When a post menopausal woman comes in to my clinic complaining of vaginal dryness or pain with intercourse, I get excited.  No, I am not a sicko.  I am excited because I  know I can usually fix the problem and make a big difference in her quality of life.  That  is very satisfying.  Women are very grateful and I become their hero. So what is going on “down there”?  Well, I’ve got bad news and good news.

The bad news is that unless you are taking hormones, sooner or later it is going to happen.  It is called vaginal atrophy.  It means the skin and tissue in the vaginal area gets thinner and more fragile.  It is caused by the decrease in estrogen which occurs during menopause.   It can cause a feeling of dryness, itching and pain with sexual activity.  The good news is that there is help for this problem.

Even women who may not be appropriate candidates for systemic estrogen may be able to safely use local estrogen creams with good result.  There are many estrogen recepters in the vaginal area which means that a very little amount of estrogen is needed to get relief from symptoms.  Because the amount needed is small, the side effects and risks are small as well.  Often just a small pearl size amount of estrogen cream a couple times a week is all that is needed to maintain vaginal  tissue health.  Other factors which contribute to vaginal health are important to consider too. 

• It is important to check for and treat any vaginal infections like bacterial vaginosis, candida vaginitis (yeast) or even sexually transmitted diseases.  Treating these conditions may clear up symptoms.
•  Maintaining sexual activity of any kind helps  good blood flow and lubrication, keeping vaginal tissues healthy.  I call it the “ use it or lose it” factor.   Widows or divorced women who may enter a sexual relationship after many years of abstinence are often greatly dismayed with their discomfort and greatly relieved that there is effective help for their problem.
• Over- the- counter vaginal moisturizers and lubricants can offer a good starting point for help with dryness  or discomfort during intercourse.  There are many good products on the shelves of any drug store.  If after trying these, you still are not getting relief, see your physician or practitioner.  They may end up being your hero.

written by Deborah McBain, CNM MSN

This month the menopause support circles are taking on the somewhat overwhelming subject of sex and menopause in our talks titled- “Sizzle or Fizzle.”  I say overwhelming because human sexual behavior and response is so complex.  Although it seems alot of women are concerned about their lack of desire or libido there seems no lack of desire to discuss it.   So we will tackle it the best we can.  Let’s see if we can get some clues to just where the excitement, the romance ,the “sizzle”  went and maybe even some ideas in how to regain some of it. 

It is important to remember that about 22% of all women regardless of age report lack of desire.  After menopause 47% report decreased desire.  But 37%  of post-menopausal women report no change in desire and 10% actually report increased desire.  So I guess I’m just writing to about half of you.  But just in case you have a “friend”  who might need some information the rest of you can read on too.  Although this entry is written from a heterosexual perspective it is easily applicable to any sexual relationship.

Back in the 1960′s Masters and Johnson’s landmark report on human sexuality described a linear model of female sexual response.   That is that sexual behavior starts with desire then  moves to arousal, followed by orgasm and then finally resolution. If only!   At least  it was a start but this model is unhelpful when dealing with much of the real world.   Although it can happen in that straight forward linear way, just between us, you know it often doesn’t.  Particularly if you have been married for say 30 years.  About 2001 a researcher/physician, Rosemary Basson  proposed a cyclical model of  female sexual response.  Her idea is that women often do not feel desire first but make a choice to have sexual contact for any number of reasons.   Actual desire may arise only after stimulation and arousal.   Emotional and physical satisfaction  then provides  more motivation.   This is not as true for men.  As a friend of mine might say, ” Women need a reason, men just need an opportunity.”  But as Dr. Basson might say ” Women’s sexual response is very contextual.”  So just why did that yummy anticipatory desire for sex turn into a desire to do it just to shut him up for a few days.  Well, what are the contextual factors?

Length of relationship- This is a normal consequence of being human.  We crave novelty. Research has found that it takes about a year for the excitement of  a new relationship to settle into routine.   Only thing you can do about that is get creative and find ways to make it new.  I don’t advise starting over for most of you; in a year you will just be in the same boat.

Environment-  If your 25 year old son is camped on the sofa and your mother-in-law is rearranging your kitchen cabinets or the roof is leaking over your bed- it ain’t gonna happen.  Kick him out, send her home, get it fixed.  Is your home safe  and stress free?  If not, why not?

Emotional closeness- Talk.  Plan dates.  Have fun together.  Where’s the romance?  Work on it.

Relationship issues-  Low self image , anger or trust issues may require professional counseling.  This has been found to be a  major cause of sexual dysfunction.  Depression also proves to be a huge issue with low libido.

Inadequate or inappropriate stimulus- Communicate clearly with your partner. Get a book. Get counseling.

Medical/Physical issues-  It really goes without saying that hormonal and physical changes do contribute to decreases in desire.  Certain medications certainly can cause difficulties as do some illnesses.  Limited mobility or partner’s ability to function as well as hot flashes, vaginal dryness and insomnia can really do a number on the libido.  Talk to your care provider.  More often than you might imagine,  medications can be changed or others prescribed to help with problems.     Menopausal symptoms can often be relieved with hormone therapy or even life-style changes. You don’t know until you ask.  

As far as I can figure, it all boils down to this-  How important is sex in maintaining a positive relationship between you and your partner?  If it is important then as you get older, sex is just going to need a little more attention and a little more effort.  Now how is that any different than anything else these days?

written by Deborah McBain, CNM MSN

I know that summer has not officially begun, but you know how it goes.  Before you know it the leaves will be turning!  Again.  Don’t groan, you know it’s true.  But there is more to look forward to than cold weather.  Starting in September, Henry Ford Health System will be beginning a new series of Menopause Support Circles.  We will continue to offer them monthly at 4 different southeastern Michigan sites.  We have selected topics which our past participants have suggested so we know they will be of interest to you.  Take a gander below at what we will be covering at our fall meetings.  Enter the the dates in your Blackberry or scribble them into that little Hallmark calendar with the curled corners kept in the bottom of your purse but mark it somewhere so you don’t forget.   Attend any or all and be prepared to be informed, entertained, validated and fed.   Please RSVP at 1-800-HENRY- FORD.  For more information on meeting locations and specific dates, click meeting details on the left or go to Menopause Support Circles page.

September 2009

 Illuminating Elimination New approaches to pelvic problems. Learn about techniques and methods for managing and preventing bladder, bowel and prolapse problems. This is a talk that shouldn’t be missed.

October 2009

Taking Care of the Girls” : In honor of breast cancer awareness month, you will learn how to reduce your risk for breast cancer. Discussion will include the newest methods of detection in breast cancer and treatment options.

November 2009

Sizzle or Fizzle: Menopause and Sex: Your body is changing and so is your sex drive. Come join the discussion and have your questions answered about what is normal and what might be cause for concern.

written by Deborah McBain, CNM MSN

What symptoms are normal and what is not normal during menopause?
During the perimenopause, irregular menstrual periods which may be longer or shorter, heavier or lighter, skipped periods or periods starting every three weeks are all within the norm. Periods coming less than every 21 days or lasting over 7 days should be reported to a health care practitioner.   Spotting between periods or after intercourse should also be evaluated.  Once menopause is reached, any vaginal bleeding should be investigated by a health care practitioner.  Often these irregularities are a result of  hormonal changes but occasionally they can herald more serious problems which should be ruled out.

Some women sail through perimenopause and menopause with nary a problem. Some have all the symptoms in the book.  Hot flashes, mood swings, trouble sleeping, skin changes, dizziness, heart palpitations have all been attributed to the hormonal changes of perimenopause and menopause.  Many women find these things manageable and do not need treatment.  It is best to discuss symptoms with a health care provider.  He or she can determine if any symptoms are suspicious for diseases like thyroid disease which may minic menopausal symptoms.

Symptoms of depression, weight gain, decreased sex drive, sleep disorders and memory loss are commonly atributed to menopause.  Studies do not show a strong relationship between these symptoms and hormonal levels.  These symptoms are often more related to stress or aging.  Unplanned weight gain or loss for which there is no explanation should be looked into.  Any symptom effecting one’s ability to function at home or at work should be investigated.

Coming- Part 3- ”Ok so now what do I do?”- Remedies and Solutions.

written by Deborah McBain, CNM MSN