I am menopausal and intercourse is very painful. My vagina feels like it's on fire. I am 58. Would vaginal rejuvenation help?

The outside of my vagina looks normal for me, the same as always. This burning feeling also occurred during sex while I nursed my children. I had my kids by C section. I have had a hysterectomy/still have my ovaries. My doctor will not let my use estrogen creams because I had an heart attack 5 years ago. My heart attack was caused by inflammation. Autoimmune problems run in my family. I have lost weight and been fine since. Water based lubricants don't help.

Doctor Answers 10

Pain with intercourse

There are many potential causes and I would first recommend a second opinion. There are a variety of non-surgical and non-medical interventions. However, it is important to first evaluate and exclude other possible causes.


Chicago Plastic Surgeon
4.9 out of 5 stars 72 reviews

Atrophic vaginitis

Your problem is most likely due to something called atrophic vaginitis, a condition that occurs due to lack of hormones. You're not going to fix this unless you get to the cause of the problem, i.e. lack of estrogen. At your age, you are better off going on hormone therapy. I would recommend you see someone who prescribes bioidentical hormone therapy, and this is not associated with an increase in heart disease (it's actually less) and stroke (it's transdermal). The other options are expensive and not long term treatments for your condition, plus you don't get the other benefits of BHT. See link below. Good luck.

Robert L. True, MD
Grapevine OB/GYN
4.9 out of 5 stars 7 reviews

You're a perfect candidate for FemiLift or MonaLisa laser vaginal resurfacing

CO2 laser resurfacing of the vagina is an excellent option for treating your symptoms without hormones. It's typically done as a series of 3 sessions spaced 4-6 weeks apart followed by an annual booster session. Effects are seen quickly after the procedure. More info below:

Post Menopausal Vaginal Dryness

Debra,

You are the perfect candidate for laser vaginal rejuvenation. The CO2 light will cause micro injury to the vaginal mucosa (lining) which will then stimulate the vaginal wall to get thicker, moister and more elastic again. My patients have all felt less itching, more moisture and less pain post treatments. I would definitely give this a try.

Best,

Leslie Kardos MD

Everything you need to know about "rejuvenating" the dry, postmenopausal vagina for great sex

Hello "Debra,"


There are several excellent ways to "rejuvenate" your viable but aging vagina to enjoy sex ("...the most fun you can have without laughing") for years & years to come (no pun intended..!) Here they are:

1. Vaginal estrogenization (sometimes a combination estrogen & testosterone cream used as well on the opening.) After good estrogenization (usually takes ~ 3 months), progressively larger dilators may be used to slowly stretch the vagina if there's narrowing. Takes 3-6 months total. Cost total time est. $150 - $200+ doctor's fees. Estrogen available via FDA- approved or compounded gels, creams, oils, suppositories and
self-retaining long-acting (3 months) vaginal rings. UNEQUIVALENTLY, the fact that you have had a heart attack DOES NOT preclude estrogen therapy, especially vaginal therapy, and probably systemic therapy, but it must be low dose and transdermally or transvaginally. 

2. DHEA suppositories 6-10 mg ~ every other night usually produces effects on vaginal skin similar to estrogen. DHEA ("Prasterone") is compounded by knowledgeable practitioners. Dilators still may be necessary (as above) for vaginal quite tight to begin with. Time frame as above. Cost est. same as above. Need a practitioner savvy in compounding.

3. The new oral medication ospemifene ("Osphena") 60 mg nightly has been shown to produce effects similar
to ##'s 1 & 2 above. Same deal if you need to stretch. Same time frame. Est cost (hugely dependant on whether your insurance will pay for this) ~ $150-$600.

4. The newest (and presently most "...stylish" )  method is either fractional CO2 laser
("Femilift" or "Mona Lisa Touch"-- SAME technology)- or radiofrequency- RF- (ThermiVa). Both are administered as 5-minute virtually painless laser or RF intravaginal treatments with 3 treatments over 3 months. RF is purported to last ~ 1 year (has to be repeated annually.) Laser has been purported to last twice as long; even longer (?2-3 years) especially if you have a "touch-up" at the 1-year anniversary of your last treatment. Results begin to be seen after 1month; average person has quite acceptable results after second month. Unknown whether dilation still necessary as above (not enough data.) Cost for series of treatments ~ $2000- $3500 for Thermi and ~ $2500- $3300 for Laser series (Our office charges $2800). Quicker, less personal responsibility, but more expensive. (...see weblink below for FemiLift info, and other areas of the site, especially blogs, for great menopausal info...)

I have been providing FemiLift fractional CO2 laser therapy for > 1 1/2 year, and am quite happy with the results, but then, in properly selected patients I am also quite satisfied with results ##'s 1, 2, & 3 above. The "gold standard" for "rejuvenating" an atrophic vagina remains intra-vaginal estrogen. Yes, these new technologies are fancy and the rage (the machines cost the doc ~ $60-80,000 so they are vigorously promoted by the docs who bought them!), and it appears that they (evidence-based) are excellent therapies, but the other stuff also works for 90% of women... 


**Of course, all of these things "rejuvenate (in the truest sense) the vagina. For the dryness on the outside, instead of water-based lubricants, why don't you try either a light vegetable oil or a silicone based lubricant such as "Wet Platinum" or "Pink Silicone. Neither of these will dry out or become "tacky," and are so fun to "play" with, mutually applying them to your mutual sexual organs . Have fun!!

MOST IMPORTANT is to see a practitioner (preferably a North American Menopause Society "Certified Menopause Practitioner") who is savvy in all things menopausal and can knowledgeably give you a CHOICE. You have several choices in Chicago and of course I could always see you in Davis..!

Best wishes,

Michael P Goodman MD

Davis, CA, USA

Vaginal Rejuvenation for Vaginal Atrophy

Hello debra11658,

Thank you so much for your question. Although we appreciate your photo to adequately address your concern a thorough examination by a well trained gynecologic/urogynecologic surgeon would be recommended to fully assess your options regarding your concerns. Based on your history and complaints it sounds as though you are experiencing classic "vaginal atrophy" which affects many menopausal women worldwide. Estrogen therapy is extremely effective at helping to reverse these changes to allow more comfortable sexual encounters, increased vaginal moisture, relief from burning and itching etc. However there are those who either cannot use hormone therapy as well as those who choose not for a variety of reasons. It is this group of women that the non-invasive treatments for vaginal atrophy (ThermiVi, Mona-Lisa Touch, FemTouch) were intended to help. They have been shown to be very effective at helping "restore" the vaginal cellular structure to a more pre-menopausal state when estrogen was more abundant in your body. The expected end effect would be more pliable vaginal tissue that is thicker with more moisture all of which can minimize discomfort during sex. Best wishes. 

Paul Pietro, MD
Greenville OB/GYN
5.0 out of 5 stars 2 reviews

Vaginal "health"

You are the perfect candidate for MonaLisaTouch vaginal laser "rejuvenation" since you are menopausal, have not had a vaginal delivery, and have limitations on sexual penetration etc. However, seek another opinion on estrogen/testosterone  options since the vaginal estrogen cream may work for you. Your blood level of estrogen doesn't really change with limited use. The vaginal opening and canal will continue to shrink in depth, diameter over menopausal time and lubricants will cease to be adequate. What is your age?

Painful intercourse

Your symptoms are most likely related to vaginal atrophy. We have seen some excellent results in situations like yours with use of ThermiVa device. It is worth to try it given no side effects related to the treatment. Hope this helps

Armen Kirakosyan, MD, FACOG, FACS
East Aurora Urogynecologist
5.0 out of 5 stars 1 review

Laser vaginal rejuvenation

YES! Pain and burning during and after sex is due to thinning of the vaginal walls from declining estrogen with menopause.  Even though vaginal estrogens are significantly less risky for cancer or cardiovascular disease, many physicians are hesitant to recommend these for certain patients. You should be able to find a physician who is more willing to prescribe vaginal estrogen.  Laser vaginal rejuvenation has the same effect on the vaginal tissue as estrogen by improving the integrity of the vaginal walls, increasing lubrication, and improving blood flow to the tissues.  I have been performing the Femilift procedure for over a year and have seen impressive results especially in women who are not interested in using estrogen. The most satisfying outcomes are restoring sexual function and pleasure to those women who failed estrogen use.  With minimal risk, no downtime for patients and  a quick office procedure, offering Femilift as an alternative to vaginal estrogen has been a satisfying adventure for me as a gynecologist.  

Joi Davis, DO
Pewaukee OB/GYN
5.0 out of 5 stars 1 review

Vaginal rejuvenation

Thanks for sharing.  If what you mean is will surgical vaginal tightening help your vaginal burning sensation that occurs during intercourse the answer is NO.  surgical tightening will make your vagina tighter and will probably increase burning during sex.  However if what you mean is the use of radio frequency or sometype of laser the answer is MAYBE. I have plenty of experience with radio frequency and have seem many  patients revitalize the vaginal skin i.e. mucosa so that it produces more moisture.  I would recommend a good physical exam by a surgeon who understands vaginal anatomy and pathology ( i.e. conditions that cause pain with sex) and possibly consider ThermiVA ( non surgical vaginal rejuvenation)


John R Miklos MD

Atlanta ~ Beverly Hills ~ Dubai

John R. Miklos, MD, MS
Atlanta Urogynecologist
5.0 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.