
(Illustration: Raquel Romero; created in Midjourney)
For midlife women, sex can sometimes be painful. The most common culprit: vaginal dryness.
More than 50 percent of post-menopausal women will experience symptoms of genitourinary syndrome of menopause (GSM), characterized by a loss of vaginal elasticity and dryness. That’s thanks to the multisystem shifts that take place during the transition: as estrogen decreases, the vagina becomes less elastic, the vaginal tissues become thinner and the cells inside the vagina turn less acidic and in turn, more dry.
But dryness is not just a side effect of menopause—some pre-menopausal women on birth control and postpartum women who are breastfeeding can experience it too.
The first step toward relief is recognizing and identifying your symptoms, says Dr. Shafeena Premji, a Calgary-based doctor who sits on the board of directors of the Canadian Menopause Society. If sex feels painful, it’s crucial to talk to your doctor about treatment options.
Those options may include menopause hormone therapy (MHT), which is systemic, or vaginal hormone therapy, which is localized. For menopausal women who experience other symptoms, like hot flashes or night sweats, MHT may also help to improve GSM.
For those tackling vaginal dryness only, Premji says the most effective treatment is the use of vaginal estrogen therapy products. These products come in the form of tablets, creams and inserts. They are prescribed by your doctor to be used locally (in the vagina), so they don’t enter the bloodstream like MHT, and usually have fewer side effects.
A vaginal moisturizer can also be prescribed or picked up at your local pharmacy. Just like a facial moisturizer, it’s applied to the vulva and inside the vagina to keep tissues hydrated—and must be used consistently in order to see results.
And for women looking to improve dryness during intercourse, Premji says a lubricant can be used in combination with other products. Look for water- or silicone-based lubes, and apply inside the vagina, on the vulva, on the penis or on any toys you’ll be using. (You can warm it up with your hands before application.)