Sex should never hurt!  But sometimes it does, particularly in menopausal woman. Healthy function of sex organs requires sex hormones.  When there is a decrease, such as occurs in menopause, tissues suffer.  Countless receptors for hormones are present in genital tissue and surrounding areas.  Without hormones, these tissues change.  Mucous secretion decreases, vaginal walls become dry and lose their elasticity.  Due to the dryness, the new cells can be damaged more easily.  This also means that they are less protected from invasion due to bacteria or viruses.  The normal “good” types of bacteria that would inhibit healthy vaginal tissues change.

Moisturizers and lubricants do not correct the tissue change, but may make intercourse easier.  Why not actually solve the problem?

The hormones needed to revert the genital tissues back to their normal state are two-fold.  Estrogen is the first. It is available in vaginal creams, pills, and rings.  But also, very important is testosterone.  A little-known fact is that the proximal third of the vagina is embryologically derived from androgen responsive tissue.  That means it has receptors and responds to testosterone, more so than estrogen.

If a menopausal woman has difficulty with initial insertion during sex, the most likely cause is testosterone deficiency.  Testosterone will revert the tissue to the healthy state it was once in.  In addition, it regenerates vaginal nerves, currently thought to be the only hormone to do this.  It also strengthens muscles, including the pelvic floor muscles.  These are a large sling which holds up pelvic organs like the uterus, and bladder.  Without adequate testosterone, the muscles become weak and may result in urinary leakage.

Replacement of both hormones directly to local tissues is necessary to remedy this problem.  Testosterone has not yet been approved by the FDA for treatment of menopausal women.  It is available in compounded formulas.  To this end, we have developed a combination vaginal suppository which has estrogen and testosterone.  It is easy to use, patients insert it before bed, and the hormones will directly affect the genital tissue, providing good repair.

Sex should never be painful.  There is no reason why women cannot enjoy their sexuality into their later years!  Repair of these crucial tissues is available and easy.  It’s like a trip back in time for your sex organs.  Why not take it?