With the significant drop in estrogen after menopause, the tissues inside the vagina often become thinner, drier, and less elastic. Medically, this is called atrophic vaginitis or vaginal atrophy. The symptoms tend to be more common and more severe if you’ve had breast cancer. This is likely because of the drop in estrogen levels that occurs with surgical menopause, medical menopause, and estrogen-lowering and blocking therapies such as tamoxifen and aromatase inhibitors. As a result, you may experience vaginal dryness and irritation; tightening or shortening of the vagina; and/or more frequent infections in the area, such as yeast infections and urinary tract infections.
All of these symptoms can contribute to painful sexual intercourse or vaginal penetration (a condition technically called dyspareunia). It’s not surprising that you might feel less motivated to have sex if there is an expectation of pain! Addressing underlying vaginal symptoms often can make intercourse/ penetration possible again without pain.
For some women, though, menopause brings on a much more complex challenge: a loss or significant lowering of their libido, or sex drive. Vaginal symptoms can be a contributing factor, but there are often many other factors at work—ranging from hormonal and physical changes, to life stresses, to changes in your relationship with a spouse or partner. For more information about reduced libido and what you can do about it, visit the Sex and Intimacy section.
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