Painful sex (dyspareunia) after surgical menopause

A surgical menopause is one caused when a woman has her ovaries removed. It can also refer to a menopause triggered following a hysterectomy that has left her ovaries in place.

There are many menopausal symptoms and some, like the hot flush, are often easier to deal with than others. Perhaps the hardest ones to overcome though are those that affect our sexual well-being and these include things like vaginal dryness or loss of libido. In this article we’re going to explore issues around painful sex because for some women libido diminishes because they start to find sex painful, so dealing with that can often sort things out in the desire department.

painful sexThere are two types of painful sex, also known as dyspareunia; the first is associated with sexual entry and the second is a much deeper pain that occurs when your partner thrusts into the vagina. The causes of both of these can vary and include things that concern all women, regardless of whether they have had surgery or not, and others that might be associated with the menopause and/or surgery.

Entry pain

The most common reason for painful sex in women who have had a hysterectomy and/or gone through the menopause is insufficient lubrication. This can be caused by falling oestrogen levels or with a lack of foreplay and it’s important to remember that you need less foreplay the younger you are and more as you get older to stimulate the glands around the vagina which help to produce the lubrication necessary for sexual intercourse. Medication such as anti-depressants, anti-histamines and sedatives can also play a part in reducing the ability of the body to lubricate itself.

Skin disorders such as eczema or Vulval lichen sclerosus (LS) and lichen planus (LP) can cause the area around the vagina as well as the vagina itself to become sore and painful. Urinary tract infections can have a similar effect and it’s worth getting them treated if this is causing a problem.

Vaginismus is a condition where the vagina spasms involuntarily and it can become a problem because a woman is afraid of the pain she may experience during sex.

Deep pain

Some medical conditions such as endometriosis, pelvic inflammatory disease (PID) fibroids, IBS, ovarian cysts and cystitis can all be a cause of much deeper pain during sex. Often a hysterectomy can get rid of this for conditions such as fibroids but it may hang around with endometriosis until its died back.

In addition, abdominal surgery such as hysterectomy (as with every form of surgery) can cause scarring which may make deep sex painful as well.

There are also a number of emotional reasons a woman might experience painful sex including stress, anxiety and depression.

 Managing painful sex

The most important thing if you are experiencing painful sex is to see your GP for a check-up. They will be able to do an internal examination to see if there is any skin condition that could be causing a problem or whether you are starting to show signs of vaginal atrophy (as a result of the vagina drying out during menopause).

The most common way of dealing with painful sex post hysterectomy that is caused by the menopause is with a low dose HRT (hormone replacement therapy) inserted directly into the vagina.

Non-hormonal vaginal products include vitamin E vaginal suppositories, lubricants such as Hyalofemme, Sylk or even natural oils such as grapeseed oil, coconut oil, sweet almond oil and sunflower oil. If you do decide to use oils make sure you go for an unprocessed organic product where possible.

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  1. I had a complete hysterectomy they also had to take my cervix, gallbladder and appendix. I have survived cervical cancer 3 times. I was 24 when I had the hysterectomy. Im now 30 and sex has almost reached being repulsive its hurts so bad to me it feels like razor blades cutting me up in there then pouring alcohol. My marriage is suffering majorly. What can i do

  2. My wife had a total hysterectomy when she was 46 due to fibroids and enomtetriosis that used to cause her very severe period pains every cycle with around 2 sick days at a time. She is now 52. Post-op, her gynae had suggested that she uses HRT (5 squirts from a dispenser on her thigh every day – not to mention the brand :-)). A few months ago, she started to lower the number of squirts and has now come off HRT altogether because she fears that to continue the HRT treatment would somehow endanger her in the future. She sought more than one opinion with one recommending that she continues whilst another saying that she could quit (based on her mother’s natural menopause timeline).
    She now has entry pains during intercourse even though we use lubricants both in her vagina and on myself. It seems that she is afraid at first and goes rigid although I take extra care.

    Is there anything else we could do apart from using water-based lubricants. Would other lubricants be more effective? Thank you.

  3. I’m 50 years old and I have had a total hysterectomy, I use to Love making Love to my Husband, As the years have past it’s got to where it’s very hard for me to have SEX with my Husband due to the fact it hurts really bad and I don’t even have a Sex Drive Please help me I need to be able to take care of man And not hurt from making love to him

  4. June 1 2016 i had a complete hysterectomy they removed tubes and ovaries seven months before that i had to have a partial hysterectomy where they removed my uterus i have had endometriosis since i was 17 i am now 35 ,,, i have been having really bad pain during intercourse and i was wondering is this normal or should i contact my OB/GYN and make an appointment

  5. I was in my thrities when I had my hysterectomy due to endometriosis I am still having a lot of deep pian with intercourse and then hurts the next day I am only 52 and yes in menopause what can I do it getting worse

  6. After four years of hysterectomy I am having terrible pain during in course I have to stop it. I feel lubricated. The longer we pursue the more painful it gets it’s like little cuts on the inside. It works it feels raw and burning when going to the bathroom.

  7. Very possibly Karen – they are often attached to hospitals 🙂

  8. Oh my goodness! Where would I find such a specialist physiotherapist who would do this sort of thing Linda? Would my GP refer me?

  9. I too have had problems with pain and some bleeding trying to keep sex life going following menopause and more recently hysterectomy which my surgeon diagnosed as vaginal atrophy which I learn is quite common. I am 56.
    I have had vagifem prescribed which is a small amount of oestrogen in the form of a little tablet you insert daily with a disposable inserter for 2 weeks and thereafter twice weekly for 3 months. In my case after 2 weeks the improvement is remarkable. No pain or discomfort. Normal sexual relations now resumed and I have had no side effects from the medication. I am trying to follow Marilyn Grenvilles alternatives to HRT and even she recommends this form of intervention as the oestrogen levels are so low and very localised.

  10. Scar tissue is an ongoing problem from any type of surgery, not just hysterectomy. It might be worth you seeing a specialist physiotherapist who might be able to advise about how to manipulate the scar tissue so it breaks down.

  11. Since a vaginal hysterectomy and prolapse repair in December 2013, I have had pain during intercourse. This was investigated by my GP who said I had a large ropey scar in my vagina. I have been told only more surgery might help, or may make the scar worse as it heals. I was prescribed lubricants which don’t help at all. Any advice? We haven’t had sex in a long time because it hurts me so much. I am on daily HRT sachets – Sandrena. I hope you can help us. Thanks.