Oregon Health and Science University
Studying Postmenopausal Pain with Sex — Treating Where it Hurts
The Program in Vulvar Health at OHSU studied the very common problem of pain with penetrative intimacy after menopause by focusing on women with moderate or severe pain, who averaged 8 of 10 (in a 0-10 scale). They applied estrogen cream in a new location in a 12-week nightly regimen. The hypothesis? -dryness in the vagina is not the cause of pain, though atrophy is present. The pain location for all participants was the inner vulva, where “burning & raw” was the primary description, acting like a pain condition, because touch pain could be extinguished temporarily with numbing liquid. Actual vaginal tenderness was rare, and 70% had failed to find relief with FDA regimens of vaginal estrogen.
Participants were provided one of two strengths of estrogen cream to apply with a finger nightly only to the vestibule and not in the vagina for a duration of three months. They experienced a 50% pain reduction in 4 weeks and a 75% decrease in intimacy pain levels at 12 weeks. The lower-strength estrogen was found not to be measurably absorbed into the body, with average levels staying in the range found in women using no supplemental estrogen.
The two strengths of estrogen (1/2 gm vs 1 gm of 0.01% E-cream) were not different in rapidity or degree of pain relief, indicating that it is essential to treat the problem before it gets severe due to the time required to correct it. The dosing regimen to maintain improvement still needs to be studied. Estrogen is the only therapy known to correct this sexual pain condition that slowly worsens over time, and this study is, therefore, a major advance in the field of menopause medicine for women and couples, as the prevalence of this pain condition is as high as 78%, with current therapies inadequate for more serious complaints.
Where does postmenopausal dyspareunia hurt? A cross-sectional report
Treating where it hurts: tailoring the genitourinary syndrome of
Treating where it hurts—a randomized comparative trial of vestibule
estradiol for postmenopausal dyspareunia
EDITORIAL
Dyspareunia—where and why the pain?
