atrophic vaginitis’.

How common are vaginal changes?

These changes occur in the early stages of the menopause –known as the perimenopause; menopause and the postmenopause stage.

More than 80% of menopausal women experience vaginal dryness and/or other similar symptoms.

Causes of vaginal changes

These occur as a result of falling oestrogen levels.

Oestrogen helps to keep the mucous membranes within the vagina moist and strong. It also produces a type of lubricant which is slightly acidic and helps to protect the vagina against bacteria and infections.

A drop in oestrogen levels causes the mucous membranes to dry out which means that the walls of the vagina become weaker, less elastic and at increased risk of an infection.

The vagina becomes thin and dry and shorter in length. Some women experience a ‘vaginal prolapse’ which means that the vagina has dropped out of position, resulting in incontinence.

Fat is lost from tissues surrounding the genitals which results in pale looking skin and a shrunken appearance.

Discharges from the vagina change those with a watery consistency. A thick discharge with a strong odour is symptomatic of a yeast or urinary infection.

The skin around the vagina is thinner, more sensitive and prone to itching. This leads to a cycle of repeated itching/scratching which is both annoying and upsetting.

Vaginal changes and intercourse

The main problem is that of vaginal dryness and intercourse. The vagina is less moist and dryer as a result which means that any force or penetration such as intercourse causes pain and discomfort.

If too much force is used during intercourse then this can damage the walls of the vagina causing pain and bleeding.

You may have noticed some bleeding after intercourse which is due to the fact that your vagina is too thin and dry to cope with the pain caused by friction on dry tissues within the vagina.

Many women avoid intercourse altogether during the menopause due to the pain and discomfort experienced as a result of these changes. This has an impact upon not only them but their partner as well.

Other causes of painful intercourse

Just a word of warning: pain experienced during intercourse is not always due to the menopause. There are women who experience pain and discomfort during intercourse which may be due to another gynaecological problem such as a sexually transmitted disease.

Another cause of pain during intercourse is ‘vaginismus’: this is a condition in which the woman experiences painful spasms in her vagina during intercourse due to anxiety or tension.

If she is apprehensive about having intercourse or cannot relax beforehand then this causes the muscles of the vagina to tense and go into a spasm.

If you are going through the menopause but find that intercourse is extremely painful then speak to your GP. Whilst it is normal to expect some level of discomfort as a result of the menopause it should not cause you to suffer intense pain during intercourse.

There may be an underlying medical condition or psychological cause which requires further investigation.

Treating vaginal changes

There are treatments available which can relieve the symptoms of vaginal dryness. These include hormone replacement therapy (HRT), lubricating creams and gels, e.g. KY Jelly and over the counter moisturising creams.

HRT is a form of oestrogen replacement treatment which is based upon restoring your oestrogen levels to their pre-menopausal state. There are a range of benefits from doing so which include maintaining bone density, easing hot flushes and ensuring that the vagina is lubricated.

But there are side effects with HRT so if you are thinking of taking this therapy then make sure that you are fully aware of what these are.

Find out more in our hormone replacement therapy subsection within the menopause treatment section of this guide.

Your GP may advise you to persists and even increase the frequency of your sexual activity. Whilst that may sound strange there is a very good reason for doing so which is to maintain lubrication within the vagina.

This lubrication reduces during the menopause but intercourse will help to stimulate this via the mucous glands at the opening to the vagina. This will ensure that the vagina is moist and pain free during intercourse.

If you avoid having intercourse then you will find that your vaginal dryness worsens as a result.

So whilst it may not seem like a pleasant proposition, especially if you have experienced painful intercourse, it is a better option than choosing to refrain from intercourse altogether.

Your GP will be able to advise you about ways of avoiding painful intercourse.