How Vaginal Atrophy can impact your sex life, and what you can do about it. 

14 05 02Sex after menopause

After the kids have moved out and retirement is just around the corner, many older couples look forward to reconnecting and rekindling their relationship—without any distractions. However, an inevitable change caused by the hands of time can wreak havoc on intimacy between partners: menopause.

You may have heard that “the big change” can cause sex to become less comfortable and that a woman’s libido may start to lag. While this is true, there is a more serious affliction that may require you to re-educate yourself—and your partner—on everything you thought you knew about doing the deed.

A recent study entitled “Clarifying Vaginal Atrophy’s Impact on Sex and Relationships (CLOSER),” conducted by Dr. Vivien Brown, vice-president of medical affairs for Medisys Health Group Inc. and a North American Menopause Society (NAMS)-certified menopause practitioner in Toronto, found that one in five Canadian post-menopausal women suffers from a serious physical condition known as vaginal atrophy (VA). We spoke with her about the symptoms of this under diagnosed issue and how you can stop it from affecting intimacy levels in your relationship.

Signs and Symptoms of Vaginal Atrophy

When a woman goes through menopause, a huge drop in estrogen leads to her periods stopping and a host of other unpleasant symptoms, such as bloating, hot flashes and mood swings.

This withdrawal also causes issues with one of our most sensitive areas. “Basically there’s no longer any support for the lining of the vagina, which is estrogen-sensitive,” explains Dr. Brown, “as well as the back wall of the bladder [the trigone area of the bladder]. That lack of estrogen makes that tissue more raw and more fragile.”

A lack of lubrication and an inability to stretch easily is what leads to painful or uncomfortable intercourse. It is the combination of these two conditions that is known as VA. It can also contribute to more frequent urinary infections due to the loss of strength in the back wall of the bladder. Symptoms worsen over time if not treated.

Great Sexpectations

Beyond the physical toll that vaginal atrophy takes on a woman, there are also emotional ones for both her and her partner. Dr. Jennifer Pearlman, MD, CCFP, NCMP, FAARM, ABAARM, a women’s health, hormone and beauty expert, explains that a “woman’s mind, body and balance undergo significant changes during the five to seven years that straddle her menopause.” On top of physical issues, other symptoms, such as increased irritability, sleeplessness, breast tenderness, hot flashes and weight gain, only exacerbate the problem of a woman’s waning libido by lowering her confidence and increasing her stress levels.

The CLOSER study found that 61 per cent of women say their sex lives suffered due to a condition of menopause, and that 66 per cent avoid intimacy because of the fear of pain. One-fifth of women with VA say it made them feel emotionally distant from their partner. 30 per cent of North American couples cited vaginal discomfort as the reason why they stopped having sex altogether.

“Sexual dysfunction in midlife women is common but still flying far under the radar,” says Dr. Pearlman. Without understanding VA, it’s understandable that a woman’s avoidance of sexual intimacy can cause her partner to feel hurt or rejected.

TIP: For more information and support on topics of menopause and sexual well-being, visit The North American Menopause Society’s website at

Bouncing back

Women experiencing some or all of these unpleasant symptoms have treatment options.

1) DRYNESS: Dr. Brown recommends using either a moisturizer or a lubricant. Lubricants are used solely during intercourse, while moisturizers are used several times a week to improve dryness.

2) PAIN AND TIGHTNESS: When you feel increased pain or loss of elasticity in your vaginal walls, Dr. Brown recommends seeking out estrogen-based treatments that are inserted into the vagina. This includes tablets (like Vagifem), creams (like Premarin) or rings (like ESTRING). These methods deliver estrogen locally, so little is absorbed into the body’s general systems, resulting in fewer side effects.

3) LOSS OF SENSATION: There is no approved hormonal therapy, but Dr. Brown says that the old adage “If you don’t use it, you lose it” actually rings true. “The less sexually active you are, the less sexual function you will have.” Dr. Pearlman says that “testosterone therapy in women has been shown to improve all aspects of sexual function, including libido, arousal and orgasm,” but a physician experienced in balancing such hormones is the only professional that should prescribe this unproven method.

4) TALK IT OUT: Finally, visiting a sex therapist can help encourage open communication about your physical and emotional issues and help come up with ways to enhance this new phase of your sex lives. “[Vaginal atropy] is a relationship issue,” explains Dr. Brown. Part of fixing the condition is getting to a new norm for your sexual routine. “Working on building or rediscovering intimacy with your partner is an important and often challenging step,” says Dr. Pearlman. Educating yourself and your partner about the effects and long-term treatment options for VA should help reignite the passion your relationship once had.

Remember, though, if you experience any pain during intercourse always get examined by a doctor first to ensure it’s not an abnormality and just a side effect of menopause.