Between 25 and 45 percent of postmenopausal women find sex painful, a condition called dyspareunia. While there are many causes, the most common reason for dyspareunia—painful sex—in women over 50 is vulvovaginal atrophy, a fancy name for a vulva and vagina that no longer have the beneficial effects from estrogen that they did prior to menopause. As discussed earlier, lower estrogen levels significantly affect your vagina, impacting its ability to secrete lubricant, to expand and contract and to grow new cells. Over time, blood flow diminishes, and the vagina and vulva can atrophy, or shrink as cells die off and aren't replaced. The result? Soreness, burning after sex, pain during intercourse and, sometimes, post-sex bleeding. [caption id="attachment_151" align="aligncenter" width="792"] Between 25 and 45 percent of postmenopausal women find sex painful[/caption] The good news is that vuvlovaginal atrophy is very treatable. One of the best treatments doesn't involve medicine! Turns out that the more often you have sex, the less likely you are to develop atrophy or, at the very least, a serious case of it. That's because sex increases blood flow to the genitals, keeping them healthy. Other treatments include: Estrogen. As you might expect, if lack of estrogen is behind vulvovaginal atrophy, then giving back estrogen should help. Both systemic estrogens (oral pills and patches) and local estrogens (creams, rings and tablets applied to the vulva and/or vagina) work. However, most major medical organizations recommend starting with the local approach first because it keeps the estrogen right where it's needed, limiting any effects on the rest of your body. Studies on the estrogen ring, cream and tablets find extremely high rates of improvement in dyspareunia, with up to 93 percent of women reporting significant improvement and between 57 and 75 percent saying that their sexual comfort was restored, depending on the approach used. [caption id="attachment_152" align="aligncenter" width="720"] When Sex Hurts[/caption] Side effects vary. Most estrogen products applied locally are associated with minimal side effects. However, each woman's response can differ. When using estrogen creams, pills or rings, it is important to talk to your health care provider about any symptoms, such as: headache, stomach upset, bloating, nausea, weight changes, changes in sexual interest, breast tenderness, abdominal pain, back pain, respiratory infection, vaginal itching or vaginal yeast infections. If you have had breast cancer or a family history of breast cancer, be sure to discuss your history with your health care professional, if you're considering using estrogen. Your health care professional likely has covered this topic with you already. Non-medicated lubricants. If you'd rather not go the estrogen route, consider using some of the over-the-counter products designed to increase sexual comfort. Long-lasting vaginal moisturizers provide relief from vaginal dryness for up to four days.