Listen up, Ladies!

First, I'd like to commend my colleague, Dr. Jen Gunter, for gracefully addressing all of the media coverage of her vagina recently. Reading her rebuttal to all the men who had the gall to critique her vaginal aroma was the highlight of my month! One phrase she used in discussing vaginal health was "the vagina is a self cleaning oven." I've used this phrase with my patients too. There's a lot of confusion out there about vaginal odors due to the entire section of Walgreens dedicated to it. I agree that this whole section of the store should be removed. Another catch phrase I use a lot with my more mature patients is "The vagina is a use it or lose it kind of organ" You'd be surprised at the reactions I get. Most women either raise an eyebrow, or full out laugh. Beautiful ladies, I'm serious. The vagina needs to be used regularly when you're heading into menopause or you'll lose the ability to use it, potentially forever.

I've uttered "the vagina is a use it or lose it kind of organ" to an average of two women per week lately. As a pelvic and intimate pain specialist, one of the more frequent sexual issues I see is vaginal atrophy (dry vagina). I deal with this all the time. Women entering the end of their fertile years are at risk for "dry vagina." This is a frustrating and potentially disfiguring disorder of the vagina near to and in menopause. Up to 80% of women aged 65+ have problems with sex mostly due to dryness!

Sex and Midlife Estrogen

When you enter into the menopausal change, your ovaries start to poop out. They slow and eventually nearly stop the production of estrogen. Estrogen is the hormone that is responsible for keeping your lady parts moisturized. It also helps keep the vagina stretchy enough to allow your partner to enter. About 50% of women that are post-menopausal have vaginal atrophy with dryness. This typically starts within a few years of finishing your periods, but it can start when your periods get irregular and start spacing out, even years before they completely stop.

With reduced estrogen, there's less cells at the surface of your vagina. This causes problems with a host of things including lubrication, vaginal elasticity, thinning walls, and increased risk of tearing with sex. Ugh! There's also a change to the good bacteria in your vagina which leaves you at risk for discharge and bad bacterial overgrowth.

Why sex hurts in menopause

With a dry vagina, having sex begins to get uncomfortable. When your vaginal elastic qualities start to diminish, as you can imagine, putting an erect penis in there starts to hurt. If you don't have sex regularly, it hurts all the more because eventually the reduced elasticity turns in to a narrowing vagina. This isn't easy to fix once it's happened. It can get so bad that the vaginal entrance becomes tight and stiff, and the lips can even get stuck together!

Low estrogen = dry vagina and smaller opening = painful sex.

How, exactly, do I need to use my vagina?

This is a topic of some debate. The first thing to consider is that once the vagina starts to narrow, it's hard to stretch it back out. If you're in a relationship where his penis can be used to keep things stretched, then by all means that's an option. But only about 25% of women are able to orgasm with penetration, and orgasm helps with all this dryness stuff too. If you're not in a relationship, then consider obtaining a "sexual enhancement device." This is my politically correct term for a BOB (battery operated boyfriend), also known as a vibrator. The vibrator is much more likely to encourage orgasm with clitoral stimulation. Having orgasms regularly seems to help with the dryness, as it pulls in extra blood flow to the area. You may find it's a little more difficult to obtain orgasm after menopause, and that's ok. Keep working at it.

How do I get this treated?

Using your vagina regularly won't prevent it from being dry in menopause. That's an estrogen issue. What can be done to treat this? The best way to improve your vaginal dryness is with prescription estrogen. You'll need your doctor to discuss this with you, because there's a handful of medical conditions that make it dangerous to use estrogen. A history of breast cancer is one of the biggies. Other than estrogen, there are a few things that can help with dryness. DHEA vaginally is one thing that's being studied. There's also a few over-the-counter meds and prescription ones that help with dryness.

If you have vaginal dryness and aren't using your vagina, you're in a bad spot. Please get in to talk to your doctor about estrogen replacement. If you don't have a doc to do this for you, I can see you in my office! Please go to Nurture Womens Health and make an appointment to talk about vaginal dryness and painful sex. And buy yourself a fun Christmas present this year! A BOB will fit nicely in your stocking.