This article is also available in Space Coast Medicine.com  and a video interview of Dr. Sprock discussing this topic is available on YouTube. 

Sex is one of the main motivators in life, however a lot of people have trouble discussing sex with their physician. Despite being so important for general wellbeing, it is often skipped in the history taking by the physician. You may be asked if you wear your seatbelt, however the sex question will often be skipped.

You are not the only one who noticed an increasing discomfort and less satisfaction with intercourse after menopause. Healthy vaginal tissue is highly dependent on estrogen. When estrogen is taken away or lowered, as it is in menopause, there is significant thinning of the vaginal tissues, which leads to diminished sensation and discomfort. Your desire will diminish as well, since you usually do not look forward to another negative experience.

Estrogen May Be of Benefit

Sex should not be a chore. It should be fun for all involved. Vaginal application of estrogen may be of great benefit to nourish the tissue in menopausal women. It restores vaginal wall thickness, which provides more natural sensation and less or no discomfort. Lubrication is often still necessary, however it alone will not do the job after menopause.

There are estrogen products available that result in minute, almost non-demonstrable levels in the blood. The FDA approved estradiol vaginal ring is an effective and acceptable treatment for vaginal atrophy. The vaginal ring consistently releases a low dose of estradiol directly to the vaginal mucosa. Studies of the estradiol ring show that it is equal to vaginal creams in restoring the maturation of vaginal mucosa. Vaginal creams are absorbed slightly more, but if used twice a week in low amounts are also effective and barely demonstrable in the bloodstream.

Premenopausal women with normal estrogen levels may experience sexual “problems” centered around diminished sensation related to vaginal changes after vaginal childbirth. It is, of course, optimal for both partners for the effects of childbirth on the vaginal canal to revert back to “normal” within a few weeks to enhance their mutual pleasure. Pelvic floor exercises are often started and can achieve improvement, however often not to the desired level.

Vaginal Rejuvenation

An option for some is interventional or procedural management of post-child bearing vaginal changes. Insurance companies will not cover the narrowing of the vagina for sexual health, however cosmetic gynecology can be performed, like plastic surgery is done for numerous other body parts.

Numerous terms, such as vaginal rejuvenation with or without laser, vaginal tightening, and vaginal plication are used to describe specific treatment for vaginal opening enlargement and decreased pleasure with intercourse. With or without laser, the vagina is tightened through some well-placed sutures. There are lasers on the market that claim tightening without stitches, however, this approach is relatively new, and, at this time, there are no solid data available about the long-term effectiveness.

Because of the “cosmetic” nature of these procedures, payment for this type of treatment comes out of your pocket, so do your homework and learn as much as you possibly can about the risks and benefits of the procedure and the alternative treatments that may be available to you. Also, be bold and ask questions about the experience of your physician and the success of the procedure in his/her hands.

I’ve touched on only a few “sexual issues” here. There are many other problems, such as vaginal prolapse and urinary incontinence with intercourse that may require other approaches to treatment.

My primary message is to encourage women to feel comfortable to speak to their physician about their sexual health or lack of it. Obviously there can be numerous reasons why sex is not pleasurable and that is the reason that at Central Florida UroGynecology you will always be asked about sex, and the seatbelt question is skipped; just make sure you wear one.