The hormone fluctuations that begin in perimenopause bring many physical changes. As estrogen and progesterone levels decline in late perimenopause and post menopause, vaginal walls often become thinner, drier, less flexible and more prone to tears and cracks.
This can be especially true for women who have never given birth or had only caesarean sections, as vaginal birth gives the walls a lasting stretch. Likewise, regular sexual activity helps maintain vaginal flexibility and reliability, presumably because it increases blood supply to the vagina and can also have a stretching effect.
Women who have thinning and inflammation of the vaginal walls — which many clinicians refer to by the term vaginal atrophy or atrophic vaginitis — may end up completely avoiding intercourse or other sex because of discomfort.
Hormonal shifts of perimenopause may also produce less lubrication, so it can take longer to become wet during sexual activity. Penetration may be uncomfortable or even painful and can lead to irritation. If the tissue of the vaginal wall become very delicate, friction from sexual activity may cause bleeding.
Some prescription and over-the-counter drugs can cause or contribute to vaginal dryness. Antihistamines, for example, dry vaginal tissue as well as nose and eye tissues. Douches, sprays, and colored or perfumed toilet paper and soaps may irritate the vaginal tissues. There are also a variety of conditions, including vulvodynia, that can cause pain and/or irritation with sex.
Vaginal dryness during sexual activity at any age may simply mean that you need more stimulation and maybe even to experience orgasm before penetration. Experiment with different types of stimulation to discover what feels best and is most arousing.
Here are some tips to relieve vaginal dryness and discomfort during sex:
- Wait until you are fully aroused before penetration.
- Use a lubricant that is made for sex. Avoid Vaseline and anything with fragrance.
- If dryness continues, try an over-the-counter vaginal moisturizer.
- Avoid scratching, which can irritate delicate tissues and lead to infections and problems. (Itching is sometimes a sign of a more serious problem that needs treatment and a doctor.)
If lubricants and other strategies are not sufficient, there are several other strategies to try.
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