What menopausal woman in her right mind wants to have sex if it hurts?
When I asked about symptoms the audience wanted to discuss at one of my recent talks for men and women, one woman called out early on "dry vagina." I always appreciate participants jumping right in and talking about these sometimes "taboo" topics because the more we realize they affect most of us around menopause, the sooner we can find solutions to resolve these types of symptoms.
Vaginal atrophy, the drying and loss of resilience of the vaginal tissues, affects 15% of peri-menopausal women and over 50% of post-menopausal women. Based on the number of women I see who complain of this issue, I wonder why it isn't 100% of post- menopausal women.
Vaginal atrophy often is accompanied by symptoms of vaginal dryness, pain, itching, burning, bleeding with sex, increased incidence of urinary tract infections, and urinary incontinence. And, understandably, if you have pain every time you attempt to have sexual intercourse, it really kills libido. "What's that?" many class participants say!
Estrogen supports a thickened and mature vaginal mucosa that has adequate blood flow to facilitate sufficient lubrication. The vaginal lining is composed of epithelial cells, not glands. Vaginal lubrication comes from a process called "fluid transduction" from a healthy network of blood vessels in the area assisted by the Bartholin's Glands near the introitus (opening of the vagina).
Estrogen receptors are also present in the lining epithelium of the bladder and urethral tissues and the surrounding supportive ligaments where they promote tone and relaxation of the muscles of the bladder. When estrogen levels decline during the years surrounding menopause - or for any other reason, including postpartum, surgery, chemotherapy, or as a result of medication - it results in decreased stimulation of the many estrogen receptors in the vagina and suprapubic tissues. Additionally, the number of estrogen receptors decrease with age and other factors, which decreases the body's ability to respond to the estrogen that is present.
Other hormones that decline with age and affect these tissues to contribute to vaginal dryness include progesterone, testosterone, and DHEA.
Hormone replacement therapies can be very effective in treating and managing vaginal atrophy, as well as urinary incontinence and chronic urinary tract infections. Estriol, a type of estrogen, is considered an effective treatment due to its high relative binding affinity for estrogen receptors in the bladder and vaginal tissue. Sometimes we combine small amounts of the other hormones into the compounded product to get the desired effect for each individual woman. It is rare that I am unable to help women get resolution of the issue of vaginal dryness.
The typical treatment protocol for vaginal atrophy or urinary incontinence due to depleted estrogen levels is application of estriol cream in the vagina nightly for 2-3 weeks and then decreasing to application 2-3 times weekly or as needed. As we get your whole body's estrogen level optimized at the same time, the effect will be maintained without the need for the continued use of estriol vaginal cream.
As hormone levels decline during the peri-menopause and menopausal stages, the pH of the vagina changes. This makes some women more susceptible to vaginal yeast or bacterial infections of various types. With bio-identical hormone optimization of the whole body, we re-establish normal pH, and this usually resolves the tendency for frequent infections.
For many women, this is a time when the muscles of the pelvic floor can lose their tone (facilitated by a decline in testosterone and DHEA) and the bladder and uterus can shift downwards. Injuries and strain from childbirth can add to this, causing increasing discomfort, difficulty with urination and bladder control. Fortunately, I often see that as we optimize testosterone levels again, use Kagel exercises (pelvic floor tightening), and re-establish adequate DHEA levels, we see major improvements with these issues and often full resolution.
An additional treatment modality that I find to be helpful for urinary incontinence, dropped bladder, or a prolapsed uterus is "frequency specific microcurrent," a treatment that is effective in normalizing tissues, structures, and processes of the body. This cutting edge modality is available with our body techs at Gordon Medical Associates.
If you are struggling with vaginal dryness or any of these symptoms that drag down your quality of life, let's talk - there are things we can do to resolve them!
Jane Kennedy
Nurse Practitioner
Gordon Medical Associates
Please send your comments or questions to me at: jane@gordonmedical.com
