“Menopausal Vaginismus, which is a common cause of painful sex at midlife and beyond, is initially caused by the dryness and thinning of the vagina due to a drop in estrogen. When a woman has less estrogen, there is less vaginal lubrication; the vagina is less stretchable and more prone to tearing. This results in the menopausal woman feeling vaginal tightness during sex with pain, burning and/or soreness. In many cases, the problem starts with small tears called microtears that cause inflammation and irritation leading to more discomfort and bleeding of the tissues with any penetration of the vagina. During this time, intercourse is possible but often results in pain and burning after, which is called dyspareunia. Artificial lubricants seem to do a poor job replacing natural lubrication. As the condition gets worse, the patient appears to develop vaginismus, and when examined, appears to have the same spasm of the entry muscle as seen in the primary vaginismus patients.The spasm can be treated with the Botox program, which includes Botox vaginal injections and progressive dilation under anesthesia together with post procedure counseling as is done in our primary vaginismus patients.”
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