Painful intercourse after menopause

[WULFRUNIAN]

I've had painful intercourse since my periods stopped. The Dr referred me for an internal scan which found nothing and prescribed for vaginal atrophy. The problem which occurs in the perineum area (where tore in childbirth) persists. Is it likely that there is something that can improve this or do I just have to put up with it?

[Mr Jonathan Broome]

Hello

You definitely don't have to put up with this!
It's going to be due to either a problem with the skin ( menopausal atrophy, inflammatory conditions i.e. lichen sclerosis etc) or an anatomical problem such as scar tissue or a deficient perineum.

Topical oestrogen cream would be the first thing to try, very safe and not the same as HRT, if the area looks a little abnormal then this could represent lichen sclerosis and your GP may be happy to prescribe a topical steroid to help, or at the least refer you to a gynaecologist. If it's just tight with an area of scar tissue then this can be excised/refashioned to give more room for intercourse.

Please don't suffer in silence, there's plenty that can be done.

Regards

[Mr Radwan Faraj]

Hi

We as gynaecologists see and treat painful intercourse regularly. However, to be successful in treating your patient, we need to understand the cause of the problem. I do feel painful intercourse could affect the relationship and also leads to avoiding having sex. Prior the menopause the common causes are endometriosis, previous pelvic infection and also perineal problems as you said related to childbirth.

After stopping the periods, we assume replacing the estrogen with vaginal HRT will solve the problem. You need full examination to rule out other skin conditions in the perinuem like Lichen sclerosus which respond to a steroid cream. Occasionally, simple surgery may be needed to the perineum
All the best

Mr R Faraj
www,faraj-gynaecology.co.uk

[ahargreaves]

Do topical oestrogen creams have any risks / side effects?
I have a similar issue to the person above and have tried every type of lubricant on the market (both oil and water-based and nothing seems to work). My vagina is always tight, dry, sore and stinging. I've been to my GP and have been prescribed Regelle but that doesn't seem to make much difference either. I've had an internal scan which shows up no physical problem. I'm at a loss as to what to try next!

[Mr Jonathan Broome]

Hello

Vagifem pessaries used twice a week are completely safe. The dose isn't strong enough to cause any systemic risk, in fact if you use vagifem for a year it's equivalent to using HRT for 1 day! It's less messy than creams but because the dose is so low it may be 6 weeks before you see any improvement. If it works then use it long term (years)

Regards

[Debsie321]

Hi

After intercourse (and sometimes during) I have a sharp pain in my right side which lasts a couple of days. My periods also seem to be very heavy some months. Is this something I should be concerned about?
Many thanks

[Mr Jonathan Broome]

Hello

Pain that lasts for a few days after intercourse could be related to a number of things, the most likely is bowel spasm or irritable bowel syndrome. The large bowel (colon) and small bowel lies behind and over the womb and this can be jiggled around during intercourse, sometimes this leads to bowel spasm which can often manifest itself as persistent pain. There may be other gastrointestinal symptoms such as an altered bowel habit, nausea or abdominal bloating. Buscopan (a muscle relaxant) bought over the counter may help. Other potential but less likely causes could be an ovarian cyst, adenomyosis, endometriosis or pelvic congestion, these usually cause pain with intercourse and are not usually a cause of prolonged pain afterwards. If the symptoms persist a pelvic scan might be helpful and possibly referral to a gynaecologist who may consider a laparoscopy.