I had a complete hysterectomy eight years ago. They took everything out (uterus, ovaries, the whole thing) so I went into menopause immediately. And I got all the symptoms right away—severe hot flashes, severe vaginal dryness, mood swings. It was almost debilitating at first. I took Premarin for about four years, but I had to stop because it’s made from pregnant horse urine and I’m deathly allergic to horses.

I’m also having issues with painful intercourse no matter what lube I use. Some positions are worse than others. It’s very painful with penetration and during intercourse. Thankfully, orgasms don’t hurt. I love sex but it feels like I’m being stabbed by 1,000 knives in my vagina. It’s very discouraging.

Do you have any suggestions for me? It’s embarrassing to talk about with just anyone. I’m open to any and all suggestions.

Thank you!
Not Ready to Quit

Dear Not Ready,

Thank you so much for sending this question. Your experience of life after menopause isn’t uncommon, but we rarely talk about it. When we don’t talk, everything feels like a secret, and we can become ashamed of our own bodies. I’ve got a whole variety of suggestions for you. Try the ones that sound like they’ll make a difference.

For the dryness, keep using lubricant for sure. Make sure to use a brand that isn’t going to mess with the microbiome of your vagina. The vagina (and every other part of your body) has its own ecosystem and it’s always in a delicate balance. I think that hybrid lubricants are a great option for post-menopausal folks. Check out One Oasis Silk or another hybrid lube. It stays slippery for quite a while and it’s rare for a hybrid to cause irritation.

Once you pick a lube, think about finding something like a Lube Shooter. This will help you apply the lube at the top of the vagina so that it can work its way down. Use it regularly, not just for sex. Lots of folks will apply some every morning to help protect the tissues and keep them from chafing or sticking to each other.

Also, make sure you’re staying hydrated. Drink lots of water and not much caffeine. Eat plenty of healthy fats, too—avocado, nuts and nut butters, olive oil, fish oil, etc. Vaginal lubrication is produced in the walls of the vagina and released through the pores in the tissue (the mechanism is similar to sweating but the fluid is obvs different). Giving your body the building blocks of the lubrication can be really helpful.

I think you might also really benefit from using vaginal dilators. After menopause, the muscles in our vaginal walls can start to atrophy, making penetration both more difficult and more painful (because the opening is literally smaller). Vaginal dilation is something you’d do on a regular basis (several times per week) just like physical therapy. You start with a device that is pretty narrow. Use a good amount of lube, go slowly, and insert as tolerated. Once you’ve got the narrowest device in place, allow it to stay for 20 minutes or so. If you can tolerate it, try moving it slowly in and out and then making tiny circular motions with it to gently (VERY GENTLY) stretch the vagina and increase its capacity. Keep using the same size until this exercise is easy/painless. Then move up to the next size dilator and do the whole thing over again.

I like the Dr. Berman Dilator Set because it’s super affordable, it has a handle to make it easier to use, and it has vibration. Vibration relaxes muscle, so it is often easier for folks to insert the dilator if it’s vibrating.  You don’t have to turn the vibration on if it’s not working for you. Of course, nothing works for everyone, and there are plenty of other dilator sets out there, too.

You also want to think about how much alcohol you consume and try not to have much before sex. Alcohol is dehydrating (increasing the risk of vaginal dryness), and it works against one of the best sex hormones: oxytocin. Oxytocin helps make the blissed out, connected feelings we often associate with sex. Alcohol prevents us from making it, which can keep our bodies from responding to sexual stimulation in the ways we want it to.

There is literally nothing wrong with only having sex in positions that feel good, too. If some positions are excruciating, just don’t do that! If penetration is too painful right now, skip that too. Use hands, mouth, and some sex toys to connect with and enjoy your partner. There are about a million different ways to have sex, but Americans are really hung up on penis-in-vagina sex and think it’s the only “real sex” you can have. While you’re using the dilators and figuring out lube stuff, skip right past penetration for now.

And finally, if you try some or all of this and you’re still having pain, ask your gynecologist for a referral to a pelvic floor physical therapist. Those folks are so, so smart and can help you fix almost anything!

Curious about cunnilingus? Anxious about anal? Do you have questions about queefs or problems with your prostate? Lucky Tomaszek is the education coordinator at The Tool Shed: An Erotic Boutique, Milwaukee’s only mission-driven, education-focused sex toy store. Send her an email at [email protected] and she’ll get back to you with an answer.

About The Author

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Lucky Tomaszek, LM, CPM, is the education coordinator at The Tool Shed: An Erotic Boutique, Milwaukee's only mission-driven, education-focused sex toy store. Most mornings you can find her balancing her cat and her keyboard in her lap, working to make the world a smarter, safer place for people of all genders and orientations.