by Teresa Murphy
JOUR E-164 Science Writing, Professor Karen Weintraub, Harvard University
When Barbie Cates remarried at age 50 she was, in her words, “fit and fabulous.” “I’ve always looked after myself, exercising, lifting weights and eating healthy foods,” said Cates.
So it came as a surprise a few months after marrying that sex was suddenly uncomfortable.
“Within a few days it burned and my vagina felt like sandpaper,” said Cates, whose condition deteriorated so quickly even sitting hurt.
When her doctor told Cates she had atrophic vaginitis, a medical condition also known as vaginal atrophy, Cates had never heard of it.
Although up to 60% of postmenopausal women suffer from the condition, many are too embarrassed to tell their doctor.
Dr. Katherine Porter, a physician at a busy walk-in clinic in Vancouver, sees the condition daily.
“About 60% of my patients are post-menopause. While giving them a physical, which includes a pelvic exam, I see symptoms including thinning, shrinking and inflamed tissues,” she said.
The cause is a drop in estrogen, the hormone which keeps the urogenital tissues healthy and vaginas moist.
Some women may experience considerable pain. Others may have discharge causing severe itching while others have burning during urination and incontinence because of shriveling pelvic muscles.
Experts agree: left untreated vaginal atrophy doesn’t get better.
Porter routinely orders a hormone level test. She takes a urine sample to determine if the patient has a urinary tract infection (UTI) and vaginal fluids samples to see if there is an infection.
Depending on test results, she may refer patients to a gynecologist, an urologist or a pelvic floor physiotherapist.
Some women find relief using non-prescription, over the counter paraben-free vaginal moisturizers, lubricants and gels to reduce irritation and itching and bring back tissue elasticity.
Other women find prescription low-dose vaginal estrogen is a solution. Available in a cream or tablet, it’s inserted into the vagina daily for two to three weeks and then twice weekly.
Barbie Cates chose to use bio-identical hormone replacement therapy prescribed by a Naturopathic doctor. These hormones have the same molecular structure as those produced in the body.
“The cream I use includes estrogen and testosterone and is made by a compounding pharmacy customized to my needs based on my hormone levels,” said Cates.
Two non-hormone alternatives include Ospemifene, an oral prescription medication which works like estrogen, and an over-the-counter hormone, Di Hydroxy Epi Androsterone (DHEA).
Harmful bacteria such as yeast and coliforms as well as fungi can take up residence in dry vaginas and urinary tracts, which will require antibiotic treatment.
Natural preventive remedies include oral and vaginal probiotic supplements which increase healthy bacteria,” said urologist Jennifer Mickelson.
Mickelson also recommends D-Mannose a sugar found in cranberries. Early evidence in clinical studies indicates it may prevent bacteria from adhering to urinary tract walls and UTIs.
Women who develop urinary urgency, incontinence, pelvic pain and painful intercourse can often be helped by a pelvic floor health physiotherapist.
Ji-Seon Kim is one of these specially trained therapists who assess and treat pelvic floor problems caused by a lack of estrogen including atrophied muscles and ligaments.
Kim looks at the condition holistically in relation to the entire body. Her treatment includes hands-on manual therapy, electromyogram biofeedback and neuromuscular stimulation to decrease sensitivity and tension and increase blood flow to atrophying tissues.
The goal is to restore pelvic floor muscle tone.
“It’s important to prescribe the right kind of exercises to meet individual needs,” said Kim.
If pain with intercourse is a problem, women may be referred to Dr. Lori Brotto, director of the University of British Columbia Sexual Health Laboratory and an Associate Professor in the Department of Obstetrics and Gynecology.
Brotto studies sexual pain and conducts experimental research on the treatment of women’s sexual health, desire and arousal complaints and difficulties.
“We know for menopausal women sex is good for vaginal health. But the effects of vaginal atrophy can be long-lasting and can cause low desire,” said Brotto.
In her search for solutions Brotto studied 150 women and found mindfulness can be effective in improving women’s sexual desire and arousal and their mood.
She currently hosts a desire support group. Brotto is also interested in the effectiveness of increasing desire using a prescription androgen hormone, DHEA, administered in a topical cream.
“There is evidence that not only does this restore vaginal lubrication, it also might be associated with increased feelings of sensitivity and pleasure,” said Brotto.
This is important for sexually active post-menopausal women, like Barbie Cates. “We need to be as informed as possible so we can be fit and healthy in all areas of our lives,” said Cates.