- 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.
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)
If you or someone you care about is concerned that they may have herpes, then you know that it can be a very worrisome time with a long list of questions. What makes it even more difficult is that you might be hearing conflicting and confusing information.
Several types of Herpes
What makes it more confusing is that there are several Herpes Simples Viruses (HSV), including the type that causes Chickenpox and Shingles.
Testing for Herpes when symptoms are present
If there are visible or active symptoms, such as sores, small bumps, crusted over lesions or small tears in the skin, then a healthcare provider can do a swab of the area and send it out for a PCR (Polymerase Chain Reaction ) evaluation. This is the most accurate way to test because it looks for the viral DNA, which is present even after a few days of symptoms. We don’t use cultures any more because they are not as reliable.
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.
When women come to my office with any one or all of the following complaints from no periods to excessive bleeding, difficulty losing weight, excessive hair growth and acne or infertility, I see this as an important opportunity to change a woman’s life for the better. Many of these women have seen many other health care providers, who more often than not aren’t able to provide a diagnosis or who may not be able to provide a comprehensive plan of care. Many women with PCOS have symptoms that impact their appearance, their self-esteem, sense of shame and guilt as well as fears of infertility.
Using the Rotterdam Criteria for diagnosis provides an objective starting point for evaluating women. A diagnosis of PCOS can be made if 2 out of the following 3 conditions are met: Signs of hyperandrogenism such as hirsuitism, acne, absence of regular ovulation and/or seeing 10 or more small cysts on 1 or both ovaries with an ultrasound.
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.
Are you like millions of women who leak urine? Do you know where every bathroom is in a 5 mile radius of your house? Or maybe you wear a pantyliner to catch the little leaks that might occur if you cough, sneeze or laugh? Or maybe you’re like my patient Joan who leaks as soon as she puts the key into her front door. What’s up with that?
You are Not Alone
If any of this sounds familiar, it’s because millions of women will experience some leaking, what we call urinary incontinence, at some point during their lives. This isn’t a topic that most women feel comfortable bringing up, even with their health care providers.
Most of my patients are surprised to learn that they’re not the only ones dealing with this. One patient told me she didn’t want to mention it because she was sure she’d be scolded for not doing Kegel exercises 10,000 times/day. As she said, “I don’t even know if I’m doing them right.”
Women who don’t leak urine are usually younger and have not had any pregnancies. As you can see in this illustration, the bladder is a nice oval shape, is high above the vagina and the the valves or urethral sphincters that stay closed so that you can stay dry. The bladder is held up in place by the pelvic floor muscles.
Eventually, over time, as gravity works it’s not so nice magic on the pelvic floor muscles the bladder can slip down into a curved position where some of the urine can stay in a pool that never quite empties, which can lead to leaking.
Should You Exercise Your Pelvic Floor Muscles?
The pelvic floor is like a small trampoline, it has a little bit of bounce and keeps all the organs in their places with bright shiny faces. Exercising your pelvic floor muscles helps strengthen them and can help women regain control leading to less leaking.
To find out if you need to exercise take this quick quiz
If you answered True to any of these questions, practicing pelvic floor exercises can help you regain more control over your bladder.
How to exercise your pelvic floor
It may be difficult to isolate the muscles of your pelvic floor and to learn how not to use your abdominal muscles to squeeze, hold and then relax. Here’s how you might practice in the privacy of your bathroom. I recommend trying while seated on the toilet.