Comedic author Ellen Dolgen, whose popular blog covers all facets of menopause, doesn’t care for the term dyspareunia. “That’s the best the medical community could do?” she says. “I call it dry vagina.”
“During your menopausal journey, you may find that one day, out of the blue, your vagina packs up and moves to the Sahara Desert,” says Dolgen, who has appeared on the “Today Show,” “NBC Nightly News,” and NPR. “It can leave you parched, dry, and preferring to mop the bathroom floor over getting in bed with your lover.”
Dyspareunia, or painful sex, is a silent menopausal symptom defined by the thinning and inflammation of the vaginal wall. It occurs when there’s a reduction in estrogen levels. Estrogens are responsible for maintaining the structure and function of the vaginal wall, elasticity of the tissues around the vagina, and production of vaginal fluid.
“Just between us, until I began my own perimenopause and menopausal journey, the only lining I ever concerned myself with was located inside my blazer,” Dolgen quips. “I now understand the difference between a thick, healthy, well-estrogenized vaginal lining versus a thin, dry lining due to estrogen loss.”
Dyspareunia can cause physical and emotional challenges. It affects as many as 75 percent of postmenopausal women. According to the North American Menopause Society (NAMS), up to 45 percent of postmenopausal women say they find sex painful. Yet only 25 percent of women seek treatment. Even more distressing, the International Menopause Society reports that 70 percent of women say their healthcare providers rarely or never raise the subject with them.
When sex talk feels taboo
When we asked the Health Stories Project community about their experiences with dyspareunia, many women responded that they felt uncomfortable asking about it and wished their healthcare providers would play a more proactive role in the conversation.
“I truly believe that doctors should be asking female patients about sex,” says Andrea. “I wish mine did. I believe they don’t understand that this is a very serious condition, and that most women are embarrassed to ask these kinds of personal questions.”
“Menopause made me feel as if my life were over,” says Cheryl. “It didn’t occur to me to talk to a doctor about dyspareunia. My physician didn’t ask me about it. I just accepted it was a part of life.”
“It feels taboo,” says Sherry. “We certainly aren’t going to talk about it without an invitation.”
Older, wiser, and still aroused
Several women suggested that ageism is a significant hurdle when it comes to getting the healthcare they need.
“I feel like healthcare providers assume we have no sexual desire, so it’s irrelevant,” says Cheryl.
“It angers me,” says Lucy. “I feel left out, as if women shouldn’t be having sex anymore. It devalues us and reinforces negative feelings about aging, as a woman, in the United States.”
“Some healthcare providers don’t listen to older women,” says Gaylene. “They don’t take us seriously.”
Getting busy in the bedroom
Yet as many women attested, sex is still a very big deal for them.
“If there’s a problem it needs to be fixed,” says Eleanor. “Sex with your mate is special and needs to happen.”
“My sexual health is tied to every aspect of my well-being,” explains Tracie. “It’s a big part of being a woman. Not to ask or give advice is just bad medicine.”
“Sexual health is just as important as physical and mental health,” says Deborah. “Women should be comfortable bringing all concerns to their providers.”
Finding Dr. Right
Among respondents, the few Health Stories Project community members who have supportive providers felt very lucky.
“I think it’s tragic that women suffer in silence,” says Marnie. “Thankfully I have an excellent young female gynecologist.”
“My gynecologist is a rarity in this day and age of medicine and healthcare,” says Gaylene. “He is ‘old-school’ and not afraid to care for his patients, ask questions, and do everything he can to solve medical issues.”
Tips and Treatments
Dolgen, whose sometimes bawdy sense of humor makes awkward subjects surprisingly entertaining, suggests that women find an expert who specializes in perimenopause and menopause if they’re not getting what they need from their regular healthcare providers.
“If you want to get the ‘O’ back in your life – and I’m not talking about Oprah – reach out and speak to your menopause specialist,” she says. “If you don’t have a menopause specialist, I have some great tips on finding one.”
Healthcare providers may suggest one or more options for treating dyspareunia, including moisturizers, lubricants, systemic estrogen therapy (pills, patches or creams), local estrogen therapy (localized in the vagina only), DHEA vaginal insert, and/or pelvic floor therapy. Some women need a combination of several of these.
When it comes to dyspareunia, Dolgen has a simple motto. “Suffering in silence is out. Reaching out is in!”