- Women’s Health
- Healthy Living
- Health Conditions
- Nurse Barb
I collaborated with AMAG Pharmaceuticals to create this post. All opinions are my own.
Recently I was invited to speak to a group of postmenopausal women who were all 50+ (plus) to discuss some of the concerns that we’re encountering from how to deal with wrinkles and weight gain to sleep and yes, we talked about one of my favorite topics – Sex!
Many admitted that talking about sex was something they learned early on as girls was a taboo topic, too personal and private to disclose, even with their closest friends. I’ve heard this at every talk I’ve given, so I asked everyone to close their eyes and then asked them to raise their hands if they had a concern about painful sex after menopause. I’m sure you can image what happened next. Over half of the women raised their hands! Over half!
Then I asked these brave women to open their eyes. After the nervous laughter died down, we realized that surprise, surprise – we’re not alone. An estimated 32 million postmenopausal women in the United States suffer from vulvovaginal atrophy, also known as VVA, and while experiences vary, painful sex is one of its symptoms! I get it, for most of us, it’s a lot easier to have sex, than to talk about it.
I just don’t know where to start
One courageous woman said, “Look, this is a very personal and private issue and it’s embarrassing. Sometimes I feel like it’s easier to just ignore it and focus on other aspects of my life, but then I think, ah, am I really ready to give up my sexuality and the intimacy in my relationship? But, I just don’t know where to start.”
I saw a lot of women in the audience nodding their heads. What I’ve found is that once we open the door to this topic, women rush in and are eager and willing to have the conversations, and let me reassure you, they don’t have to be Painfully Awkward.
What is going on?
What I heard that night and what I hear from my patients every day are these questions:
The Low Down
After 50 and sometimes a little earlier, our bodies experience shifting hormone levels that can lead to hot flashes and night sweats and eventually impact the vulvar and vaginal tissues. They become thinner, drier and less able to stretch. This collection of symptoms is known as Vulvar and Vaginal Atrophy or VVA and can cause pain with sex, also known as dyspareunia.
Unlike hot flashes and night sweats which often improve over time, VVA just gets worse. That’s right, without treatment, these symptoms generally will not improve over time. Some women relate that just wearing tight workout clothes or using certain soaps leads to vulvar and vaginal irritation. Others say that the tissue is so dry that no amount of lubricant makes reduces the pain associated with intimacy. Many have tried various remedies from their pantry to help things slide and glide but find those are just as irritating and they’re not making a lot of progress.
(Images courtesy of AMAG Pharmaceuticals, Inc.)
Don’t just accept this
One of my patients said what many others have expressed. “We get started, and I’m a little nervous, but willing to try again. But then, as soon as we try, it hurts and then poof, the mood vanishes and I’m done. I feel bad for me and for my husband. This is not fun!” She wondered out loud if she should just give up on having sex. And, the answer to that is NO! Do NOT give up on your sex life. You don’t have to put up with this and there’s a lot that can be done. Women deserve to have a sex life after 50!
There are many treatment options available. This video from my friend Dr. Sheryl Kingsberg explains why you deserve better if you’re experiencing pain with sex. https://www.pausesexpain.com/dyspareunia-treatment
Finding a Health Care Provider
Unfortunately, many health care providers are so busy talking about when to have a mammogram and getting cholesterol and diabetes testing that they don’t bring up any aspect of sexual activity, let alone painful sex. Some haven’t been trained to talk about sex and honestly, don’t know how to start the conversation with you. But that doesn’t have to stop you or discourage you from finding a health care provider with whom you are comfortable talking about sex and who has the knowledge and experience to help you find treatment options. Do talk to your friends, read reviews and consider going to the North American Menopause Society’s website, Menopause.org for more information and if you want to find a certified Menopause Practitioner in your area.
Preparing to Talk to Your Health Care Provider
Now that you’ve found a provider to talk to, here are a few questions to jot down.
Talking to Your Health Care Provider
Now that you’re prepared, don’t let embarrassment prevent you from living life and enjoying sex. You can visit www.PauseSexPain.com to learn more.
Though there are undoubtedly people who are born with “The Happy Gene” and are natural optimists, I’ve seen many people choose to be optimistic and not give in to their negative self-talk. Here’s what I use with my patients:
Source: ACOG, Committee Opinion. April 2013 (reaffirmed 2015), number 557.
A Woman’s Normal Anatomy
PALM – Structural causes of AUB
P – Polyp
A – Adenomyosis
L – Leiomyoma (fibroids)
M – Malignancy/Hyperplasia
COEIN – Non-structural
C – Coagulopathy
O – Ovulatory
E – Endometrial
I – Iatrogenic
N –Not Classified
Source: Established by FIGO – Fédération Internationale de Gynécologie et d’Obstétrique (the International Federation of Gynecology and Obstetrics)
I received compensation from Bayer Consumer Health, makers of Phillips’® Colon Health® to write this post. All opinions are entirely my own.
When my patients come to see me for their annual exam, I always ask about nutrition and digestive issues including whether they are experiencing any occasional bloating, gas, constipation and/or diarrhea. Many times my patients answer yes, but aren’t sure what to do about their symptoms. They are so used to living with the symptoms and inconvenience, they don’t take that next step for relief. And yet, with a few questions, we can often get to the root of the problem and then together come up with some solutions.
Are Donuts A Food Group?
I saw a patient, who I’ll call Karen (not her real name) who had a combination of occasional diarrhea, gas and bloating and constipation. As we talked about what she had eaten over the last 2 days, she started recognizing how a few things might be contributing to her symptoms.
A self-described picky eater, who didn’t like vegetables, Karen laughed and asked me if donuts and coffee could be considered a real food group. That’s because she stopped at her favorite Donut shop on the way to work for a few glazed donut holes and an extra large black coffee for the stressful 45 minute morning commute. By the time she pulled into her parking spot at work, she was invariably bloated and though she was a little reluctant to admit it, she sometimes had diarrhea.
I also noticed that Karen’s typical lunches and dinners consisted of mostly breads, potatoes, pasta and some protein with very few vegetables or dairy. She liked to snack on bananas and peanut butter pretzels in the afternoon with another cup of coffee. It was difficult to know exactly what was causing Karen’s digestive symptoms because they can be caused by stress, our food and beverage choices or a combination of factors. (more…)
Many women I speak to are surprised to learn that they can take birth control pills in their 40’s and early 50’s as long as there are no contraindications.
Many women who are in Perimenopause, that is the time when there are a lot of menstrual irregularities, the start of hot flashes, night sweats and vaginal dryness, will benefit from taking a low dose birth control pill to help with their symptoms as well as provide contraception.
Fertility after 40
While fertility rates do decline after 40, if a woman is still having her period, even if it’s irregular, she can become pregnant. Contraception is advised if a woman does not want to become pregnant.
By Nurse Barb Dehn
Disclosure: I was invited to attend an event about IBS-D by Salix Pharmaceuticals and am working with them to help get information out about how to talk about IBS-D symptoms and treatment options. Salix provided me with a stipend and paid for my travel and accommodations related to the event; however, all opinions are my own.
I really like this photo of models who’ve had their tummies painted to represent what it’s like to have Irritable Bowel Syndrome with diarrhea (IBS-D). Between the cramping, bloating, pain and let’s face it, the frequent and unpredictable trips to the bathroom, if you have IBS-D, this might be exactly how you feel.
Could you have IBS-D? Take Nurse Barb’s Quiz
If you answered yes to these questions, then you should talk to your healthcare provider and ask if you could be like the up to 16 million Americans with IBS-D. Your HCP should evaluate your clinical history, perform a physical examination, ensure diagnostic criteria for IBS-D are met and that alarm features are absent before making a diagnosis.
Experts weigh in on IBS-D – It’s unpredictable
Recently I attended an informational event with Dr. Mark Pimentel, Executive Director of the Medically Associated Science and Technology (MAST) program at Cedars-Sinai Medical Center in Los Angeles, California.
Dr. Pimentel explained that living with IBS can be enormously frustrating and that people with IBS-D don’t often know when they’re going to need to visit the bathroom, which can cause people to limit their lives for fear of not being able to find a restroom.
Imagine getting up and not knowing if you’ll visit the bathroom once or let’s say 12 times that day and not knowing when the urgent need to use the restroom will come up.
If you have IBS-D, then you don’t have to imagine this, you may know what it’s like to not know when you have stop what you’re doing and find a bathroom––Quickly. No wonder people start to stay home and skip doing the things they love.
And, despite a lot of well-meaning advice about what foods to eat and which ones to avoid, people with IBS-D may find that they are unable to predict if they will experience symptoms on any given day. It can be frustrating and depressing.
Quick Facts on IBS
• Some people with IBS experience constipation in more than 25% of bowel movements and diarrhea in more than 25% of bowel movements, this is known as mixed IBS.
What Causes IBS-D
– Aha! Could this information help us find effective treatments?
– Stay tuned.
Find a Gastrointestinal specialist
If you think that you might have IBS-D, then DO find a gastrointestinal specialist, known as a GI specialist, who has experience with IBS-D. Your primary care provider may not be as familiar with the latest research and treatments.
I know that this may be embarrassing to talk about, but the talk doesn’t have to be as uncomfortable as the symptoms. I really like this website: LetsTalk-2 that has resources and a list of questions for you to talk to your health care provider about.
My tips for preparing to talk to your health care provider about your symptoms
Questions about IBS-D for your health care provider
Treatment options for IBS-D
Dr. Pimentel presented data about a treatment option for IBS-D that has helped provide significant relief of both abdominal pain and diarrhea. Click here to learn more about an IBS-D treatment option.
If you’re asking this question, you’re not alone. If you’re under 30 about 1/3 of women use something slippery (lube or lubricant) to help everything glide and slide with sex. If you’re in your 50’s or beyond, it’s more like 50- 75%.
Which lubricant is best? Well that depends. Most of the manufacturers of lube have several different varieties for any situation. Here are some guidelines:
– These include Good Clean Love, KY, Sliquid, Aloe Cadabra, Sylk, Yes
– These can be used with any toy made out of anything
– Ok with all condoms
– Available in sugar-free flavors
– If you’ve used a water based lubricant and it’s feeling a little dry, instead of applying more lubricant, you can use a little bit of water to rehydrate the lubricant. (hint- your saliva will also work)
– Won’t stain the sheets and rinses off with water
Here are the facts:
Myth #1: All “Milks” are the Same
Myth #2 Milk is loaded with….. (more…)
There’s lots of reasons why sex might be painful after you turn 50. For many women as estrogen levels decline during midlife, their vaginas become much more dry and don’t have the same elasticity or ability to stretch.
What you might notice
I hear from a lot of women who are suddenly ready to have a baby. They want to be pregnant as soon as possible. Others are considering pregnancy and trying to get prepared.
Stop All Birth Control
It may sound obvious, and that’s because it is! If you’re ready to become pregnant, then the first thing to do is to STOP using any birth control.
With most birth control methods once you stop using them, your menstrual cycle will start up again. It may take a few weeks to see a period return, but the process that leads to your period resumes as soon as you stop birth control.