Q: I am 40 and having my normal menstrual cycle every month but for the past few months I’ve been experiencing a dry vagina and pain in the walls and on minora after and before having sex, I’m very worried; please help. There is itching all the time around that area.
A: I recommend seeing a gynecologist for an examination. According to the North American Menopause Society (NAMS), although the average age of menopause is around 51, common ages for menopause can range from 40 to 58, with some even younger or older than that range.
Maybe It’s Hormones …
It may be that your estrogen levels are declining, which can lead to vaginal dryness and discomfort. Some women, together with their healthcare providers, decide to use an estrogen-based vaginal moisturizer to provide some relief. Itching and vaginal dryness are common signs of lower levels of estrogen. There are also non-hormonal vaginal moisturizers available at drug stores, on the Internet, or in grocery stores that may help to improve the feel of sex. Vaginal moisturizers are often used a few evenings per week, with the moisturizer inserted into the vagina before bed so that it has time to moisten the vaginal walls. This makes them different than lubricants, which are usually used only at the time of sexual activity. You can learn more about vaginal moisturizers from the American Congress of Obstetricians and Gynecologists.
Maybe It’s Lichen?
Much less often, some women experience genital skin conditions that can contribute to discomfort and itching – for example, a condition called lichen sclerosus can cause similar symptoms, including painful sex and frequent itching. Because various kinds of health conditions can cause these common symptoms, we recommend checking in with a doctor or nurse who can help you with your own personal health questions.
Additionally, you can learn more about vaginal health, painful sex, hormonal changes, and vaginal dryness in books like “The V Book: A Doctor’s Guide to Complete Vulvovaginal Health” or “What’s Up Down There? Questions You’d Ask Your Gynecologist If She Was Your Best Friend”.
Update: After publication, Dr. Ellen Laan – sex researcher extraordinaire – Tweeted us to note that an important factor is “taking sufficient time to become fully aroused before penetration” and that “menopause is no dryness-disease.” She’s right, of course. And while I and others have often written, here on KC and on other sites, about the value of spending time engaging in kinds of sex play that build arousal for those involved – I somehow neglected to mention that here and I should have. Thanks to Ellen for the reminder.
One often reads something along the lines of spending time in “foreplay” to build arousal, which is a phrase I find limiting mostly because for so many people foreplay is equivalent to kissing and breast touching. However, what’s important in building arousal is understanding one’s own sexual response – what feels good for you? What turns you on? What conditions help foster arousal and excitement? For some, it is relaxation. Others might be turned on at the risk of being “caught” or overheard having sex. Some people are turned on by breast/chest touching, others by oral sex, erotic stories, dirty talk, romantic talk, kissing, and so on. And it also happens that what turns a person on one day may be different from what turns the same person on another day. The take-home message, however, about spending sufficient time to enhance arousal remains important.
That said, yes, some women still find it helpful or necessary to add lubricant or to use a vaginal moisturizer (especially if they are symptomatic in other ways, including urinary irritation or discomfort). And because of the intense itching you noted, I’d be remiss if I didn’t stress the importance of checking in with a healthcare provider, as vulvar itching is not only a symptom of low estrogen and lichen sclerosus, but can also be an early symptom of vulvar cancer.
Thank you again for your very good questions and to Dr. Laan for joining the conversation.