Understanding Vaginal ‘Tightness’ After Menopause

woman with a painful vagina

Of all the changes that happen after menopause, painful sex may be the most frustrating. It’s also among the more common: 20 percent to 30 percent of postmenopausal women report vaginal discomfort. Considering that many women are suffering in silence, that could be even higher. Some women express their discomfort as “tightness,” but it’s really the pain that results from the vaginal wall getting thinner — a natural part of aging.

Painful vaginal sex, otherwise known as dyspareunia, is a persistent condition that occurs during or after intercourse. Extreme vaginal spasm during sex is called vaginismus, and it is also painful. Vaginismus can cause involuntary tightening or muscle spasms that happen at the time of penetration or even when you try to insert a tampon. There are a number of causes of vaginismus, including emotional triggers like anxiety and physical triggers like menopause.

Some other possible causes of pain or a feeling of tightness during sex after menopause include vaginal dryness, a thinning of the vaginal lining called atrophic vaginitis, side effects of some antihistamines that cause dryness, endometriosis, and inflammation. Pain or the experience of difficulty with penetration during sex can impact your overall sex drive, which in turn can impact your relationship and leave you feeling sad.

Symptoms of vaginal atrophy

If you’re dealing with vaginal atrophy, you may feel

  • dryness
  • itching
  • burning
  • discomfort
  • pain

That’s because vaginal tissue is thinner and needs moisture. It’s caused by the decline of estrogen in menopausal women but there are other causes as well, that can impact just about every area of your life, both before and after menopause. Vaginal atrophy can be diagnosed and treated by your doctor.

Relief for vaginal tightness 

If you’re experiencing tightness and pain during sex, know that you aren’t powerless. If you have severe and persistent pain, see your doctor to rule out causes that are not dryness or atrophy. You can also start incorporating a vaginal moisturizer into your daily routine. Many women find fast relief that way. A vaginal lubricant before intercourse can also help.

If you struggle with vaginismus, Kegel exercises can help you find more control over your vaginal muscles. Pilates, too, can strengthen your pelvic floor. Finally, since vaginismus is linked to sexual anxiety that can be caused by trauma, a good therapist can help you talk through your fears.

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