Q: I’ve been without a partner for a long time, but now I’m starting a new relationship. Since I haven’t been intimate for years, is sex going to hurt?
A: Intercourse is likely to be uncomfortable at first because the vagina can atrophy from lack of activity. Also, if you are postmenopausal, vaginal tissues can become thin and dry due to the natural decline in estrogen and testosterone levels, exacerbating the discomfort of penetration. Fortunately, there is a lot you can do now to prepare yourself so that intercourse will be enjoyable.
Try any or all of the following…
Start using a nonhormonal over-the-counter vaginal moisturizer, which is a topical suppository, cream or gel with long-lasting effects. Routinely applied two or three times per week, it helps rejuvenate the vaginal tissues, making them more moist and resilient. Good brand: Replens.
Once daily, use a pin to pierce a vitamin E gel-cap supplement (500 IU), squeeze the oil onto your fingertips, then rub it onto the labia and around the vaginal opening. This plumps up and strengthens the cells.
Ask your gynecologist whether a prescription topical estrogen cream or suppository is appropriate for you. Topical estrogen can improve the integrity of the vaginal lining, reducing the chances of tearing and lessening any discomfort you might experience during sex—and because very little gets into the bloodstream, it does not carry the same level of risk for systemic side effects as oral estrogen does. (Topical estrogen generally is not recommended for women at high risk for breast or ovarian cancer, but there are exceptions.) Also ask about specially compounded testosterone cream to be applied to the vulva. Though not FDA-approved for this purpose, doctors have been prescribing this to women for many years.
Keep a water-based or silicone-based personal lubricant on hand so you’ll have it when you need it. Used during foreplay and intercourse, it helps minimize pain and heighten pleasure. Some lubricants contain ingredients that can irritate delicate tissues, particularly in menopausal women, so look for a product that is organic, hypoallergenic and/or paraben-free. Excellent brands include Hathor Aphrodisia, Pink and Sliquid.
Do Kegel exercises, aiming for 20 minutes or 200 repetitions per day. Repeatedly squeezing and then releasing the muscles you use to start and stop the flow of urine can increase the flow of blood, oxygen and nutrients to the pelvic floor, strengthening not only the muscles but also the tissues in that area. Bonus: Kegels help prevent incontinence and may intensify orgasms.
Masturbate on your own, with a vibrator if desired, to rediscover what makes you feel aroused. Sometimes getting back in the game takes practice.
Consider talking to your gynecologist about a vaginal dilator, which is a set of smooth cylindrical probes in varying sizes. You use the dilator at home to gradually stretch the vagina—so that by the time you want to have intercourse, you are physically ready.