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    Includes Expert Content
    Painful Sex
    toadywot posted:
    I was diagnosed as post-menopausal in 2010 and continued to enjoy sex up until 2014. I've had sex exactly twice since then because it has become quite's like being reamed out with sandpaper. Same goes for my yearly Pap smears....the speculum too gives the sandpaper effect, just on a smaller scale. I asked my physician about HRT, but he said as long as I was having no problems...meaning hot flashes, night sweats, etc.,....he didn't want to prescribe them. Obviously he did not consider painful sex to be a problem, but to me it's a big one. I was given a prescription for Premarin Cream but I did not have it filled....$300.00, no way could my budget handle that. I use an enormous amount of lubricant (KY Jelly) and it still hurts. I tried Replens Vaginal Moisturizer and that too failed to make an appreciable difference. I feel guilty that I can't make love to my S.O in this way. In addition, I have lost any and all interest in sex in spite of his efforts to arouse and satisfy me in other ways....never thought I'd ever fake an orgasm, but I've done a lot of it for two years.....I don't have the heart to tell him his efforts to please me does absolutely nothing for me. He is very understanding and no longer initiates sex. But the guilt is eating me alive.

    No one told me about this, that I'd have to spend the rest of my life without sharing the closeness that intimacy brings, and oral sex just doesn't bring that closeness. Worse, if I have to cease intercourse, my partner will have to as well.

    Any thoughts, suggestions, or comments would be gratefully appreciated.
    Mary Jane Minkin, MD responded:
    Dear Toadywot,
    Sounds like you need some help quickly. Sounds like some medical intervention would help. From an economical point of view, vaginal estrogen cream would be most cost effective. What I would suggest is that you price out Premarin vaginal cream and Estrace vaginal cream (check to see if your insurance will cover either one, and check on line to see if there are applicable coupons for you.) Many insurances will cover vaginal creams, and they often have coupons available. And I would check with several discount pharmacies. The other option is the new oral medication Osphena. Again, check on line for coupons; there are usually substantial discounts available. Always go to the websites of these medications, as many do have coupons available. Both vaginal estrogens and Osphena rate to be very helpful for the symptoms you are describing.
    Another non medical option to consider is the use of a vibrator; anything that increases pelvic blood flow should help to enhance vaginal moisture.
    Most of the problems that you are having with decreased desire I am sure are related to the pain you are experiencing; and these approaches should be helpful in decreasing the pain.
    Good luck,
    Mary Jane
    toadywot replied to Mary Jane Minkin, MD's response:
    UMy lack of desire began long before intercourse became was at that point I began to understand how fake orgasms came to be. I assumed that lack was due to the reduction in hormones brought on by menopause.

    Premarin and Estrace require a prescription and as I said, my doctor refuses to give it to me. Even if he did, I have no insurance and simply cannot afford it. I will check the websites, but doubt if that changes anything from a financial standpoint. I use Replens every night, more than the suggested use but I haven't had the courage to see if there is any changes to the level of pain.

    I understand that the vaginal walls start to atrophy from lack of use and that intercourse on a regular basis is needed to prevent it. But what can you do when it hurts even when penetrated by a mere finger?

    This might sound dumb but how exactly is a vibrator used to enhance moisture? Where is the point of contact? If it's the clitoris, doesn't prolonged use of the direct stimulation make it more difficult to achieve satisfaction through the act of intercourse alone?

    I've about resigned myself to the fact that my sex life is over, but it's not about me. I feel so badly for my significant other for being unable to provide him with the intimacy and closeness intercourse brings. Oral sex and hand jobs do not provide the emotional and physical closeness we need. He's tried to arouse me through oral sex, but that part of me is completely dead. I am now beginning to understand how and why women fake orgasms....I do it to keep that delicate male ego intact..

    Am I the only one with this problem? Not once have I met, or know, of anyone experiencing this. Seems other women sail right through menopause with no pain during sex and no changes in libido. The fact that I may have to live another thirty years with no sex distresses me. I am so frustrated that there seems to be any way out of this.
    Mary Jane Minkin, MD replied to toadywot's response:
    Dear toadywot,
    Just a few more thoughts. First of all, these problems are unfortunately fairly common-a significant minority, if not majority, of women have issues with sex after menopause. Using a vibrator both externally and internally can be helpful. A couple of other suggestions: you might want to check in with your local Planned Parenthood; they do a lot of women's health checkups, unrelated to birth control issues, and they have a sliding scale for cost; and they may be able to suggest local options for less expensive medications. One option that you could look into would be systemic estrogens (Pills by mouth, for example)-those might help with other issues; and cost may actually be much less costly. And they might help with the libido issue.
    Good luck,
    Mary Jane
    toadywot replied to Mary Jane Minkin, MD's response:
    My physician won't prescribe pills either, saying if I wasn't experiencing problems, it was best to stay off them. Apparently he doesn't consider painful sex a problem. I'm so frustrated to the point of actually crying over it.

    But thanks for trying.....guess I'll have to deal with it as best I can. Sayonara, sex life...,you've treated me well in the past.
    Rolayne replied to Mary Jane Minkin, MD's response:
    I am experiencing everything you are. I just recently stumbled upon KY Vaginal Beads. You shoot them up like you would for a yeast infection. Has the little injector just like that. I actually felt like my younger self. Sex was awesome!! Hope you can find some. And KY usually sets me on fire. But the beads did not.
    Illiana7 responded:
    Dear Toadywot,

    The lack of libido you describe is so common, most of the women, if not all that I've talked to, lost it after menopause. I mean countless and countless of women, myself included. I have heard it so often that I'm not even surprised anymore. From my experience, that goes first, the 2nd most common symptom is insomnia or fractured sleep. There is the issue of vaginal walls atrophy and then there is drastic decrease in testosterone which is, however little we have of compared to me, is responsible for sexual energy necessary for arousal, sexual fantasies and achievement of orgasm. Women are usually so embarrassed or ashamed of this happening and think they are the only one, they tend not to talk about it. That would explain why you have not heard of it. I have a way of asking women and normalizing the topic, talking about myself first. When I talk to men, they tend to not give this a lot of thought because women hide the problem and fake their orgasms. Plus a lot of men would not even bother finding out if the woman had an orgasm as long as she acts satisfied. They would maybe not even want to know as it involves extra work for them. Not all of the relationships, of course, but a lot of the traditional ones. A lot of women still, sad to say, just spread the legs and bear it, in fear that the guy would leave them. I would say, yes, hope you enjoyed it in the past and going forward it's pretty much over.

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