I am a 54 year old woman and have had a terrible sex life after menopause. I feel the dryness and pain and sex with my partner has become more of a painful affair and a liability than a pleasure. Is there anything that can be suggested?

Dr. Arun DesaiAyurveda11yrs exp

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DYSPAREUNIA Dyspareunia is painful sexual intercourse due to medical or psychological causes. The pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain. CAUSES In women, common causes for discomfort during sex include 1.Infections. Infections that mostly affect the labia, vagina, or lower urinary tract like yeast infections, chlamydia, trichomoniasis, urinary tract infections, or herpes tend to cause more superficial pain. Infections of the cervix, or fallopian tubes like pelvic inflammatory disease [7] tend to cause deeper pain. Atrophic vaginitis or vaginal atrophy which is a common condition that causes thinning, drying or inflammation of the vaginal lining in postmenopausal women Urinary tract infections, vaginal yeast infections, or sexually transmitted diseases like candida, herpes simplex or genital warts Skin disease, such as psoriasis or lichen sclerosus. Cystitis or inflammation of the bladder wall caused by a bacterial infection 2.Malignancies of the reproductive tract, including the ovaries, cervix, uterus, or vagina. 3.Tissue Injury. Pain after trauma to the pelvis from injury, surgery or childbirth. Anatomic variations. Hymenal remnants, vaginal septa, thickened undilatable hymen, hypoplasia of the introitus .retroverted uterus. Or uterine prolapse can contribute to discomfort. 4.Hormonal causes: Endometriosis and adenomyosis ,Pelvic masses, including ovarian cysts, tumors, and uterine fibroids can cause deep pain. 5.Pain from bladder irritation: cystitis 6.Vulvodynia: Vulvodynia is a diagnosis of exclusion in which women experience either generalized or localized vulvar pain most often described as burning without physical evidence of other causes on exam. Atrophic vaginitis or vaginal atrophy which is a common condition that causes thinning, drying or inflammation of the vaginal lining in postmenopausal women 7.Muscular dysfunction: For example, levator ani myalgia 8.Psychologic, such as vaginismus. Depression, fear, and anxiety which can affect sexual arousal and lead to conditions such as vaginismus, or vaginal dryness 9.Side effects of some drugs, Allergic reaction to clothing, or spermicides MANAGEMENT 1.General measures Treatment should be directed at the underlying cause, where appropriate. Research in this field is often of poor quality but it appears that psychological treatments are as effective as medical treatments, independent of the cause of the pain. A multidisciplinary approach, which includes psychosexual medicine, physiotherapy, clinical psychology and pain management teams, may be required. Modification of sexual technique and altering position may help to reduce pain with intercourse. Increasing the amount of foreplay and delaying penetration until maximal arousal will increase vaginal lubrication and decrease pain with insertion. Women may be concerned that their vagina is too small to allow entry of a penis. In response to sexual arousal, the vagina increases in length by about 35-40% and expands in width at the upper end by about 6 cm. 2 Pharmacological Vaginal infection may need treatment. Hormonal manipulation may benefit endometriosis. Local injections of corticosteroids, local anaesthetic and hyaluronidase have been well tolerated with significant improvements in pain scores and sexual function for chronic localised pain following childbirth or vaginal surgery. Vaginal oestrogens are a safe and effective treatment for genitourinary syndrome of menopause.fections that mostly affect the labia, vagina, or lower urinary tra 3.Surgical Surgery is required for pelvic masses and sometimes to remove chronically infected tubes or to clear endometriosis or adhesions. Fenton's operation (to enlarge a tight introitus) may help. Removal of sensitive scar tissue bridge can be highly effective when there is pain following episiotomy. Ventrosuspension to 'correct' a retroverted uterus in an anteverted position is occasionally proposed but it is not known if it is effective as there are no randomised controlled trials of this procedure TREATMENT DEPENDS UPON THE UNDERLINED CAUSE The treatment of dyspareunia varies according to the cause: In case of dyspareunia which is caused by vaginal dryness, the doctor prescribes vaginal lubricants and may also suggest adequate foreplay. In case of infections and sexually transmitted diseases, the doctor will prescribe antibiotics. Psychological counselling may be required for women who have suffered from sexual abuse and trauma. Exercising for Managing Dyspareunia 1.Stretch exercises which strengthen the pelvic floor can help immensely in doing away with the symptoms of dyspareunia. Practicing yoga regularly can help in strengthening and removing the tightness of muscles that can cause the pain associated with dyspareunia. Yoga can also decrease stress levels, anxiety, depression and boost your self-image and self-confidence. 2.The Kegel Exercise Practice the Kegel exercise for a week or two. Follow the steps given below: Contract your pelvic muscles. A) Squeeze and hold for 3 seconds b) Then relax for another 3 seconds. C) Repeat the exercise for as many as 10 times each session, until you can do around 15 repetitions.  

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