In this advice column we try to answer all of your confounding “What the Heck Is…?” questions. We’ll be getting advice from experts, but — beware — we may not always have the best answer. Feel free to share your own advice in the comments below .
Q: I recently visited my gynecologist complaining of painful intercourse. “Oh,” she said peering through my parted knees, “that’s because you have vaginal atrophy.” Whereupon we just blinked at each other. The advice she gave me? “Try HRT” (hormone replacement therapy). Seriously? At my age?! I am not ready to be dealing with menopause in my mid 40s, but then again, I’m not ready to be done with sex, either! Bottom line: Vaginal atrophy has turned sex into a painful ordeal, rather than something I desire. As you might imagine, this also deals a crushing blow to the libido. Where do I turn for a truly effective, long-lasting solution to this problem?
Silently Atrophied in NYC
A: Whoa, ouch. Agreed: Mid-40s is waaaay too early to be done with sex. But technically, it’s not too early to be going through menopause (cold comfort, but just so you know). “One of the most common misconceptions is that menopause doesn’t happen until you are in your 50s,” says Margery Gass, M.D., the executive director of The North American Menopause Society and consultant for the Cleveland Clinic. “Actually, the normal range for women is 41 to 58. So it’s perfectly possible to be experiencing menopausal symptoms in your mid-40s.”
OK, but vaginal atrophy? Atrophy?! Who comes up with these terms? That sounds like there’s something shriveled up and dying between your legs. Really not the kind of mental imagery one needs before a hot date. Or dinner with the hubby. What’s next, clitoral gangrene?
Lest your imagination be galloping ahead of you, be reassured that your condition is reversible with the help of medical science. “Vulvovaginal atrophy, or VVA, happens due to lower estrogen levels as a woman goes through menopause,” says Andrew Kaunitz, M.D., professor and associate chairman in the department of obstetrics and gynecology at the University of Florida College of Medicine in Jacksonville. “Because of this, the vaginal tissue loses some of its blood supply and becomes thinner, and the vaginal pH changes, which can lead to dryness or irritation.” Translation: Even when you’re turned on, your vagina is flashing the “Do Not Enter” sign to all who dare come close.
The first thing you want to do, says Dr. Kaunitz, is rule out other potential causes for your predicament. Anti-histamines, for instance, can cause vaginal dryness; the issue is also far more common in smokers. Also, fess up, when was the last time you had sex? This matters because “if it’s been a long time since a woman last had intercourse, the vagina can constrict and get smaller,” says Dr. Gass. “Combined with the dryness associated with menopause, this can make sex very painful.”
Once you’ve ruled out the other likely suspects, your first stop should be the local drugstore (or if you must, the drugstore one town over) for simple OTC lubes. Choose water-based (Astroglide, K-Y Jelly) over oil-based ones, since those can actually increase irritation in the area. Vaginal moisturizers, like Fresh Start or Replens, may also alleviate discomfort. Unlike lubes, moisturizers are absorbed into the skin and mimic the body’s natural vaginal secretions.
If DIY methods fail to smooth things over, talk with your doc about taking a form of vaginal estrogen. “Estrogen replacement products come as creams, tablets or a ring,” says Dr. Kaunitz. “The method of delivery really depends on personal preference.” How they work: Beyond providing the immediate relief from dryness and irritation that you get from OTC products, these prescription treatments actually increase vaginal blood flow and reverse the thinning of surrounding tissues. Because of the concern over estrogen’s side effects, these products should be used in the lowest effective dose.
For those who would rather not deal with inserting cream or tablets in their vagina (can’t imagine why!) a recent introduction to the market — an oral pill known as ospemifene — is promising. Approved by the FDA in 2013, ospemifene is a selective estrogen receptor modulator. “It may have less stimulation in the breasts than other treatments,” says Dr. Gass. The pill, taken by mouth daily, works in a similar manner as the vaginal products to thicken the vaginal lining and improve blood flow to the area.
Odds are, one of these treatments will work for you. What doesn’t work? Blaming yourself or accusing your partner of, you know, lousy sex. “Low desire may be linked with relationship issues, but painful sex is grounded in physical, anatomical science,” says Dr. Gass. “If someone is complaining of painful intercourse, sure, it can lead to a lower desire to have sex, and lower desire can lead to relationship problems. But the condition should be addressed from a medical perspective, not a relationship one.”
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