Ask the Doctor: Patricia Korber, M.D.

Q: I’m over 50 years old and my period stopped three years ago, so why am I suffering from painful intercourse now?

A: Women in menopause often develop painful intercourse. This is called Genitourinary Syndrome of Menopause (GSM). About 45-54 percent of postmenopausal women develop at least some of the symptoms of GSM. These symptoms can include vaginal dryness, painful intercourse or dyspareunia, vaginal itching, discharge and pain. Due to the dryness, some women also develop fissures or tears, and even bleeding. Many women will also have urinary symptoms such as urgency, incontinence, frequent UTI, painful urination, and frequent night time urination.

Why does GSM happen? The answer is once a woman’s menstrual cycle stops, her estrogen levels gradually fall. The genital system, including the vagina, labia and vulva, as well as the urinary system, are dependent on estrogen to stay normal and healthy. Without estrogen, the tissues become thin and dry, or atrophic. The vagina can lose its elasticity and become shorter and narrower. The vaginal opening especially can become painfully tight. The urethra is also affected by lower estrogen levels resulting in many uncomfortable urinary problems.

The good news is that GSM is very treatable, especially if you start early. Tell your gynecologist if you are having any symptoms of GSM, particularly painful intercourse. Your doctor can do an exam to check for changes that indicate you may have GSM.

If your symptoms are very mild, you may be able to manage them with an over-the-counter vaginal moisturizer and a lubricant with intercourse. However, for most women, the best treatment is estrogen. It has been proven to quickly alleviate GSM symptoms. Of course, your doctor will discuss your specific situation and make sure you are a candidate for estrogen therapy. Another treatment option is increased sexual activity which has been shown to maintain vaginal elasticity. It improves blood flow to the vagina, lubrication, and response to sexual stimulation.

Talk to your gynecologist about painful intercourse, or any of the other GSM symptoms, and they will help you to choose the best treatment options based on your life style, medical conditions, risk factors, and personal preferences.

Patricia Korber, M.D., F.A.C.O.G., specializes in gynecology and gynecologic surgery, and has been on Hoag’s medical staff since 1992. She is the current chair of Hoag’s OB/GYN department.