The Menopausal Vagina Dialogue. Menopause and sex.

What does menopause do to your vagina? Your sex life? Your intimacy? Your relationship? Your quality of life?

If you’re over 50 and sexually active you KNOW that sex feels different now compared to 10-15 years ago.
It’s usually because estrogen (and other sex steroids) decline (check with your MD to rule out other possible causes).
Estrogen acts on several tissues and organs in the female body, including the vagina; when it declines during the menopause transition women experience physiological changes that affect sex enjoyment.

Women may notice lack of lubrication, decreased arousal, and difficulty achieving orgasm; penetration may cause pain due to reduced elasticity of the tissues and narrowing of the vagina, and bleeding sometimes occurs because the lining of the vagina has become thinner and more friable. Women that are not sexually active may experience changes as well: vaginal dryness, discharge, and itching. This cluster of symptoms is called vulvovaginal atrophy (VVA), and if accompanied by bladder symptoms like incontinence (read my blog from August 2016 for more information on incontinence) and urinary tract infections, it’s included in the genitourinary syndrome of menopause (GSM). Unlike hot flashes, the most common and best-known symptoms of menopause, that improve with time, vulvovaginal atrophy worsens with time.

If you ever said or thought something like this…
“I go to bed before my husband and pretend I’m asleep when he lies down beside me, to avoid intimacy”.
“My private parts feel so raw during sex it overpowers all the pleasure I could be having”.
“I don’t want sex because it hurts. But then I feel guilty for depriving my partner of it. So I give in to my ‘duty’, and spend the time hoping it will be over soon. I feel no romance, pleasure, or intimacy during the act”.
…you’re most likely experiencing VVA. And you’re not alone: millions of women experience similar symptoms. In fact, GSM affects 50% of women, at least, and many don’t even know these symptoms are related to hormonal changes around menopause.

Vaginal discomfort affects a woman’s sexuality and self-esteem, upsets the relationship with her partner, and decreases intimacy, sexual desire, and quality of life.

In a survey of over 8,000 men and women from several countries, 69% of women and 76% of men reported avoiding intimacy due to symptoms of VVA. That’s a lot of people!

Most women suffer in silence and don’t seek help because they believe there’s nothing that can be done.

Talking about genital problems and sex is still taboo for many women and in many physician’s offices. During a visit women assume or expect their doctor will bring up the subject, and the doctor expects the women to ask for help if she has a concern with her vagina. Most women are embarrassed and uncomfortable discussing the problem and some clinicians don’t think VVA is a critical symptom that should be evaluated. Statistics show that only a small percentage of women affected by GSM get treatment and only about 7% are on any prescription.
Since treatment must be individualized, ask me or your physician what treatments are appropriate for you. Here are some choices:

Non-hormone treatments:

  • Over-the counter moisturizers applied a few times a week to increase moisture, and lubricants applied during sex may improve comfort but don’t resolve the problem.
  • Regular sexual stimulation,
  • Vaginal dilators and
  • Pelvic floor exercises provided by a specialist.

Hormone treatments:

Several vaginally-applied therapies are available, but if you also suffer from hot flashes then oral therapy may be more helpful for you.

If vaginal therapy is recommended for you do not be put off by the warnings and precautions on the accompanying product insert. If you use low dose vaginal therapies the systemic (affecting the whole body) absorption of the estrogen is very small, much smaller than if you were taking an oral pill, for example; we presume that the adverse effects are less too. But, for many reasons, the information in these low dose vaginal products doesn’t reflect that difference and lists the same warnings and precaution as for the oral products. It doesn’t make sense; we believe it doesn’t reflect the scientific knowledge we have about these therapies, hence many groups advocating for women’s health are trying to get the FDA and the manufacturers to change the information in these pamphlets.
To complicate matters a little more I must say that some available vaginal products, if used as recommended by the manufacturer, aren’t considered low dose, therefore it is very important that you be properly informed about the different vaginal therapies available and choose the most indicated for you.

If you have doubts, questions, or want to learn more about vaginal health visit my website.

Teresa Isabel Dias

BSc Pharm, RPh, NCMP
Pharmacist and Certified Menopause Practitioner

Visit my website www.menopausED.org to learn more about menopause and book a consultation

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@MenopausEDTID

2018-04-16T04:15:02+00:00