Sexual problems and solutions / Discomfort of vulva and vagina during intercourse:

Estrogen is a hormone. If its production goes down, vaginal intercourse can become painful. Read what the reasons are and what you can do about it.

What causes low levels of estrogen?

During breastfeeding and after menopause, estrogen production naturally goes down. But other things can also cause low estrogen levels: an eating disorder, being very underweight, or excessive exercise, for example. Some hormone treatments and health conditions can also impact the production of estrogen: an oophorectomy (ovary removal) for example.

What are the consequences of low estrogen levels?

A lack of estrogen can cause the vaginal walls to become thinner. This results in less blood flow to the vagina and less lubrication (wetness). The skin of your vulva and around your vaginal entrance can also become drier and more sensitive. All this can lead to pain during sexual intercourse.

What to do if I don't get wet enough?

You might be used to getting aroused and wet quite quickly, and so you might be frustrated because that doesn't work anymore, due to low estrogen. But if you give yourself an extra 10 or 15 minutes, you might be surprised. Your body's sexual arousal response is still there – but it might take longer. So give yourself and your partner more time for sexual play before vaginal intercourse, so that your body can really become sexually aroused. Obviously, a good lubricant also helps a lot. Use it generously!

What to do if my skin is overly sensitive?

It's important what you do before vaginal intercourse. Quite often, the skin around the vaginal entrance – especially towards the rear – is particularly sensitive. If the penis enters the vagina and this skin gets stretched too much too fast, it can cause quite a bit of pain. So, gently stretching it before intercourse will help. You can use your fingers or your partner's, and/or their tongue to do that. Always make sure that the fingers are well lubricated. When you feel ready for intercourse, make sure you're the one that actively takes the penis or dildo inside. Don't let your partner be the guide – they don't feel what you feel. You can move your pelvis to steer the process and take in the penis/dildo at your own pace and preferred angle.

Can I do something on a regular basis?

Yes, you can. Actually, this is crucial. You've probably heard the term "use it or lose it". Frequent touching and massaging of your vulva and vagina, movement of your pelvic floor muscles, and sexual arousal promote blood circulation in your genitals. This will promote cell growth and healing, preventing atrophy and heightened pain sensitivity. If you're not in the mood to masturbate three times a week, you might consider doing pelvic floor exercises. We also suggest a ritual of applying oil to your vulva and vaginal entrance and gently massaging it, every morning and evening. What oil? Try pomegranate oil. It's a wonderful treat for genital skin. Do a web search for "Pomegranate oil for intimate care".

Should I avoid having sex?

You should avoid anything that's painful. But keep in mind, sexual arousal is actually good for your skin, so do anything that's possible. It's important that you talk to your partner. Tell them what hurts and what they can do. If intercourse isn't possible, maybe a gentle genital massage (with lots of oil...) is. Make sure they understand that you need lots of lube and lots of time. Make sure they understand that you have to dictate the pace. The rule of thumb is: Regular sex with a partner or alone is good for you and can counteract the physical changes caused by low estrogen levels. This is especially important if you've stopped menstruating for good.

What about hormonal substitution?

Your doctor will talk with you about hormonal substitution. If you supplement estrogen, the symptoms of low estrogen levels will go away. Rather than taking pills, you can use a prescription estrogen cream for use inside the vagina. Estrogen creams don't have the same side effects estrogen pills do. This is especially important if you're somebody who shouldn't take estrogen pills for medical reasons. Estrogen creams come in many variations. You'll need to apply the cream inside your vagina for about a month before it starts to have an effect. After that, applying a bit of cream twice a week can make all the difference in the world. If you can't use an estrogen cream for medical reasons, we recommend speaking to a phytotherapist or a gynecologist who knows something about phytotherapy: There are plant-based alternatives. Don't give up. Find out what works for you. You are making an important contribution to your sexual health.