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Sex After MenopauseDo you feel like sex changes so much after menopause it is “not worth the trouble“? I hear that statement often…and it’s troubling. As women, many changes occur after menopause that effect sexual health. However, with the variety of options available to improve sexual function, women should consider taking control of their symptoms, with a goal of achieving a well-rounded quality of life…..including a fulfilling sex life.

The tissues of the vagina and bladder are responsive to estrogen. Every year that they go without estrogen, they become more thin and dry. Estrogen is needed for the pelvic tissues to remain thick, healthy and strong. In menopause, the ovaries stop supplying estrogen to the body. This can lead to overall symptoms such as hot flashes, mood changes, and sleep disturbances. These systemic symptoms of menopause will for most women gradually go away over time. The pelvic symptoms of menopause, including vaginal dryness, pain with intercourse and bladder dysfunction, will only get worse over time.  A long-term maintenance plan must be in place to achieve adequate pelvic health.

There are three ways to maintain the tissues of the vulva, vagina, and bladder for the long run.


The first is the use of vaginal moisturizers. Daily or weekly administration of a vaginal moisturizer, such as Replens, can improve symptoms temporarily, but will not strengthen the vaginal tissue.

Option number two is vaginal estrogen. Replacing estrogen in the vagina can strengthen the vaginal tissues and improve symptoms. Again, this is only helpful if it is continued weekly for maintenance. If the estrogen is stopped, the benefit will stop. Estrogen can be placed in the vagina either through a cream, a pill that dissolves in the vagina, or a ring that sits at the top of the vagina for three months at a time. The application of vaginal estrogen leads to only very small amounts of the hormone absorbed into the bloodstream. It is a safe option for most women unless there is a history of breast cancer or a deep blood clot.

The third option is Mona Lisa Touch Laser therapy to the vagina. This is a non-hormonal option to vaginal strengthening. The laser causes a small amount of superficial “damage” to the tissue of the vagina so that the body will attempt to repair the damage with collagen, thereby mechanically strengthening the tissue without hormones. It is a safe, quick in-office option for the treatment of vaginal thinning. Thousands of MLTouch laser procedures have been done without any safety concerns. There is no safety risk. The only risk is that you invest financially (this procedure is not covered by insurance), and see if you get the outcome that you want. Outcomes are usually very good, however, no guarantee can be made. The benefit is no messy creams or use of hormones. The downside is this procedure is not covered by insurance, therefore requires a financial investment.

Keeping the pelvic tissues strong with either estrogen or the MLTouch laser can also improve bladder function and reduce symptoms associated with urine leakage. It is important not to discount the importance of the quality of the tissue with regard to the treatment of bladder issues.

Adequate pelvic health should be a normal part of our health maintenance as women. It should not be an after-thought or an out-of-reach goal. Talk with your health provider to learn options for maintaining pelvic strength, or for a referral to a specialist that is ready to discuss these needs with you.


About the Author:

Dr Shannon BradleyDr. Bradley is a Board Certified OBGYN at Mid Dakota Clinic in Bismarck, ND. She attended medical school at University of North Dakota School of Medicine in Grand Forks, ND and completed her residency in Obstetrics and Gynecology at Mayo Clinic Graduate School of Medical Education.

Dr. Bradley is a fellow of the American College of Obstetricians and Gynecologists and is a Clinical Assistant Professor of OB/GYN, UND School of Medicine and Health Sciences. Dr. Bradley has professional interests in cosmetic gynecology, MonaLisa Touch® vaginal laser, Orgasm Shot®/O-Shot®, endometrial ablation, laparoscopic/robotic-assisted da Vinci® hysterectomy, vaginal hysterectomy, general and high risk obstetrics, pelvic relaxation surgery, including vaginal repair/rejuvenation, treatment of abnormal vaginal bleeding, pelvic pain, unwanted urine loss, and bladder issues.

Kendra Roloff, Nurse Practitioner

Kendra Roloff is a board certified Nurse Practitioner. She has been providing pelvic health and continence care for 10 years. Kendra has professional interests in urodynamic testing, pelvic floor rehabilitation, postpartum pelvic floor disorders, pelvic pain, and pelvic organ prolapse. Kendra is dedicated to delivering high quality, dignified care to her patients. She believes empowering individuals through education is the key to success.