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Posts Tagged ‘vaginal atrophy’

What you ask about specifically is your clitoris, which, along with other genital tissues, does typically shrink with the loss of estrogen—whether through menopause or some other medical event. Because you’re under 40, which is young for what you’re describing, I’d encourage you to express your concern to your health care provider and have a thorough pelvic exam. The exam will be helpful in finding out whether there’s another vulvar condition causing the tissue changes—or whether you’re experiencing normal changes.

As we lose estrogen, we do face something of a “use it or lose it” proposition. That is, circulation and stimulation keep our genital tissues healthier; left to their own devices, they’ll atrophy. If you don’t have a partner right now, a vibrator is a great choice to provide stimulation and increased blood supply to the area. Maintaining your health means you’ll be ready for intimacy when—just when you least expect it—a relationship emerges!

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From what you describe, you’ve experienced the kind of atrophy that’s very common in post-menopausal women. Without intervention, some estimate that women lose up to 80 percent of their genitals—which is surprising to many of us, just as puberty is sometimes surprising! It’s good to act just as soon as you can, and then maintain the progress you’ve made.

From what you describe, I might recommend that you look at creams or tablets for localized hormones to start. The Estring is inserted for 90 days. Having any foreign body placed in fragile tissues causes irritation or ulcerations for some. But once you’ve achieved a healthy vagina, you could switch from other forms to the Estring, which certainly has a convenience advantage.

Adding estrogen for two to three months will tell you what other actions might be helpful. Along with the vaginal tissues becoming fragile and thin without estrogen, the vagina actually becomes shorter and more narrow. Dilators help to restore capacity, and they’re easy to use.

Congratulations on deciding to reclaim intimacy with your husband! Best of luck, and we’re here if you have questions along the way.

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Ouch! That’s a description I hear more often than you think. You’re not alone. Other women also describe the sensation as sandpaper, cutting, burning, or ripping.

When a woman describes that sensation, it’s usually caused by vaginal atrophy, or more likely vestibulodynia/vulvodynia. A careful exam is needed to determine exactly what’s happening; proper treatment can make sex comfortable again.

It’s likely that vaginal estrogen is necessary to make those tissues healthier; that alone may solve the issue. If that doesn’t completely resolve the pain, treatment options for vestibulodynia/vulvodynia should be explored.

The good news is that there is nearly always successful treatment! You can regain the intimacy you’re missing in your relationship.

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Maybe you’re divorced or widowed. Maybe you’ve been single and partnerless for a while. Maybe you found someone after a long dry spell. Or, maybe sex has just been darned painful lately.

Time was, you could count on your vagina to do its job. It just worked. You didn’t have to think about it. But with loss of estrogen you’ve been experiencing lately, that uncomplaining organ begins to act up. And if you haven’t used it lately, it actually begins to shrink and shorten.

Now, if you’ve been on the sidelines, sexually speaking, for a while, you won’t be able to jump back into the game without some preparation. At this point, sex can be surprising, and not in a good way.

After menopause, the name of the game is “use it or lose it.” Furthermore, it’s a lot easier to maintain vaginal health than to play catch-up after ignoring the situation downtown for a while.

As we explain in detail in our recipe for sexual health, when you lose estrogen, the vaginal walls become thin, dry, and fragile. They atrophy. Without regular stimulation, the vagina can become shorter and smaller. It can also begin to form adhesions and stick together. Some cancer treatments exacerbate this process.

We’ve talked about moisturizers, practicing your kegels, using a vibrator or other form of self-pleasuring as part of your sexual health maintenance program.

But another important tool, especially if you’re currently without a partner (or are trying to rehabilitate now that you’ve found someone) is the regular use of dilators.

Say what?

Dilators are sets of tubes, usually made of high-quality, cleanable plastic, that start small (half-inch) and gradually larger (up to an inch and a half). They’re inserted into the vagina in gradually increasing sizes to stretch the vaginal walls, making them open enough (which is called patency) and capacious enough to do their job.

It isn’t quick, but it is effective.

Occasionally, I run across suggestions for homemade dilators that make use of various round objects. Don’t try this. It’s important for all kinds of reasons to use only high-quality dilators that are smooth and easy to hold, that increase in size gradually and consistently, and that can be cleaned well.

You should only use the safest, highest quality product in this important place. If you don’t know where to look, we offer a selection of dilators on our website that we’ve carefully vetted. These will work much better for you than those candles you were eyeing.

Here’s how you use them:

Relax. Take a bath—it makes all those tissues soft and pliable. Lie comfortably on your back with your knees open.

Lubricate the smallest dilator well with a vaginal lubricant.

Gently insert it into the vagina. Keep all those pelvic floor muscles relaxed. Breathe. Push the dilator in as far as you comfortably can.

Hold it there for 20 to 30 minutes. Do this twice a day.

When you can comfortably insert the smallest dilator, graduate to the next largest size.

It can take three months or more to restore vaginal capacity.  Once you’re comfortable with the largest dilator, continue the regimen at least once a week if you aren’t having sex regularly. And don’t forget the moisturizers.

It takes patience and diligence to rehab your bottom, but you can do it. With a little TLC, everything will work as well as it ever did and sex can be every bit as luscious as it ever was.

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So glad you’ve been successful with the dilators you ordered from MiddlesexMD! Vaginal dilators can help to restore capacity and comfort for intercourse. Our website has instructions for how to use them to restore the vaginal opening.

Once you’ve been successful with that therapy, if you’re not having regular intercourse, I recommend that you use dilators at least once a week to maintain the progress you’ve made. Stimulation is important to retaining vaginal health—which is what we mean when we say “use it or lose it.” If you find that you’re having more discomfort, increase the frequency of dilator use.

Post-menopausal women find that using a vaginal moisturizer (like Yes or Emerita) really helps to maintain elasticity.

Congratulations on following through with the dilators—and stay with it! You’ll find it easier to maintain than to regain your comfort.

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You say you were diagnosed five years ago with fibroids, and you’ve reached menopause (one year without periods) quite recently. The good news is that fibroids tend to shrink in menopause, so they’re unlikely to be causing the soreness you describe after deep intercourse.

The less good news is that your symptoms sound most consistent with vaginal atrophy, the typical consequence of the absence of estrogen in the vagina. I’d recommend that you start using a vaginal moisturizer or vaginal estrogen as soon as possible. The moisturizers are readily available; you’ll need a prescription for the estrogen, which comes in a variety of forms for local application.

What you’re experiencing is normal and easily treated—more good news!

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You say the skin is becoming lighter and sometimes is dry, sometimes moist or itchy. That sounds completely consistent with the changes of vulvovaginal atrophy (VVA), which results from the absence of estrogen. It’s a gradual progression; it may not be particularly bothersome at first but may be more noticeable in the months and years to come.

The consequences of lost estrogen are often most noted in the vulva or vaginal tissues. Our bodies have lots of estrogen receptors, meaning estrogen plays a role there–from head to toe. But there are more estrogen receptors concentrated in the vagina and the vulva than in any other part of the body.

In and of itself, VVA doesn’t require treatment. If you have uncomfortable symptoms, there are treatment options, including localized estrogen, Neogyn vulvar soothing cream, vaginal moisturizers, and more.

You might also be aware that natural vaginal pH levels rise in the absence of estrogen, which means a woman can be more susceptible to infections. Symptoms to watch for are discharge, irritation, and/or odor.

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Estrogen is the queen of hormones. From our brains to our bones to our bottoms, estrogen keeps our systems regulated, lubricated, elastic, and running smoothly. Estrogen doesn’t just trigger sexual development in our breasts, uterus, vagina, and ovaries (although it does that, too), but it also regulates the production of cholesterol in our liver; it affects mood and body temperature from the brain; it protects again loss of bone density; and it keeps our sexual organs responsive and functional.

Estrogen is actually a category—a group composed of three chemically similar hormones. Estrone and estradiol are mostly produced in the ovaries, adrenal glands, and fatty tissue of all female mammals. Estriol is produced by the placenta during pregnancy. These estrogens circulate in the bloodstream and bind to receptors located throughout our bodies.

Not surprisingly, most of those estrogen receptors are located in the vulva, vagina, urethra, and the neck of the bladder, and that’s  why we talk about estrogen so much in this blog and at MiddlesexMD. It’s the critical hormone that keeps our sexual apparatus healthy and functional.

Before menopause, a healthy vagina has

  • thick, moist “skin,” or epithelium
  • tissues with many folds (rugations) that allow the vagina to expand and become roomier
  • differentiated layers of cells—superficial and intermediate
  • secretions from the vaginal walls and cervix that help maintain a slightly acidic pH balance
  • an increase in blood flow and lubricating secretions during sexual arousal
  • toned pelvic floor muscles that help to hold our internal organs in place

So, ladies, it’s easy to see that when our estrogen levels drop dramatically during menopause, virtually all of us will experience significant change to our vulvovaginal tissue. The umbrella term for that change is “vulvovaginal atrophy.” Here’s what happens to our genital area when we lose estrogen:

  • the epithelium becomes pale, thin, and more likely to tear
  • the vagina shortens and narrows
  • vaginal walls lose rugations (those folds or pleats) and become smooth
  • cells become less differentiated—there are more intermediate and fewer superficial cells
  • the vagina becomes dry without secretions to maintain a good pH balance or to lubricate during sex
  • the vulva shrinks and pubic hair thins
  • the pelvic floor loses muscle tone, so organs relax and sometimes sag (prolapse)

It’s not a pretty list, but it’s our new, postmenopausal normal. Vaginal atrophy can bring more frequent vaginal and urinary tract infections as well as more painful sex. And since painful sex usually means less sex, both our relationship and our quality of life can suffer.

Fortunately, as we’ve discussed many times in this blog and at the MiddlesexMD website, there are simple and effective ways to ease the effect of estrogen loss. These include using moisturizers and lubricants or topical estrogen products, doing our kegels, and talking to our doctors about vulvovaginal changes.

Losing estrogen and its beneficial effects is inevitable as we grow older, but losing function, sexual or otherwise, isn’t. Sex—and life—can be just as enjoyable. They just take more maintenance now.

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Okay, so you’ve tried everything. You regularly use a good, natural moisturizer, plus a lubricant during sex. No soaps, sprays, scents, dyes, or synthetic underwear ever touch your bottom. You’re the queen of vaginal hygiene. And still you’re troubled by dry, itching, or inflamed genitals and painful penetration.

What now?

Talk to your doctor about using a localized estrogen product for your vagina. These medicines deliver low dosages of estrogen right where it’s needed: the vagina and vulva. Not only is localized estrogen medication very effective at relieving the discomfort of vaginal inflammation or atrophy, but it also restores natural vaginal lubrication and elasticity. In fact, while it won’t relieve other menopausal symptoms—like hot flashes—low-dosage vaginal estrogen is sometimes more effective in relieving menopausal genital problems than systemic hormone replacement therapies (HRT). Moreover, the dosages are so low, the side effects and complications so negligible, it is often used by breast cancer survivors.

Vaginal estrogen comes in several forms: a cream (used twice a week), or slow-release tablets (used twice a week), or a ring (which needs to be replaced every three months). Don’t, however, confuse the Estring vaginal ring with Femring, which is the high-dosage HRT in a vaginal ring form. (Confusing? It can be.) Your doctor will tailor the amount and frequency of application for the maximum effect at the lowest possible dose. It may also take several weeks for treatment to become fully effective.

A few precautions:

  • Avoid applying your estrogen cream right before intercourse, since your partner can absorb it through his penis. Estrogen rings and tablets are meant to stay in place and don’t have this effect.
  • Continue to use non-hormonal lubricants and moisturizers if necessary.
  • Have regular vaginal intercourse to augment natural lubrication and a healthy vagina.

While localized estrogen may not be the first line of defense against the unpleasant genital changes related to menopause, it’s an important option when simpler methods (like vaginal lubricants or moisturizers) fail.

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Remember that play that premiered a few years back called, “The Vagina Monologues”? Well, I wish someone would write one called, “The Vagina Dialogues” so that women would start to realize that it’s okay to talk with their doctors about their vaginas!

As you know, menopause brings with it all kinds of changes to various body parts, including your vagina.  There’s a very common condition called vulvovaginal atrophy (referred to as VA in the medical world), in which the walls of the vagina become thin, dry, and possibly even inflamed due to a decline in estrogen. (The vulva refers to your external genital organs, including the labia and clitoris.)

Symptoms of vulvovaginal atrophy include:

  • Vaginal dryness, irritation, or burning
  • Burning and/or urgency with urination
  • Urinary tract infections
  • Urinary incontinence
  • Discomfort and/or light bleeding after intercourse

About half of all postmenopausal women will experience some symptoms of atrophy. But often they’ll look at these signs in isolation, not realizing that a urinary tract infection may be directly related to the discomfort they feel during intercourse—and that both might be indicative of vulvovaginal atrophy.

Although treatment is readily available, it has to be diagnosed first. But because women are often too embarrassed to talk with their doctors about vaginal problems, they don’t mention it during annual physicals, let alone pick up the phone when symptoms first concern them.

Instead, they try to treat it themselves, guessing at what might work, not knowing there’s a name for what they’re experiencing. And while over the counter lubricants may offer some short-term relief for dryness, vulvovaginal atrophy is chronic and requires ongoing treatment to address the underlying cause.

Typically, treatment for vulvovaginal atrophy involves some sort of estrogen therapy, in the form of a vaginal tablet or ring or topical cream. But the first step is getting a diagnosis. That’s why it’s so important to talk with your doctor about any changes you experience in your vaginal area.

So please: Don’t be shy and don’t wait. Be proactive and bold when it comes to taking charge of your own body. As with many other parts of life, it’s much easier to maintain healthy tissues and organs than to treat problems long after they’ve begun.

As soon as you feel anything unusual, lubricants don’t seem to work as well, or you begin experiencing any of the symptoms listed above, make the call to your physician. And begin your own vagina dialogues, the sooner, the better.

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