Painful sex (dyspareunia) after surgical menopause
A surgical menopause is one caused when a woman has her ovaries removed. It can also refer to a menopause triggered following a hysterectomy that has left her ovaries in place.
There are many menopausal symptoms and some, like the hot flush, are often easier to deal with than others. Perhaps the hardest ones to overcome though are those that affect our sexual well-being and these include things like vaginal dryness or loss of libido. In this article we’re going to explore issues around painful sex because for some women libido diminishes because they start to find sex painful, so dealing with that can often sort things out in the desire department.
There are two types of painful sex, also known as dyspareunia; the first is associated with sexual entry and the second is a much deeper pain that occurs when your partner thrusts into the vagina. The causes of both of these can vary and include things that concern all women, regardless of whether they have had surgery or not, and others that might be associated with the menopause and/or surgery.
The most common reason for painful sex in women who have had a hysterectomy and/or gone through the menopause is insufficient lubrication. This can be caused by falling oestrogen levels or with a lack of foreplay and it’s important to remember that you need less foreplay the younger you are and more as you get older to stimulate the glands around the vagina which help to produce the lubrication necessary for sexual intercourse. Medication such as anti-depressants, anti-histamines and sedatives can also play a part in reducing the ability of the body to lubricate itself.
Skin disorders such as eczema or Vulval lichen sclerosus (LS) and lichen planus (LP) can cause the area around the vagina as well as the vagina itself to become sore and painful. Urinary tract infections can have a similar effect and it’s worth getting them treated if this is causing a problem.
Vaginismus is a condition where the vagina spasms involuntarily and it can become a problem because a woman is afraid of the pain she may experience during sex.
Some medical conditions such as endometriosis, pelvic inflammatory disease (PID) fibroids, IBS, ovarian cysts and cystitis can all be a cause of much deeper pain during sex. Often a hysterectomy can get rid of this for conditions such as fibroids but it may hang around with endometriosis until its died back.
In addition, abdominal surgery such as hysterectomy (as with every form of surgery) can cause scarring which may make deep sex painful as well.
There are also a number of emotional reasons a woman might experience painful sex including stress, anxiety and depression.
Managing painful sex
The most important thing if you are experiencing painful sex is to see your GP for a check-up. They will be able to do an internal examination to see if there is any skin condition that could be causing a problem or whether you are starting to show signs of vaginal atrophy (as a result of the vagina drying out during menopause).
The most common way of dealing with painful sex post hysterectomy that is caused by the menopause is with a low dose HRT (hormone replacement therapy) inserted directly into the vagina.
Non-hormonal vaginal products include vitamin E vaginal suppositories, lubricants such as Hyalofemme, Sylk or even natural oils such as grapeseed oil, coconut oil, sweet almond oil and sunflower oil. If you do decide to use oils make sure you go for an unprocessed organic product where possible.