"I'm 54. Sex is Painful. What Can I Do?"

“Just use more lubricant.” “It’s normal at your age.” Get used to it.”

If you’ve heard any of these dismissive responses, I’m here to set the record straight: painful sex after menopause isn’t something you have to live with.

There are ways to ease the pain and, even better, bring pleasure back into the picture. Here’s what you need to know:

Why Sex Becomes More Painful As We Age

Why does sex become painful for some women as we get older?

In a word: estrogen. During perimenopause or menopause, estrogen levels drop fast. This triggers a cascade of changes in your body since it has estrogen receptors in many tissues and organs (skin, brain, bones, and, you guessed it, genital tissues).

In the lower genital tract, less estrogen means reduced blood flow, as well as lower collagen and moisture levels. That’s a perfect recipe for the tissue in and around the vagina to become thinner, drier, and way more fragile.

Basically, it becomes the Vaginal Sahara Desert—and that leads, unsurprisingly, to painful sex.

What You Can Do About It

If sex is painful, there are solutions—and you don’t have to commit to systemic Hormone Replacement Therapy (HRT) to get relief.

The first option that is generally recommended is vaginal estrogen. This prescription treatment, which comes in either a vaginal pill or cream form, is widely considered as safe and effective. That goes for women who’ve had breast cancer since it’s used locally and has little to no absorption into the rest of the body.

• Zoom In:  If prescribed, your doctor would give you a generic estradiol cream 0.01%, along with instructions on how to use it—typically, every 2-3 nights using a small amount from a dosed applicator.

While it may be a few weeks until you notice any improvements, the benefits can be significant. It not only reduces discomfort during sex, but it can also lower the risk of developing urinary tract infections and other urinary symptoms common during menopause.

Quick Note on Over The Counter (OTC) Lubricants: They’re like putting ice on top of a cracked driveway. The surface may feel slippery, but the foundation is weakened.

So while it initially might feel better at first, long-term, the tissue is still weak and damaged. In addition, most OTC lubes contain ingredients that actually dry out the vaginal mucosa MORE over time, which is why I recommend either coconut oil or sunflower oil as a vaginal lube if necessary!

Now that we’ve tackled pain, let’s talk pleasure.

From Discomfort to Pleasure

I’ve heard from hundreds (if not thousands!) of women who weren’t sure they’ve ever had an orgasm. That’s not to say they didn’t enjoy sex. Many did. They just felt that The Big O had always been elusive.

Turns out, they had a good reason to feel that way. Having an orgasm is not as simple as it sounds. A 2018 study published in the Journal of Sex and Marital Therapy found:

That’s more than a third of women who need clitoral stimulation to orgasm!  

Why Women Feel Disconnected From Orgasm

Here’s my theory:

Men learn about sex in adolescence through a lens of physical currency. The goal is straightforward—find the target (the vagina), feel pleasure, orgasm. Simple.

Women, on the other hand, learn about sex in adolescence through a lens of emotional currency. Sex is about love or being chosen—not so much as an activity that produces physical pleasure. (I’m generalizing here but stay with me.)

In traditional heterosexual dynamics, the woman is largely dependent on the man to provide pleasure. And if her partner is focused only on penetration, the clitoris tends to be…forgotten.  Also, culturally, we tend to accept and encourage boys to self-pleasure, but don’t with girls. That should change!

Considering a significant percentage of women can only orgasm with clitoral stimulation, they don’t even realize what they’re missing!

You may think your sex life is on life support when in reality, you just need a new experience with your partner…or with yourself!

Let’s Talk Vibrators

That’s right: we’re talking vibrators.

Because vibrators offer high-frequency, targeted stimulation for as long as you need (and you control the intensity), it can be a very effective way to show some much-needed love to the nerves and tissues in the genital area.

They can also be helpful to women experiencing painful sex since you can choose the location and penetration, letting you explore at your own pace.

Start solo or use the vibrator with your partner. While vibrators are not a one-size-fits-all (and require quite a bit of trial and error), I will say this: The Rolls Royce of clitoral vibrators is the Form 2 by Jimmy Jane.  

It’s designed specifically for external use, with a shape that stimulates both sides of the clitoris—making it a top-tier pick for discovering (or rediscovering) what feels good.

Here’s to getting your groove back!

This question came directly from a member of the Ajenda community.