What can cause painful sex in women over 50, besides vulvovaginal atrophy?

Since many women over 50 do not experience vulvovaginal atrophy, the most common reason for painful sex in women over 50, 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. Cystitis, which involves inflammation of the bladder, is a common cause for painful sex, because the bladder sits on top of the vagina and can be aggravated during sex. There are several kinds of cystitis. In postmenopausal women, lower estrogen levels change the pH and make bacterial infections more likely. Lack of estrogen also can make the vagina more vulnerable to vaginitis, including bacterial vaginosis and yeast infections. Both can cause pain and itching.
  • Other causes. A uterus that has "dropped" or prolapsed may cause pain during sex. Endometriosis, a condition in which the uterine tissue grows outside the uterus, usually ends after menopause but may continue in women taking estrogen and can cause pelvic pain. Sexual trauma and childbirth trauma, such as episiotomies or tears and repairs, may also cause painful sex.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.