McGill study shatters myths about postmenopausal pain during sex

Using hormone replacement therapy to alleviate painful sexual intercourse in post-menopausal women is not effective for a significant proportion of sufferers, according to a review study by McGill doctoral candidate Alina Kao, a student of Professor Irv Binik’s Laboratory for the Biopsychosocial Study of Sexuality. “This often-prescribed hormone replacement therapy (HRT) has mainly been studied in women who suffer from vaginal atrophy, a condition caused by declining estrogen levels, and changes in the genitals,” Kao said.

Although postmenopausal dyspareunia is a widespread problem which seriously affects a woman’s quality of life, Kao’s research team found that little is known about women’s primary complaint: pain.

“Dyspareunia in postmenopausal women: A critical review,” to be published in the upcoming edition of Pain Research and Management, is the first of its kind in pain literature.

Traditionally, postmenopausal dyspareunia has been attributed to declining estrogen levels and the changes this decline causes in the genital tract. Postmenopausal women have been prescribed hormonal replacement therapy to alleviate this problem.

Roughly one in three postmenopausal women suffer from dyspareunia, Kao said.

In questioning the effectiveness of HRT, Kao’s team found the therapy is not effective for a substantial proportion (10 – 27 per cent) of women. There may also be factors other than declining estrogen involved and these should be considered in future studies, the researchers concluded.

Although the use of a lubricant does help to decrease friction during intercourse, it generally does not alleviate the pain of dyspareunia, Kao said. This is likely because pain is often caused by factors other than lack of lubrication.

“In looking at the evidence, it seems there are numerous types of conditions that cause pain during intercourse in postmenopausal women, such as infections, dermatological conditions, problems with the pelvic floor muscles and chronic vulvar pain syndromes, to name a few,” Kao said. “However, these conditions are being overlooked by most treatment guidelines and healthcare providers,” she said. “Women shouldn’t have to ‘live with their pain;’ they deserve appropriate treatment geared to the causes of their individual pain conditions.”

Kao and her research team are conducting a multidisciplinary investigation, based on the emerging findings of this review, to classify the different factors associated with pain during intercourse in postmenopausal women. Women who take part in this research receive comprehensive medical and psychosocial evaluations of the causes and effect of their dyspareunia, as well as individualized treatment recommendations and referrals.