When the big “O” means “ouch,” part 1

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Sex after menopause can be a real pain. Call it by its medically correct name, “dyspareunia,” if you want. The rest of us will just suffer quietly. Or loudly. Your call. But you don’t have to suffer forever, because we have some fixes for you. In this here Part 1, we’ll cover non-prescription options.

For midlife women, the problem usually comes from the loss of estrogen. After menopause, many women develop what is technically called “atrophic vaginitis” or “vulvovaginal atrophy.” By any name, the condition involves the thinning of the vaginal and vulvar lining, and the loss of self-lubrication. And it can hurt like hell during sex.

While that sounds bad, Ye Olde Vagina can be restored to comfortable working order fairly easily. Here are some possible options for you.

Use it or lose it. One of the best treatments is to have more sex. Isn’t that fantastic? The more often you have sex, the more blood flows to your vagina and vulva and helps increase overall health and comfort.

Take care of yourself. Stress, lack of sleep and general dehydration can have a negative impact on all things sexy time. Sleep well, dames.

Water-based lubricant. Some women are happy with water-based lubes, like K-Y Liquid, Astroglide and Vagisil Intimate, which are easy to find in most drugstores. But: They are messy and might not last as long as the sex does. With the right partner, you can just include a touch-up in the action.

Silicone-based lubricant: For more comfort and staying power, try a silicone lubricant like Pjur, Babelube, Shibari or ID Millennium. They feel great on the skin and last a long time down-under, too. You can even use silicone lube as shaving crème or a hair de-frizzer. Another plus is that silicone lubes tend to have fewer ingredients than water-based varieties, and are less likely to cause irritation. But: a word about use with silicone sex toys: Some devices are made with lower-grade silicone that becomes a sticky mess when combined with silicone lube. Research your products so you don’t accidentally destroy your favorite toy.

Natural oils. If you don’t want to be seen buying sex lube or personal moisturizer, you can use grocery-store-variety baby oil, petroleum jelly, coconut oil or even olive oil—just like the ancient Greeks. They can improve elasticity and comfort. But: They can contain bacteria that triggers infection and petroleum gels or oils will break down a condom or diaphragm in a few short minutes.

Vaginal 10W-40, aka “personal moisturizer.” Some doctors advise against short-term lubricants because they may increase risk of infection or irritation. Better is a long-term moisturizer, like Replens, Gyne-Lubrin, Gyne-Moistrin, Silken Secret by Astroglide, Moist Again, or K-Y Long Lasting that you apply every couple of days. These are great not just for sex, but for general dryness from cold weather or sleep deprivation. But: you might have some discharge because the body absorbs only what it needs. And you might still need an additional lubricant for sex.

Natural remedies. You can find products that claim to be replacements for estrogen or to ease vaginal dryness with vitamin E or other substances. Research generally doesn’t support these claims, but maybe they’ll work for you.

Of course, certain other medical conditions can cause pain during sex. Don’t be shy about talking your doctor about other kinds of vaginal or vulvar pain you might have. Your doctor has heard it all before and will probably have an idea or two about helping you feel better.

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