Since many women over 50 do not experience vulvovaginal atrophy, women with sexual pain should be aware that there are other medical conditions that could be responsible for their symptoms. These include:
Vestibulodynia. Vestibulodynia is the most common cause of sexual pain in women under 50, but it can also affect older women. Women with this condition feel severe pain when any type of pressure or penetration is attempted at the entrance to the vagina (an area called the vestibule). It is treated with topical anesthetics, estrogen cream, antidepressants, antiepileptic drugs (often used for nerve-related pain) and physical therapy.
Vulvodynia. This condition involves stinging, burning, irritation, rawness or pain on the vulva, the tissue that surrounds the vagina. The pain and irritation can occur even when nothing touches the area and is likely related to abnormal nerve firing. Vulvodynia is treated similarly to vestibulodynia.
Vaginismus or Pelvic Floor Muscle Dysfunction. In this condition, the vaginal and perineal muscles involuntarily spasm with attempted sexual activity. This can make vaginal entry very difficult or even impossible. Vaginismus can occur after a trauma (such as nonconsensual sex), or it can be related to underlying physical conditions, including musculoskeletal injuries or vestibulodynia. Vaginismus is often treated with dilator therapy (in which women are taught relaxation techniques while using progressive-sized dilators in their vagina) and physical therapy.
Urinary tract conditions, such as cystitis, or fungal infections can also cause pain upon intercourse, as can endometriosis, or a uterus that has “dropped” or prolapsed.
Time to Speak Up
Unfortunately, most women do not talk to their health care providers about sexual pain or problems, nor do their health care providers bring up the topic. In an international survey of 391 women by the Women’s Sexual Health Foundation, fewer than 9 percent of women said their health care professionals had ever asked if they had sexual problems. Obviously, if you don’t bring up the topic of sex with your health care professional, it won’t get addressed. So speak up!