What to Do When Sex Is Painful

One of the less-than-wonderful physical surprises as women get older is that the natural lubrication of the vagina diminishes. After menopause, this happens so gradually that you may not notice at first. But you might reach the point when intercourse becomes painful — and that can be a total turnoff.

What to do?

Sometimes the cure is a simple one: Buy some artificial lubrication. There are dozens of good ones, either water-based or silicone-based. The water-based ones dry up more quickly with the friction of intercourse, but they can be reactivated with saliva. Silicone-based lubes are smooth and last longer, but some women find them too slick (making it difficult to feel any friction at all) or resist the notion of introducing that compound into their bodies. In general, either one of these artificial applications will solve the pain problem — though it may take you a bit longer to get over the anticipation of pain.

Another way to redress the situation is via Replens, a moisturizer that plumps up vaginal tissue. This product requires repeated applications over time, but for some women it's a welcome answer to the issue.

As women get older the natural lubrication of the vagina diminishes, sometimes to the point where intercourse becomes painful.

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Occasionally, however, the usual lubrication is not enough. A step higher in remediation of the vaginal walls is an estrogen-based product. Most women who have had cancer of any kind should stay away from estrogen; even if that describes you, however, some estrogen-based products may be safe because they are absorbed only by local tissues. (No one but a doctor can make this determination.)

For women without that complication, by contrast, estrogen-based products (or prescription estrogen creams from your gynecologist) are a godsend. The estrogen changes the vaginal wall from brittle to bountiful, making painful sex a distant memory.

Now here's what puzzles me: Why don't women and their partners reach out for these answers right away? Some believe that changes in vaginal ability are inevitable (they aren't) or cannot be corrected (they can). Others suspect the dryness is a reaction to their partner — and they may be right: Lack of lubrication is sometimes about the partner, or about deeper psychological issues that are inhibiting excitement or causing you to clench up, making intromission difficult. If there are relationship issues, or if pain during intercourse has nothing to do with dryness (from the penis banging too hard against the cervix, for example, or from some other factor such as herpes or HPV), see a doctor for diagnosis and treatment.