Vaginal dryness and painful intercourse are common concerns that can affect women of all ages. While these symptoms are particularly common after menopause due to declining estrogen levels, they can also occur in younger women and may be related to a variety of gynecologic, hormonal, pelvic floor, or vulvar conditions.
Common causes of vaginal dryness or painful intercourse may include:
• Genitourinary syndrome of menopause (GSM)
• Vaginal dryness related to hormonal changes
• Vulvodynia and vestibulodynia
• Vaginismus and pelvic floor muscle dysfunction
• Endometriosis or deep pelvic pain
• Certain medications or medical conditions
• Inadequate lubrication or arousal
Painful intercourse is not something women should simply have to "live with." Fortunately, many effective treatment options are available, including lubricants, moisturizers, vaginal estrogen therapy, pelvic floor physical therapy, medications, and other individualized treatments.
The resources below provide information about common causes of vaginal dryness and painful intercourse, treatment options, pelvic floor therapy, and support resources.
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Genitourinary Syndrome of Menopause (GSM) is a common condition that occurs when declining estrogen levels after menopause cause changes in the vaginal and urinary tissues. These changes may lead to symptoms such as vaginal dryness, burning, irritation, decreased lubrication, painful intercourse, urinary urgency, urinary frequency, recurrent urinary tract infections, or discomfort with daily activities.
Unlike hot flashes, GSM symptoms often worsen over time if left untreated. Fortunately, a variety of effective treatment options are available.
Many women are surprised to learn that treatment can significantly improve comfort, sexual function, urinary symptoms, and overall quality of life. If you are experiencing symptoms of GSM, talk with your healthcare provider about which treatment options may be right for you.
Common treatments may include:
• Vaginal moisturizers and lubricants
• Vaginal estrogen therapy (cream, tablet, insert, or ring)
• Vaginal DHEA (prasterone)
• Systemic hormone therapy in selected patients
• Pelvic floor physical therapy when muscle tension or pelvic pain is contributing to symptoms
Managing Vaginal Dryness in Women With or at High Risk of Breast Cancer (NAMS)
Clinical Consensus Statement on Vaginal Energy-Based Devices (AUGS)
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Vulvodynia is chronic pain, burning, irritation, or sensitivity involving the vulva (the external female genital tissues) that cannot be explained by an infection or another identifiable condition. Symptoms may occur with intercourse, tampon use, prolonged sitting, exercise, or even light touch. Several different types of vulvodynia exist, and treatment often involves a combination of medications, pelvic floor physical therapy, lifestyle modifications, and other individualized therapies.
Vaginismus is a condition in which the muscles of the pelvic floor tighten involuntarily, making vaginal penetration difficult or painful. Some women experience discomfort with intercourse, tampon insertion, pelvic examinations, or vaginal dilators. Vaginismus is common and treatable, often with pelvic floor physical therapy, vaginal dilation therapy, education, and other supportive treatments.