Like most things in life — our interests, our bodies, our politics, our taste in music — our sex lives evolve as we age. But if you think "evolve" is a euphemism for "end", you’re in for a pleasant surprise. Although you may encounter unexpected challenges between the sheets as levels of sex hormones wane and relationships mature, there is good help available — as these women found.
The Physical Therapy Solution
“Two years ago I noticed that intercourse was becoming painful—it stung a little and I sometimes felt a mild tearing sensation,” says Grace (not her real name). “The pain got worse, until I couldn’t have sex at all. Finally, I talked to my gynecologist.” Grace’s doctor said her vaginal tissues looked healthy and referred her to a physical therapist who specializes in pelvic floor problems. The therapist discovered that the opening to Grace’s vaginal canal had shrunk with age. To stretch the vaginal walls, the therapist gave Grace a dilator, a smooth, plastic, pencil-like device that she was instructed to insert into her vagina a few times a week, for increasingly longer durations. “After a few sessions, I was able to move up to larger dilators,” she says, noting that she now has a 10-minute daily routine. Two months into therapy, she’s almost ready for intercourse. “I can’t wait,” she says. “I can’t believe how easy it’s been to solve this problem.”
Take-home from an expert: Specialized physical therapists can address a variety of problems that make sex painful, including episiotomy scars and endometriosis. “With a proper diagnosis, most issues are treatable,” says Raquel Perlis, a physical therapist in Wellesley, Massachusetts. To find a therapist, go to the Women’s Health Section of the American Physical Therapy Association (womenshealthapta.org). But first, visit a doctor to rule out any potentially serious causes of pelvic pain.
The RX Rescue
Katherine, 53, Newport Beach, California: Katherine’s sexual problems started soon after her breast cancer ordeal ended. “Chemotherapy knocked out my ovaries. After that, my vagina was so dry during intercourse, I felt I was being ripped in half,” she recalls. For five years, the pain was so severe she and her husband engaged only in oral sex. Finally, her oncologist referred her to a sexual medicine specialist, who prescribed a vaginal estrogen tablet as well as a dilator to expand her tissues. Eventually, she was able to have intercourse again, and now, she says, things are back to normal.
Take-home from an expert: As estrogen level declines, vaginal fluid diminishes, leaving the tissues less pliable. Although OTC lubricants help, some can be irritating, and they don’t counteract the underlying changes. A better solution: local estrogen therapy, in a prescription cream, tablet or ring, says Michael Krychman, MD, of the Southern California Center for Sexual Health and Survivorship Medicine, in Newport Beach.
Bonus: All forms of estrogen may increase the intensity of orgasms. Because vaginal estrogen is absorbed into the blood stream only minimally, it’s generally considered safe. “But breast cancer survivors should talk to their doctors,” Krychman says. He also notes that since vaginal dryness can be caused by a number of medical problems, including diabetes, you should begin by having a physical exam to rule those out.