**Vaginal burning and itching during intercourse could be signs of infection.

** Burning in the vaginal area during sex can also occur from changes in hormones that cause thinning of the tissue from menopause. The discomfort and possibility that a sexually transmitted disease could be causing symptoms during intercourse underscores the importance of diagnosis and treatment.

Considerations

Vaginal burning during sex does not always mean an infection is present.

Menopause leads to estrogen decline and thinning of the vaginal walls and surrounding tissue. Deficiency of the hormone estrogen can cause vaginal burning during intercourse from lack of lubrication. Other symptoms might include dryness and itching.

**A physician’s exam can determine whether vaginal changes associated with menopause, known as atrophic vaginitis, are the cause of burning 13.

** Friable vaginal tissue can also make women more susceptible to infection.

It is important to note that vaginal atrophy is not inevitable after menopause. According to the American Academy of Family Physicians, 40 percent of women experience vaginal atrophy associated with menopause.

Sexually Transmitted Disease

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Vaginal burning can also be a sign of a sexually transmitted disease such as herpes, Chlamydia and bacterial vaginosis 2. Bacterial vaginosis can spread between female sex partners, according to information from the CDC, and should be treated 2. Changes in the normal balance of bacteria in the vagina contribute to bacterial vaginosis, which also increases a woman’s susceptibility to HIV 2. Burning during urination, vaginal discharge and a fishy odor are sometimes reported. There may be no symptoms. **Chlamydia is a sexually transmitted disease that often is silent.

Without treatment the infection progresses to the pelvic organs, causing pelvic inflammatory disease with symptoms of vaginal burning, pelvic pain and vaginitis 3. ** Herpes is a sexually transmitted infection that can recur.

In addition to burning and pain, herpes also causes fluid filled lesions that may or may not be visible externally. The lesions can be present inside the vaginal canal.

Significance

Vaginal burning associated with infection can damage the reproductive organs and lead to infertility. Regular exams are important for women with vaginal burning, discharge, odor or abdominal pain. Without antibiotic treatment, infection can be spread between sexual partners. The discomfort of menopausal vaginal burning with intercourse can lead to psychological distress and lack of intimacy that is important between partners.

Finding the cause of symptoms of vaginal burning during intercourse is important for successful treatment, prevention of complications and psychological distress. Sometimes vaginal burning is merely caused by chemical irritation from lotions, synthetic fabrics worn by women, spermicides, soaps and bubble baths.

Prevention/Solution

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Good hygiene is important when it comes to preventing vaginitis, vaginosis and irritation that can cause burning and pain during sexual intercourse 3. Women can reduce the chances of infection by practicing safe sex and by limiting sexual partners.

Postmenopausal women can prevent vaginal atrophy that causes burning and pain during sex by remaining sexually active. Sexual activity, with or without a partner, improves blood flow to the vagina and keeps the tissues healthy. Lubricating products, estrogen creams and rings and estrogen tablets inserted into the vagina are effective treatments for burning and pain during intercourse associated with estrogen decline. Some women may choose hormone replacement therapy but the risks and benefits should be thoroughly discussed with a physician.

Loose clothing and use of natural fabrics and hypoallergenic lotions and bath products can also remedy causes of vaginal burning. Vaginal infections require specific treatment, depending on the cause.

Identification

A vaginal exam can identify the source of vaginal burning. Testing is performed by taking a sample of bacteria using a cotton tipped swab during a pelvic examination and sending it to the lab for analysis.

Hormonal causes of vaginal burning during sex may be visible. Vaginal atrophy causes a typical shiny appearance to the labia and surrounding vaginal tissue. A hormone blood test can confirm menopausal status.

Because vaginal atrophy can increase the risk of infection, lab testing might also be necessary. Chemical irritants can be identified as the cause of burning during sexual intercourse by eliminating the use of lotions, bubble baths, douching products and potentially irritating laundry detergents.