AARP Hearing Center
I’m Resentful My Wife Has Given Up on Sex
She says sex is painful but is worried about hormone treatment. What should they do?
Kiersten Essenpreis
Sex for women in their older years isn't always comfortable — usually due to dryness. And that can make even the idea of sex a turnoff.
The good news: This is a completely solvable problem. Our email query this week is from D.W. — a distraught husband whose partner has shut down their sex life due to pain during sex. Painful sex and what to do about it is something In the Mood gets a lot of questions about. Hope this helps.
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My wife has decided no more sex because it has become painful for her. She is going through menopause and does not want to take hormones. Needless to say, I am not happy about her decision. What can be done about painful sex short of taking hormones? I’m becoming very resentful since this is 100 percent my wife’s decision, and I feel she does not care about my needs.
It’s unclear from your question why she’s anti-hormones, but I’m guessing it’s because they got a bad rap for so long. The thinking on that has changed a lot in medical circles.
But before anything else, ob-gyn Maureen Slattery says your wife should get checked out by a gynecologist to determine exactly what’s causing her discomfort.
About hormones. The headline from all our medical experts: Vaginal estrogen, a low-dose hormone, is the best option, and there’s nothing to worry about.
As ob-gyn William F. Lee, an associate professor of clinical obstetrics and gynecology at Vanderbilt University Medical Center in Nashville, bluntly puts it: “There’s not a person out there that shouldn’t use it, including people who have had breast cancer. There is no medical contraindication.”
When Lee explains to patients that vaginal estrogen is not systemic — as some hormone replacement therapy is — 95 percent of women elect to use it.
How it works. Topical estrogen restores elasticity and plumps up the vaginal walls while relieving the dryness that can cause pain during penetrative sex. You apply it twice a week via vaginal suppositories, tablets or a cream — or from a ring, which stays in the vagina for three months. Topical estrogen requires a prescription and is covered by insurance.
If she’d like a second opinion. Not all gynecologists are created equal — some know a lot about menopause, others don’t. Retired gynecologist Marilyn Jerome, whose practice was focused on menopausal women, encourages your wife to speak with a menopause consultant about her individual situation and the hormone treatments, such as vaginal estrogen and testosterone, that are available to her.
Sexuality educator Gretchen Frey, a retired ob-gyn, recommends consulting a medical provider who is credentialed as a certified menopause practitioner by The Menopause Society. To locate one in your region, go to menopause.org and click the “find a practitioner” tab.
If your wife is still against using hormones. Slattery says that while not as effective as topical estrogen, an over-the-counter vaginal moisturizer with hyaluronic acid can be used on the vulva and in the vagina to create moisture and a pH-balanced protective barrier so that tissue isn’t as easily irritated.
She recommends moisturizers from Good Clean Love, Lubrigyn and Hyalo Gyn. The product is applied two to three times a week.
And during penetrative sex: Lube, always lube, whether you’re taking hormones or using moisturizers or not.
“Even 20-year-olds should be using it,” says Slattery, who is also a certified sexual health counselor and sex educator. “Lube does not represent some kind of failure on anyone’s behalf. It’s a necessary tool for comfortable sex for people who are very young and for those of us who are older.”
Other ways to prep for penetrative sex. Using a dilator in the vagina, starting small and gradually increasing in size, can help stretch it.
“She needs to be committed to working on this,” Jerome says. “It could take time and effort.”
There’s also a payoff. As Slattery notes, “If you work on gradually stretching the tissue, you may well find your way back to sexual activity without pain.”
And if you do start having penetrative sex again, Slattery says a woman, through positioning, can control the depth and rate of penetration. She’s also doing most of the moving.
Examples: He is on his back and she is on top in a cowgirl position or reverse cowgirl, facing away from him. “Those are the two easiest ones,” Slattery says. Or you can do the same thing in a seated position on a chair, she adds.
Explore alternative sex play. If your wife becomes amenable to meeting your needs for sexual pleasure, Frey says you both should be open to the idea that sex does not have to involve penis-in-vagina sex. Other options, such as oral and manual stimulation, should at least be on the table.
Now about how you are feeling. While the pain your wife is experiencing can definitely result in a lack of interest in sex, Slattery says your feelings and thoughts about sex are also valid.
“When someone unilaterally decides something that affects both people, it’s a big deal,” says Slattery. “He didn’t sign up for her to make all the ultimate decisions about their sex life.”
Slattery, who practices at Rochester Regional Health in New York, suggests that you and your wife consult a couples therapist or a sex therapist about your sexual impasse.
As Frey notes, “The discussion about what she wants for herself, and what they want as a couple sexually, is mandatory.”
Do you have questions about sex or relationships as a 50-plus adult? Send them to sexafter50@aarp.org.
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