A new chapter in life brings new misconceptions about sexual health.
By the time you reach menopause, you might think you know everything there is to know about maintaining your sexual health. However, menopause brings some unique changes, and there are some misunderstandings about how those changes affect your health and your sex life.
HealthiNation asked ob/gyns about the most common myths they hear about sexual health after menopause. It’s time to debunk these four sexual health myths:
MYTH: Sex is always painful after menopause
There is a touch of truth to this: Unfortunately, vaginal pain during intercourse does become more common during and after menopause. “This is from loss of vaginal estrogen, [which] can cause vaginal dryness, burning, discomfort, and eventually pain and narrowing and/or shortening of the vagina,” says Dr. Nina Carroll, MD, ob/gyn of Your Doctors Online.
However, this *can* be remedied, and you don’t just have to put up with vaginal pain (or avoid sex altogether). Painful sex after menopause “may be common, but it is not normal and should be evaluated by a healthcare provider,” says Dr. Carroll.
Water-based lubricants, vaginal estrogen, and vaginal moisturizers can all help. Learn more about sex drive after menopause here.
MYTH: You can stop getting Pap tests once you’re menopausal
It’s a myth that “Pap smears” are for women in their 20s and 30s. The myth probably stems from the fact that infection with human papillomavirus (HPV) causes 70 percent of cervical cancers, according to the World Health Organization (WHO), and most HPV infections occur in young adulthood.
Even if you’ve been in a monogamous sexual relationship for decades, you could still develop cervical cancer after menopause. It can take 15 to 20 years for cervical cancer to develop, according to WHO. That means an HPV infection from your 30s could potentially lead to cervical cancer in your 50s.
Additionally, Pap tests aren't testing for HPV; they're looking for abnormal cell changes that could indicate cervical cancer. “The goal is to find these abnormal cells when patients do not have symptoms, and treat these before they get to more advanced stages,” says Rebecca Teng, MD, FACOG, board-certified ob/gyn in Austin, TX.
While most cervical cancers are diagnosed between the ages of 35 and 44, about 15 percent of cases occur in women over the age of 65, according to the American Cancer Society. For this reason, doctors recommend Pap tests every three to five years to catch abnormal cervical cells early—until it’s no longer necessary.
“Each year during a patient’s annual exam, cervical cancer risk factors should be assessed to consider if a Pap smear and HPV testing are appropriate,” says Dr. Teng. Learn more about how often to get cervical cancer screenings here.
MYTH: You can stop using condoms when you’re menopausal
Sure, if you’re in a monogamous sexual relationship, it’s probably safe to lose the condoms. However, even if you can no longer get pregnant, you can get STIs at any age.
“Ob/gyns still recommend condoms in new relationships for safer sex, [as well as] appropriate screening depending on risk factors,” says Dr. Teng. “While condoms are not 100 percent effective, as they can break and because no one wears full-body condoms, they are the best prevention available.”
MYTH: Once periods become irregular (i.e., perimenopause), it’s safe to ditch birth control
Pregnancy during perimenopause is rare … but definitely possible. As if an unexpected pregnancy in your 50s isn’t stressful enough, the risk of complications during this age is very high. Talk to your doctor about which birth control is right for you at this age, and when it’s safe to stop using it for pregnancy prevention.
Menopause brings many changes, but it doesn’t mean you have to pause your learning about your sexual health.
Contraception: you need it longer than you may think. Pepper Pike: OH: The North American Menopause Society. (Accessed on January 3, 2020 at https://www.menopause.org/for-women/sexual-health-menopause-online/reminders-and-resources/contraception-you-need-it-longer-than-you-may-think.)
Human papillomavirus (HPV) and cervical cancer. Geneva, Switzerland: World Health Organization, 2019. (Accessed on January 3, 2020 at https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer.)
Key statistics for cervical cancer. Atlanta, GA: American Cancer Society, 2019. (Accessed on January 3, 2020 at https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html.)
Pain with penetration. Pepper Pike, OH: The North American Menopause Society. (Accessed on January 3, 2020 at https://www.menopause.org/for-women/sexual-health-menopause-online/sexual-problems-at-midlife/pain-with-penetration.)