After the menopause period, reduced levels of estrogen in the body can lead to a loss of elasticity or atrophy of the vaginal muscles, which makes a woman’s intimate life difficult, explains American gynecologist Dr. David Herzog. Dryness and pain during intercourse are two of the main causes of female sexual dysfunction, which affects more than 40% of women between the ages of 45 and 64, data shows. Other reasons are lack of interest or inability to experience orgasm. A 2007 study found that 34% of women between the ages of 57 and 64 avoided sex altogether, citing reasons such as experiencing pain (18%), vaginal dryness (36%), decreased desire for intimate contact (44%) . For vaginal atrophy or dryness, hormone replacement therapy is usually used. There is another, new method that could help deal with the problem. The procedure is called laser vaginal augmentation (LAVA), helping to relax and shape the outer layer of the vaginal opening to allow for easier penetration during sex. The modern procedure is currently performed by only a few trained doctors in New York, California and Canada, says Dr. David Herzog. After a certain age, especially after childbirth, the vaginal opening usually widens. But because of the lack of hormones, muscle atrophy backfires, often in women who have never had children or who have only given birth by caesarean section. The procedure is also suitable for young women whose partners have incompatible genitalia. NEWS_MORE_BOX In older women, dryness and lack of elasticity, sometimes in combination with a partner’s use of erectile dysfunction drugs, can make penetration difficult or prevent prolonged sex. It may also cause the vaginal tissue to tear. The procedure has been successfully applied to over 80 women. It usually lasts about 2 hours, and the total recovery from the intervention is several weeks. Pain is felt only in the first few days after the procedure, explains Dr. David Herzog. “The procedure can help many women, but not everyone needs it. For every 10 patients who report having this problem, only two are real candidates for the procedure. Surgery is always a last resort,” emphasizes Dr. David Herzog, who has medical offices in Staten Island and Brooklyn, New York. Other specialists oppose any type of vaginal surgery. “A dry atrophic vagina doesn’t need surgery, it needs a lot of estrogen,” says Mary Jane Minkin, professor of gynecology at Yale University and co-author of “The Woman’s Handbook of Menopause and Perimenopause.” In his practice, Dr. Minkin in some cases recommends dilators, in combination with a vaginal cream with estrogen, to patients with an overly tight vagina.