“I am always happy to talk about happy vaginas,” Dr. Mary Jane Minkin told us as we started our interview about the subject of vaginal atrophy. When you get a quote as good as that, you lead the story with it!
Dr. Minkin is clinical professor of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine and has a private practice in obstetrics. We wanted her to teach us a thing or two about VA, which affects “well over 50 percent of post menopausal women,” but is an issue which few women talk about, she explained.
First things first: What is Vaginal Atrophy?
VA is a treatable chronic condition that affects the vagina and the surrounding tissues during and after menopause due to declining levels of estrogen. Symptoms include vaginal dryness, pain and bleeding during intercourse, itching in and around the vagina, vaginal soreness, urinary tract infections and painful urination.
Why have I never heard of VA?
We are a purely puritanical society and sometimes people look at me funny when I talk about vaginas. But VA as an aspect of menopause is extremely important. Although the prevalence of VA is high, only 25 percent of sufferers seek medical help. Many women aren’t even aware that it’s a treatable condition.
I am going to teach you about a terrible term in gynecology that relates to all this. The Pudendal Nerve is one of the main nerves in the pelvis and one of the most important nerves in the body. It innervates the vaginal and clitoral areas, which, in laymen terms, means it supplies nerves to those areas. Interestingly, the Latin meeting of the word pudenda is that of which you should be ashamed.
Besides feeling ashamed, women are not taught enough about their own bodies. Menopause knowledge hasn’t been promoted very much because we’re a society that values 22, not 52 year olds, and menopause is a result of aging.
But the FOF Generation is changing that, isn’t it?
It is, but slowly. We need to talk about menopause. The average age at menopause in 1900 was 48 and the average female life expectancy was 48. We’re leading longer lives, well beyond past our menopausal age, and we’re going to get dry vaginas. We want to lead good lives, not just longer lives.
Viagra was introduced in 1998, but no one bothered to talk about the men’s partners.
Is VA treatable?
Yes, three modalities of estrogen treatment make vaginas moister and more comfortable and come in the form of creams, tablets and rings. They all work to reverse the atrophic changes in the vagina, as far as the FDA patients and doctors are concerned.
What is the difference between taking an estrogen pill and estrogen delivered via the tablet, cream or a ring?
The estrogen a woman takes systemically, in the form of a pill, delivers estrogen to her blood stream and it definitely reaches her vagina and is delivered to her vaginal tissue. Estrogen taken this way also eliminates hot flashes.
If estrogen is placed directly into the vagina, it will treat VA but it won’t take care of hot flashes or other menopausal symptoms because it doesn’t reach the blood stream. Hot flashes, however, tend to be prevalent around menopause and then improve over the course of time, whereas vaginal symptoms can get worse over time.
Which treatment do women prefer?
Different women prefer different treatments. I try to tailor the method I recommend to the woman, based on her preferences.
The Ring: Some women don’t want to think about their vaginas and like the ring. They insert it, it stays put for three months and then they change it. Others can’t stand something foreign in their body or their partners can’t stand the way it feels. Some women fail to change the ring or renew their prescriptions after three months.
The Cream: Some women like the feel of a cream; others hate the mess of a cream, or the need to wash the applicator. Many women who’ve had vaginal infections often associate the cream with the way they felt about Monistat. They don’t like the leaking.
The Tablet: I was the lead author of a study of 79 post-menopausal women currently taking vaginal tablets, who were previously treated with cream (85 percent), the ring (9 percent), or both (6 percent). We found that the majority of former cream users (66 percent) was “much more likely” to use the tablet.
Published in the International Journal of Women’s Health, our study showed that for 52 percent of all respondents, the switch to tablets was recommended by the patient’s healthcare professional. Slightly less than 20 percent of patients themselves requested to change treatments and 15 percent specifically wanted to use tablets. “These insights show us that patient preferences should be ascertained and help guide the type of treatment we recommend.
What is the difference between lubricants and estrogen therapies?
Many women find a lubricant, such as K-Y or Astroglide, helps at the time they’re having sex. But these products don’t have long-lasting effects; they just make intercourse easier.
The estrogen treatments we’ve been discussing are all considered moisturizers, which provide ongoing moisture to the vagina, not just at the time of intercourse.
Estrogen increases pelvic blood flow and the nice tissues that line the vagina, which make nice plump cells.
If a woman hasn’t had sex in years, can she use estrogen therapies?
Absolutely. Vaginal therapies will reverse her symptoms. And even if you haven’t had sex in years, you still might have a new relationship at some point and will want to benefit from ongoing moisturizing.
Also, some women will end up with urinary tract infections if they let their vaginas stay dry for too long, since the bladder and vagina sit right next to each other.
The cells lining the vagina are basically the same cells that line the urethra and the bladder. When the vagina is dry, I know the bladder is dry. This leaves a woman more prey to being infected.
When the vaginal tissues become drier and thin out, because of lack of estrogen, then the good guy bacteria don’t like to live there anymore and you end up with a nastier crowd of bacteria, which can cause vaginitis and more urinary tract infections.
Does intercourse, without treatment, make VA worse or not?
It makes it better. The more sexual activity you have, the more pelvic blood flow you’ll have.
*Photo source: http://www.wikipaintings.org/en/georgia-o-keeffe/flower-of-life-ii