- 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.
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.
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
It’s important to note that guidelines are just that, guidelines based upon data from large populations, however they may not apply to every woman that you encounter, especially to those who have unique circumstances and let’s face it, are more challenging and more rewarding as we provide personalized, individualized care.
The current American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for pap smears differ from those of the US Preventive Services Task Force (USPSTF)
The USPSTF guidelines recommend that Pap smears be stopped at age 65 if there have been adequate prior screens, however it’s not clear what the definition is of adequate prior screens.
There are as many different experiences of menopause as there are women. For some women, menopause arrives like a gentle breeze with barely a feeling of warmth or any other bothersome symptom, while others experience menopause like a Class 5 Tropical storm with overnight drenching hot flashes and night sweats, mood changes and a complete disruption in life.
While many clinicians understandably and appropriately focus on hot flashes and night sweats, many women may be more concerned with sleep disturbances, weight gain, loss of libido, vaginal dryness, incontinence and mood changes.
I just gave a talk to a group of about 75 women at midlife. When I asked for a show of hands for how many women experience urine leaking with a cough, sneeze or laugh, about 1/2 raised their hands.
Yes, about a third to a half of us are having a little pee pee problem. Fear not! There’s an App for that now too!
Strengthening the pelvic floor means you’ll be less like to deal with this possibility.
When I ask my patients to do a Kegel or to try to squeeze their pelvic floor muscles during an exam, it’s clear that only about 1/2 are able to isolate and squeeze the right muscles. Many use their abdominal muscles, many push out and many simply don’t have the sensation. Once we work on how to do the exercises and get women started practicing, most report that their lives have changed, for the better because they aren’t leaking at all or nearly as much.
We’re all busy, so here’s some options to help you stay dry and a surprising option at the end.
At home Kegels! There’s an App for that
For women who want to work on their pelvic floor muscles in the privacy of their own home, here’s a few new options:
Discreet vaginal inserts
Lightweight, small, discreet vaginal inserts that use Bluetooth technology connected to your smartphone so you can see if you’re doing your Kegels correctly. (more…)
Most women know that doing Kegel exercises can help prevent leaking urine, but many are surprised to learn that being able to isolate and strengthen the pelvic floor muscles can also enhance sexual functioning. Really! Strengthening these muscles has the potential to improve sexual sensation, satisfaction and orgasm in women.
It’s never too late
Many of my patients throw in the towel, so to speak, and shrug their shoulders, figuring there’s not much they can do now, and those days are behind them, settling for watching episodes of Outlander.
Studies have confirmed what real women experience – pelvic floor concerns tend to lead to more sexual complaints, from low libido and problems with sexual arousal to inability to achieve orgasm.
“Unfortunately, many women feel that decreased sexual function is an inevitable part of aging,” said Leslie Rickey, MPH, MD, Associate Professor of Urology and of Obstetrics, Gynecology and Reproductive Sciences; Fellowship Director, Female Pelvic Medicine and Reconstructive Surgery, Yale School of Medicine. (more…)
High Tech Kegel Exercises with PeriCoach – I was so excited I tried it myself!
Like many of my patients, Jana* was hesitant and embarrassed when I asked about whether she was experiencing leaking urine. She nodded and told me that it happened a few times a week and while she tried to remember to do Kegel exercises, she wasn’t sure if she was even doing them right.
Jana was also surprised to learn that she wasn’t alone. The fact is that 1 in 3 women will experience leaking at some point in their lives. Women are doing the best they can to adapt to leaking urine. We wear protective pads, visit the bathroom as often as possible and try to remember to do those Kegel exercises.
There’s an App for that!
Recently I heard about a new, easy-to-use at home pelvic trainer and app, the PeriCoach system. It teaches women with real time visual feedback via a Bluetooth connection to their smartphone how to exercise and strengthen their pelvic floor muscles, in other words how to do Kegels and do them correctly.
Women can see how strong their muscle contractions are on their smartphone and track their progress. There’s even a secure portal at my.pericoach.com that women can share with their clinicians so they can both keep track of their progress.
Lots of things change as women continue on their journey through mid-life. Some, like increased confidence and less worry about what others think, are fantastic aspects, others like unwanted changes in our bodies can be frustrating to deal with. What’s worse? Insensitive comments, such as the one’s I’ve compiled below.
Want to learn more?
This Saturday, Sept 26, 2015, El Camino Hospital will be hosting a FREE women’s health fair from 9:30 to 12:30. Seating is limited, so register by clicking here or call: (800) 216-5556
• Is that a beard? Have you ever considered electrolysis? – The fact is that during the menopause transition, lots of women start to lose the hair on their heads and around their pubic areas (which is probably age related) and at the same time discover alarming new hair growth where we don’t want it! – Our upper lips, chins and necks.
Blame hormonal changes for the thick, coarse hairs that seem to sprout every day. Plucking, waxing, threading are good temporary measures. If the hair is dark then laser will still work. Personally, I have my electrolysis expert on speed dial. She has vanquished both dark and light hairs over many months. (more…)
Menopause is that one magical day when a woman hasn’t had any menstrual bleeding for 12 months. The following day, she is considered post-menopausal. Women may experience menopause starting in their 40s or 50s. The average age is 51.
What most of us consider menopause is actually Peri-menopause, or as I call it, the Hormonal Roller Coaster. This is the time in life when periods are erratic, symptoms like hot flashes and night sweats begin and women start to feel more fatigued, notice some leaking urine, less sex drive and more wrinkles. (more…)