Can’t walk, can’t sit, can’t have sex – welcome to the debilitating world of vaginal atrophy. Author Jane Lewis knows it well and explains what it is and how you can get through it.
Our Vaginas go through a lot – childbirth, periods, infections… but with menopause you’d finally start to think they were going to get a break – but hell no!
In the lead up to menopause (when our periods finish), and beyond it, our oestrogen levels decline and our vaginas start to ‘atrophy’.
What that means is the vagina shortens and the walls become thinner and less plump. They may become dry, sex may be painful, there can be an increase in urinary tract infections (UTIs) or thrush-like symptoms. Externally, the vulva (the external genitalia) can be itchy or feel like it’s burning. And you can have issues with your water-works like stress incontinence (peeing when you sneeze, laugh or exercise), or urgency – when you feel like you ‘have to go’ and worry that you won’t make it to the loo.
In some cases these can be debilitating – as was the case with Jane Lewis – whose vagina takes centre stage in her book – “Me and My Menopausal Vagina”
This is her story. (You can see the video here.)
“Im 53 now. When I was in my early 40’s life was normal. I was a horse rider, riding around 3 hours a day. I was in tight jodhpurs, tight jeans, all the things you take as normal because there is no problem. But roughly, at around 40, sex may have become slightly painful. It was so insignificant that I didn’t even mention it to my husband. Then as the years went on, mid 40’s, I suddenly couldn’t wear sanitary pads any more, I couldn’t wear the jodhpurs, I was getting burning and itching in the vulva area, needing to go to the toilet several times a night, and I’d never done so before. I had recurrent UTI’s.
“And I had a look one day and I was truly shocked at the state of my episiotomy scars – I have 3 – and they were literally on the verge of splitting because the skin had become so thin.”
The pain Jane experienced meant she had to give up work as she could barely sit or walk. And she couldn’t sleep.
At night she went to bed with a frozen can of baked beans wrapped in a pillowcase wedged between her legs to try and dull the never-ending burning sensation. (Why baked beans? They stay frozen for a long time.)
“It was a long time before I could eat baked beans again,” she says, “but that’s what I had to do to get through.”
An Unwelcome Surprise
This was not what she was expecting as she moved into mid-life.
“We’re not told about any of this,” she says. “We might be told about ‘vaginal dryness’ and that makes it sound like a bit of dry mouth – ‘have a drink and it’s gone’ – but it’s so different and it can chaff and rub and when its in such an intimate area – where you sit, wear pants, rub when walking, have sex – it affects your mental health hugely and I was in an extremely bad place.”
At one point she contemplated suicide, wondering if anyone would notice if she quietly “slipped away.”
Jane’s pain made her feel isolated.
Other forms of pain like back pain are easy to discuss openly, she says, – but starting a conversation about your burning vulva isn’t so easy.
But one day she decided enough was enough and started to speak out.
With her daughter, she wrote “Me and My Menopausal Vagina” on it and has set up support groups to help women with similar stories.
One of the most important places to start in taking care of your vulval/vaginal health, she says, is getting to know your own anatomy.
Many women, she says, confuse the vagina (which is internal) with the external genitalia (or vulva) and some women even think they pee from their vagina rather than their urethra.
So, we need to know our bodies, because we can not guide doctors to the right place if we’re giving them the wrong directions.
She recommends getting a mirror and taking a look – and doing it regularly, once a month as you would check your breasts – so you can see if there are any changes that should be seen by a doctor.
Jane went to see a counsellor who helped her out of the mental mire, and also started on a long merry-go-round of medical investigations, seeing GPs, women’s health centres, gynaecologists and dermatologists to try and find out what was causing her problems.
Because she was still having periods, dryness and vaginal atrophy wasn’t on the radar, and it took quite a while for practitioners to recognise that her symptoms were related to declining hormone levels – particularly oestrogen.
At one stage was misdiagnosed with lichen sclerosus and given steroid creams that thinned the skin and made her condition worse.
Eventually she was prescribed HRT and localised oestrogen pessaries and creams which she uses both internally and externally, and she is now in a much better place. In the process, she’s become an expert in vulval and vaginal issues.
For many women, she says, these types of symptoms can be confusing. Often they think they’re having repeated bouts of thrush and self treat. And while thrush treatments may give temporary relief, they are not addressing the underlying cause – a lack of oestrogen.
The UTIs are an issue too she says. Many women have repeated infections and this can end up being a chronic (and massively debilitating) condition if it is not treated properly. Often 3 days worth of antibiotics are prescribed but Jane says there is a growing number of doctors who are saying the course is not long enough and is encouraging antibiotic resistance.
Why ‘Use It Or Lose It’ Doesn’t Work
The other vaginal issue associated with the atrophy is vaginal tightness – which means having sex or a smear test is all but impossible.
One treatment for this is a set of different sized dilators that you use with a water-based lubricant. Jane says you start with the smallest size and over time you work up through the sizes.
Even if you aren’t having penetrative sex, it’s important to keep the vagina open so you can have smear tests, she adds. It can take 6-8 weeks – and it’s important not rush it.
Jane uses a set that is made from medical grade silicone which is available from Jo Divine.
She says asking for a small speculum is a good idea and if you know you’re likely to have an issue, preparing 6-8 weeks in advance with the dilators and using a local oestrogen creams can help.
Jane says this is especially helpful for women who’ve had radiotherapy, vulval cancer and lichen sclerosus.
Why Looking After Your Vagina Is A Life-Long Journey
Often women are prescribed localised oestrogen for a short period – say three months, but once you stop the problems will return, Jane warns.
“It’s like a plant – you don’t water it once and then leave it – you have to keep on watering it,” she says. “Vaginal care is for life.”
From about the age of 40 onwards she recommends moisturising the external genitalia with an appropriate cream.
In the UK there are around 8 creams and pessaries that are available to use locally, internally and/or externally such as vagifem (pessary), ovestin, estriol, imvaggis, intrarose, estring (a ring that is placed inside the vagina which releases oestrogen over time).
The amount of oestrogen in the local pessaries is the equivalent to one oestrogen tablet a year, so it considered safe for women even if they’ve had an oestrogen receptive cancer, she says.
How Do You Talk To Your Partner About This?
This isn’t always easy. It can be emotionally confronting for women – in many ways its a journey on its own to come to terms with the changes you’re going through – but, as Jane says, communication is key. Your partner “is not a mind reader” and if you’re off sex they might be thinking that you’re no longer interested in them.
Most partners would be mortified if they thought they were inflicting pain on you, she says. And she also reminds us that there are many ways of having sex that don’t involve penetration. But if you are having penetrative sex, a good unscented, water-based lubricant can help. “Bathe in it,” she says.
- know your anatomy and exam yourself regularly
- don’t self treat
- seek help from your GP, menopause clinic or GUM clinic (genitourinary medical clinic)
- see a women’s health physiotherapist for pelvic floor issues
- don’t suffer in silence – talk to your partner, join a support group and talk to your doctor.