Call it the silent stalker, the medical problem women don’t want to talk about.
Vaginal atrophy is hardly a sexy topic but it afflicts half of all middle-aged and older women, dampening or eliminating their sex lives, causing discomfort and often triggering incontinence and a whole host of other problems.
The tragedy is the disease is highly treatable, yet because it is profoundly embarrassing for women to address, only five per cent seek help, according to Maureen McGrath, a Vancouver-based RN specializing in sexual health and continence problems for both men and women.
As women enter the pre-menopausal, menopausal and post-menopausal stages of their lives, estrogen levels drops, causing the walls of the vagina to become thinner and drier. This can lead to itching, irritation, painful sex and urinary tract infections.
“It’s such a taboo subject that people don’t even speak about it,” says McGrath. More than happy to talk about it, she is an anomaly. “I’m alone on my ship, although some people are getting on board.”
She wants to send women suffering from it a powerful message: you are not alone and there is help for it.
The lifebuoy for the afflicted comes in the form of prescription localized estrogen therapy. It can be a ring, a pill or a cream. All carry virtually no side effects.
McGrath says these treatments are highly effective, kicking in after roughly two weeks and achieving optimal results in two to three months.
No one treatment is better than the other, although some women find the creams to be messy and don’t like the scent they carry. The dosing can also be unreliable. If a treatment delivers too much estrogen, it can trigger a yeast infection. Others find the ring packs too powerful a punch, delivering too much estrogen for the estrogen sensitive.
But all the treatments are effective and safe, perhaps even for breast cancer survivors, although McGrath counsels that they need to have a discussion with their doctors about this.
A recent academic study that surveyed 4,100 females and the same number of males in the United Kingdom, Finland, Norway, Sweden, Denmark, Italy, France, Canada and the US told a tale of women reluctant to discuss the problem with their partners. Yet, sadly or encouragingly, depending on how you look at it, the men in their lives were eager to address the problem with their wives or girlfriends.
The study found that 28 per cent of women did not tell their partners when they first encountered vaginal discomfort mainly because they felt “it was just a natural part of growing older” (52 per cent) or because of embarrassment (21 per cent).
Conversely, 82 per cent of males wanted their partner to share their experiences with vaginal atrophy. Men were also more comfortable discussing it than women (68 per cent vs. 58 per cent).
Having sex less often (women: 58 per cent, men: 61 per cent), having less satisfying sex (women: 49 per cent, men: 28 per cent) and putting off having sex (women: 35 per cent, men: 61 per cent) were the main effects of vaginal atrophy.
“Women haven’t been socialized around sexuality,” says McGrath. “They don’t think about their vagina until there is a problem with it.”
She has seen patients as young as 43 on the brink of divorce because sex for them has become so painful. “It’s like sandpaper. Nobody wants to do something that hurts.”
Some older women may argue they don’t give a hoot about their sex lives, but there are still compelling medical reasons to seek treatment.
Vaginal atrophy can lead to what is called vaginal prolapse, which basically causes the bladder to fall down, leading to incontinence. One of the first signs, says McGrath, is a leakage of urine when coughing or sneezing.
Women over 65 with vaginal atrophy also run a big risk of urinary tract infections. Most women, at one point or another in their lives, have experienced this and been successfully treated with antibiotics.
But as McGrath points out, these infections can be anything but benign. They can lead to sepsis, caused when the body releases chemicals into the bloodstream to fight the infection, triggering inflammatory responses and a cascade of changes that can cause multiple organ failure. This can require hospitalization and can even lead to death, says McGrath.
Yet another health risk posed by vaginal atrophy is women are more prone to sexually transmitted infections or diseases such as HIV, chlamydia, herpes, hepatitis B., gonorrhea and syphilis. That’s because infections and viruses pass more easily through thinner vaginal walls.
Lest you think these diseases are more of a worry for the younger, more sexually active set, think again. A study by the US-based National Institutes of Health found that seniors are one of the fastest growing demographics contracting STDs. This group is less likely to use condoms, forgetting that they are not only to prevent pregnancy, but also prevent the spread of disease.
Tragically, older people first diagnosed with HIV are often at a late stage of infection and frequently become ill with AIDS-related complications and die sooner than their younger counterparts. These deaths can be attributed to original misdiagnoses and immune systems that naturally weaken with age, according to the US study.
So, there are many reasons to seek treatment for vaginal atrophy, yet few women do.
McGrath says some women believe that penetrative sex helps to keep the walls of the vagina healthy and helps to prevent atrophy but, she adds, the jury is still out on that one.
In any case, for an older woman who has not had sex for a year, the experience is likely to be painful and even more so if she has vaginal atrophy.
McGrath emphasizes that while many symptoms of menopause like hot flashes and night sweats gradually disappear, vaginal atrophy does not. Hence, it requires lifelong treatment.
And it’s never too late. Even if you are 80 and have never been treated with localized estrogen, it could still help you.
McGrath wants to get women back in the bedroom with their sex partners. She wants health practitioners to shed the misconception that most people don’t like sex after 50, anyway, and that shrinking vaginas are a normal part of growing older. She maintains that nothing could be further from the truth.
In addition to treating patients in private practice in Vancouver and North Vancouver, Maureen McGrath hosts a Sunday night health show on CKNW radio in Vancouver and writes a blog all about vaginal health called 50 Shades of Pink.
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