Something else? Ask Aunt Vadge – bottom left of your screen!
Dear Aunt Vadge,
I’d like help with some painful sex. I’m almost postmenopausal, and have been prescribed Ovestin oestrogen cream for it. I don’t know if the pain is from vaginal dryness or vulvodynia — possibly both. I’d be grateful for any help.
Regards,
Hurting
Age 57, Australia
Hi there Hurting,
First, the good part: you’re already on one of the best treatments there is. Ovestin is a local (vaginal) oestrogen, and for menopausal vaginal dryness and pain it really is the gold standard.
Two things to know about it — it works gradually, so give it several weeks of consistent use rather than just before sex, and it acts locally, with very little absorbed into the rest of your body, so it’s generally very well tolerated.
What you’re describing is part of what’s now called the genitourinary syndrome of menopause (GSM): as oestrogen falls in the later stages of perimenopause, the vaginal tissue gets thinner, drier and more easily irritated. This makes sex painful.
You asked exactly the right question — dryness or vulvodynia? — and yes, you can have both.
A rough way to tell them apart: GSM and dryness pain tends to be friction, rawness or burning that’s worse with penetration and eases as the tissue rehydrates with oestrogen and lubricant, whereas vulvodynia is a nerve-related pain — often burning, stinging or rawness that can be there without any touch, or set off by light contact — and it doesn’t fully settle with oestrogen alone.
So the useful part is this: if your Ovestin gradually eases things over the coming weeks, it was largely GSM; if pain persists even once the tissue is healthier, a vulvodynia component is more likely, and that’s treated differently, often with pelvic-floor physiotherapy and a vulval-pain-aware clinician.
Alongside your cream, use a good lubricant for sex and a plain, fragrance-free vaginal moisturiser between times, lean on phytoestrogen-rich foods, which may gently support things, and support your adrenal glands, which matter more in menopause as they become a bigger source of your hormones.
Peri- and menopausal vaginal pain is one of the things we work with most. And the winning approach is usually layered: local oestrogen for the tissue, lubrication for comfort, and sorting out whether there’s a nerve (vulvodynia) component that needs its own treatment.
So keep using your Ovestin as prescribed and give it time, see someone about the vulvodynia angle if pain lingers once the dryness is sorted (a pelvic-floor physiotherapist or vulval specialist), and if you’d like holistic menopause support tailored to you, you can book an appointment with one of our practitioners — just check any herbal menopause product is safe for your situation first.
You’re already pointed in the right direction; this is very treatable, and comfortable sex is a realistic goal.
Warmest wishes,
Aunt Vadge
This is general information based on current research and our clinical experience, not a substitute for personalised medical advice.
