Menopause: Kate Wells
Painful sex in menopause plagues many women.
It is not uncommon for me to hear: “Dear Abby – I am 70 and not done with sex, my vagina hurts – what do I do?”
Of all the many, many changes women experience with menopause, no one prepares women for changes in vaginal health. Our mothers didn’t have the knowledge, the language, the permission to talk about such things. And yet vaginal dryness, itching, pain with sex, thin skin, bleeding skin, affects over 75% of women after menopause.
Women are resourceful, at first, they try things – coconut oil is a favorite, as are vitamin E suppositories and using a lubricant for sex. These actions can often help in the short-term, however women want long term solutions so that their vaginas are healthy for the rest of their lives.
What Is Going On Down South?
If you take one thing and one thing only away from reading this article, let it be this: estrogen is critical for vaginal health and can be safe to use long term.
We don’t tend to think of the walls of the vagina as being a layer of skin that needs maintaining. We see our faces in the mirror every day, we see the changes in stretchiness, the new wrinkles. Well, ladies, those same changes are happening in the skin of the vagina and the vulva.
Most of us are not doing a daily internal check of the vagina so we don’t see the skin changes, but eventually we feel them! The skin cells in the vagina have receptors (tiny doors on the cell surface) especially designed to accept estrogen. When estrogen passes through that door into the cell it signals many things, including messages to keep the skin supple, plump, and strong.
“We don’t tend to think of the walls of the vagina as being a layer of skin that needs maintaining.”
As estrogen levels decline with menopause there is no longer enough estrogen available to send the signal to the skin cells to keep them supple, plump, and strong. As a result, the skin loses lubrication, gets thinner, and can easily tear. A doctor doing your annual pap smear will see changes in the strength and health of your vaginal skin.
Penetrative Sex:
Penetrative sex (penis, toy, finger) can end up grazing or even tearing the skin. Sometimes women will see signs of bleeding after sex – this is a sure sign that your skin is thin and starved of estrogen.
Enter inflammation! Think back to being a kid – you rode your bike, you fell off, you grazed your skin, it hurt, you had to clean it to stop bacteria getting in. Your young immune system came to the rescue working hard to respond to the tears in the skin. The graze would be red all around as the natural inflammatory response took over.
Gradually the skin surface rebuilt itself, although it was probably pretty itchy for a while and your mother was forever saying “don’t pick”. This is the body’s natural and essential inflammatory response to repair breaks in the skin.
Sex Is Good – Painful Sex In Menopause Is Not:
Well now, when the vaginal skin is damaged, your immune system does the exact same thing – “Eek, tear in the skin, not good, send all the immune chemicals to repair the skin.” Except that because the skin is so thin, it is harder to repair it. Healing can take longer and longer and it’s itchy and painful and the very last thing you are thinking about is sex.
It will hurt to have sex and hurt for days afterwards. And no one can feel sexy in that situation! It’s not just about missing sex…it’s about the body being in a state of constant irritation and inflammation. Inflammation is at the root of so many other health conditions: heart disease, dementia, cognitive dysfunction.
Ensuring this part of your body is free from inflammation contributes to reducing your overall inflammation load. Oh – and sex is good for your immune system so let’s get you back to having plenty of that!
There is Good News – Go Tell THIS This From The Mountain Tops:
If lack of estrogen is the major cause of vaginal dryness – we can put estrogen back into the system through specially designed hormone creams. There are three major forms of estrogen: estrone, estradiol and estriol.
Estriol is the “weakest” of the estrogens and, in small doses, can be applied daily to the vulva/vagina to rebuild the reservoir of estrogen in the tissues of the vagina. Bioidentical (same structure as the body) estriol cream is a very safe, easy, and affordable way to maintain the supply of estrogen in the vagina.
“There are three major forms of estrogen: estrone, estradiol and estriol.”
Even the Menopause Society recommends estriol for vaginal dryness even with or after breast cancer. By using estriol on a frequent and regular basis, you provide enough estrogen to go through the cell doors and send the messages to help the skin repair and to stay healthy. FYI, if you stop – the dryness will return.
Can I Get Estriol From My Doctor?
A very small percentage of doctors understand that estriol is a safe and effective way to help their patients with vaginal dryness. A study released in 2002 gave the wrong message that estrogen causes cancer, and doctors and their patients ran from hormone replacement faster than lemmings over a cliff.
As a result, millions of women did not receive the care and hormone replacement they needed and suffered because of it. While the errors in that study analysis have been revealed many times, most doctors have not yet learned this.
Doctors don’t know what they don’t know.
If you think your knowledge of menopause was limited, it turns out that less than 30% of doctors receive any training in menopause and most of them receive less than one month training. For the last 22 years doctors have been taught not to put women on hormones!
The Times They Are A-Changin’:
Here is the dream scenario – a woman goes to her doctor and is proactively asked about vaginal dryness, and the doctor offers an affordable, safe solution that she can afford to use for the rest of her life. While we wait for this particular dream to become reality here are some things you can do:
- Estriol is available over the counter so find a reputable company with lots of education resources that makes an estriol cream for vaginal health. Buy some, use it with confidence.
- Join a menopause group online so you can learn more and share ideas.
- Use a high-quality lubricant for sexy times.
- Share this article with your intimate partner about what is happening to your body so they understand and can work to adjust your sex play to help you learn to relax into sex again.
- Share this article with all your women friends; be the brave one – open the door on conversations that can be uncomfortable but are necessary to honor women’s health and their awesomeness.
- Watch the PBS Special on Menopause called The M Factor.
- Demand more from your practitioner, don’t take “it’s just part of getting old” for an answer.
Yes! It is worth having a healthy vagina, for both your intimate relationships and/or for your overall health. Many women feel the loss of sexy sassiness with vaginal changes – if that’s you – now you know there is a solution.
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About the Author:
Kate Wells is a hormone expert and true biochem nerd who has been educating practitioners about hormones for many years. Starting out as a High School science teacher, and then pivoting to the business world, Kate new she wanted to combine her passions for science and business and found the perfect match in leadership roles at labs specializing in hormone testing and hormone formulation.
She currently runs her own bioidentical hormone product companies where she writes educational articles and continues to educate practitioners on the role of hormones in optimal longevity. Beyond nerding-out on the latest research, Kate is an avid hiker, regularly putting in 20-mile hikes in the beautiful wilds of Colorado, loves to build stuff, swing dance, and work with fabric to make colorful quilts. Kate is the author of A Forecast for Health and is the CEO and co-founder of Parlor Games LLC. Kate holds a BS, MBA, and has completed a Fellowship in Herbal Medicine.
