How to Deal with Vaginal Atrophy Post-Menopause

Every month in Sex at Our Age, award-winning senior sexpert Joan Price answers your questions about everything from loss of desire to solo sex and partner issues. Nothing is out of bounds! To send your questions directly to Joan, email sexpert@seniorplanet.org.

I’m a 60-year-old single woman who hasn’t had real partner sex in 20 years, ever since I was in an accident that left me seriously ill, in pain and hypersensitive to touch. A hug would make me scream. I had a lover at that time and set him free, not wishing to be a burden.

Eventually I healed from my injuries, but I had other problems that kept me isolated. I was — and still am -— the sole caregiver to an older family member who is on hospice in my home. There’s no time and no opportunity for a relationship.

However, I met a man on Facebook through shared interests and, over time, our friendship became flirtatious and then intimate (as intimate as an online relationship can be). Although we live on different continents, we now have virtual sex and romance via Skype and sexting. Our first Skype session lasted 6 hours. For one hour of it we were both masturbating.

He’s 10 years younger. I told him I was too old for him, but he disagreed. He checked with me daily when things were going badly with my family member and became a good friend as well as my virtual lover. He is patient, loving, kind, fun and well educated. After 18 months of our sexy Skyping and sexting, we want to meet, but he has a disability and with my family issues, the travel is impossible for now.

Something is happening, though, and it makes me embarrassed and scared. In the past weeks, although I feel desire, I have become very dry, and touching myself internally hurts! I recently bought a vaginal moisturizer and lubricants. I’ve read that not having sex in a long time may cause vaginal atrophy. Could sex become impossible? Any suggestions?

I was always very passionate, but now I’m afraid I can never enjoy real sex again. I’m also embarrassed because I don’t know anyone else with these issues and I have no one to talk to about it. I’m afraid that these changes to my body will get in the way of this relationship — and prevent a future relationship from ever happening. Telling this to any man would be horrifying. Telling a younger man would be even more so. I’ve had to halt my video Skyping because of this, and I’m losing hope. —Alone Too Long

Joan Responds

Let me say first that I have great respect for you for providing full-time care in your home to your family member. I know that can be relentlessly stressful, both physically and emotionally.

You’ve found a terrific solution to the challenge of needing companionship and sexual expression — your online relationship is warm, emotionally fulfilling and sexy. Many of us are single and lack opportunity or time to meet someone in person. As long as we’re careful about the person we’re communicating with (readers: never, never, never send money to an online acquaintance!), virtual relationships can be a way around our feelings of being boxed in by our circumstances.

At our age, a 10 year age difference isn’t at all significant. He’s 50, you’re 60, that’s nothing. You’re both in the over-50 demographic, with more life experiences in common than not. So let that go!

The bigger issue is your vaginal pain. Yes, you need to use lubricant for any genital touching – we’re just too dry without it. That’s not a defect. It’s a fact of life as we age. See my Senior’s Guide to Lubrication for more info and recommendations.

When there’s discomfort even with lubricant, it’s important to know why you’re hurting. You’re right that not having sex for 20 years may result in vaginal atrophy — a thinning, drying and inflammation of the vaginal walls. This is caused primarily by lack of estrogen, and it’s intensified by not having regular sexual activity, whether with a partner or solo. At least a weekly orgasm is recommended for this and many other health reasons.

There are other medical conditions that can cause painful penetration, so it’s always best to see your doctor to find out what’s going on and develop a treatment plan, if one is warranted. Since this started recently and it’s bad enough to retreat from your otherwise satisfying Skype video sessions, it’s especially important to find out if there’s a medical cause for your pain. It might be an infection that you can treat. It might mean replacing your declining vaginal estrogen with an estrogen ring worn internally, if this is right for you. To learn more about possible reasons for vulvar/vaginal pain and more resources, see my article “Painful Sex: Where to Go for Help” on Senior Planet.

Many of us get frustrated because our doctors aren’t very knowledgeable about vaginal atrophy and even have trouble seeing us as sexual beings. (If they were better educated and cared more about our sexuality, more post-menopausal women would know about vaginal atrophy before problems start!) I always recommend saying some version of this to your doctor: “My sexuality is important to me. This is interfering with my responsiveness and pleasure. Let’s run the tests to find out what’s causing it. If you can’t help me, please refer me to someone who can.” If we all said this to our medical professionals, they’d realize that they need to get educated about older-age sexuality and create a referral list for specific issues.

Whether or not there’s a medical cause beyond low estrogen, I implore you – and all readers with vaginas – to read and follow the superb Vaginal Renewal Program from A Woman’s Touch. This program works to promote blood flow to the genitals and leads to more flexibility and vaginal thickness. It teaches a step-by-step, daily practice of both external vulvar massage and moisturizing, and internal massage with vibration. It also promotes at least an orgasm a week for genital health and makes dietary and other lifestyle recommendations.

Please don’t hesitate to confide in your online lover about your pain. If he’s as patient and loving as you say, I’m sure he would rather understand what’s going on for you than worry about why you’re avoiding Skype dates with him! Give him a chance to show you his empathy. I’m sure you’ll be happy that you did.

My books are full of people’s stories about meeting their great loves in later years, after long periods of being alone. Keep yourself sexually alive now by giving yourself at least weekly orgasms, get your pain diagnosed and treated, and you’ll be ready when a lover – either your online lover or a new one — crosses your path.

For all our unpartnered readers: Keep yourself sexually active on your own in case a lover crosses your path. It’s important for your sexual health, your overall health, and your emotional well-being – plus it feels so good!

More Resources for Vaginal Atrophy

• “Vaginal Atrophy: The 21st Century Health Issue Affecting Quality of Life” by Michael L. Krychman, MD
• “Postmenopausal Atrophic Vaginitis” by Sandy Calhoun Rice

Would you like to see more questions and answers? See all of Joan’s advice in Sex @ Our Age.

More About Joan Price

Send Joan your questions by emailing sexpert@seniorplanet.org. All information is confidential.

Joan Price is the author of the new “Ultimate Guide to Sex After 50: How to Maintain – or Regain! – a Spicy, Satisfying Sex Life”;  the award-winning self-help book “Naked at Our Age: Talking Out Loud about Senior Sex”; and the sexy memoir, “Better Than I Ever Expected: Straight Talk about Sex After Sixty.” Visit Joan’s  blog, “Naked at Our Age,” and her Facebook page.