Menopause: Pelvic Pain & Pain With Sex Isn't Untreatable

With Menopause comes a whole host of changes, but one of the biggest changes is a decrease in estrogen levels. This drop in estrogen is one of the main causes of the mood swings, irritability, and changing energy levels that make menopause noteworthy, but it can also impact the tissue of the vulva (the area of the pelvis including the labia, the vagina, the clitoris, the opening of the urethra, and the mons pubis), contributing Genitourinary Symptoms of Menopause (GSM).

In a pre-menopausal vulva, the labia major are typically thicker, and populated with fat cells, acting as a ‘covering’ for the sensitive structures (vulva actually means covering). The fatty folds of the labia insulate these structures, and the hair follicles and provide a cushion from any potential irritants.

In a pre-menopausal vulva, the labia minora are the more interior folds, pinker, and typically more “mucosal,” and have a natural stickiness to them. These labia minora are filled with glands that secrete that lubricate and protect your vulva.

As estrogen levels drop, the tissues of the vulva grow more sensitive, thinner, less resilient, and dehydrated. The common term is “vaginal dryness”, but really, it should be called “vulvar dryness”, because it’s all of the tissues in this area that are affected. The fat pads of the labia majora thin and the folds reduce, so there’s less protective coverage. The labia minora also shrink, potentially fusing to the majora, and reduce their glandular function, so there’s lubrication and moisturization of the tissue.

In the vagina, there are three layers of tissue, and the most superficial one relies heavily on estrogen to maintain its thickness and elasticity. Without it, the tissues of the vaginal canal itself thin and are less elastic, less able to adapt to the rigors of sex.

To summarize, as the estrogen levels drop, the layers of protection that your vulva has decreases, making it more sensitive to irritants, fabrics, chafing, pressure, and trauma.

All of this can drive pain with sex, because the tissues are more sensitive and not as properly lubricated.

What should you do if you’re having vulvar pain and tenderness?

One of the first things to do is to start incorporating lubricants into your sexual repetoire. Since your vulva no longer naturally lubricates, using a vaginal lubricant will reduce friction, help moisturize the tissues, and prevent any potential tearing.

We recommend water based lubricants, as they won’t stain any fabrics, and won’t dissolve any latex or plastic toys.

Our favorite brands are Good Clean Love, or Sliquid’s Natural or Organic line. Both are hypoallergenic, non-toxic, and water based, so you can enjoy your pleasure without the complications.

You can also start utilizing vaginal moisturizers, to help improve the quality of tissue itself.

Firstly, the best moisturizer in the world

–is water.

That’s right, we spend millions of dollars a year of oils, moisturizers, lotions, but honestly, the first thing that I recommend when people come to me is to start drinking more water. Buy a 32 oz water bottle, drink two of those a day for a week, and then see how you feel.

Secondly, because there are physiological changes at hand that are impacting your vaginal tissues, they can receive some extra love through topical moisturizers.

Good Clean Love has an excellent HLA moisturizer that can help nourish and support the tissues of the vagina.

Now, we’ve talked through the pain, ittichiness, irritation, and increased sensitivity caused by menopause that can make sex painful–

But what if you’re having pain with deeper penetration, or only certain positions?

This kind of pain can be caused by tightness in the muscles of the pelvic floor. The pelvic floor is the bowl muscles at the bottom of the pelvis that support our organs and regulate our continence and our sexual appreciation. And, just like our muscles can get tight and tender (have you ever gotten a massage and found some incredibly tender spots?), the pelvic floor can grow overly tight, and tender.

Especially if your vulva has been aggravated by all these changes, the pelvic floor can compensate by tightening. And, if you’ve been worrying about your continence and “holding” your bladder, that can also contribute to pelvic floor tightness, and pain with sex or penetration.

What should you do if you’re having pain with deeper penetration?

First of all, don’t feel ashamed for having sex, and don’t let yourself be pressured into having sex that doesn’t feel good. The world needs more pleasure and less martyrdom.

Start with identifying what positions aggravate you the most, and have a clear discussion with your partner about avoiding those.

You can also consider experimenting on your own with a vibrator. The vibration can promote relaxation of tender and sore places, and you can really bring your attention to what areas are uncomfortable. The same way a massage therapist will press on a tender place, you can use a vibrator to apply some LIGHT pressure.

With this, do not over do it. Avoid pressing the vibrator straight down, towards your rectum, and straight up, towards your pubic bone and bladder. If your pelvis is a clock, avoid the 12” position and the 6” position. You can use the vibrator to explore the semi circles in between.

In fact, using a vibrator and having sex can actually help nourish your vulva, by promoting increased blood flow to the tissue. The goal is to get the right amount of stimulus and pleasure, without straining the tissue.

Secondly, reach out to a Pelvic Floor Physical Therapist so they can identify the cause of the pelvic pain. They’ll help facilitate the lengthening and relaxation of that muscle, and teach you self-release techniques that you can carry with you for the rest of your life.

Because pelvic floor pain can be caused by a number of factors, it’s important to see an expert who can help set you on the right path for your recovery.

Ready to identify the root cause of your pelvic floor pain, and take back control of your life and your pleasure?

Reach out to us today to get scheduled!

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