Although commonly known as vaginal atrophy, the medical term is genitourinary syndrome of menopause (GSM) because it includes changes to both the genitals and the urethra and bladder. The numbers dance: between 50 and 90% of women will suffer from it at some point.
Why is that imprecision? Well, it is because not all speak openly about this. Sometimes, they don’t even consult their doctor despite suffering symptoms as bothersome as pain during sexual activity. “Before it was thought that a few women had it. Now we see that it is something very frequent and that in a very high percentage of women it is symptomatic, that is, that it will not only happen but also appear in an annoying way”, explains Laura Cámara, mid-wife, sexologist, and expert in sexual and reproductivehealth.
It is about vaginal atrophy, a disease that has physical consequences but, without a doubt, also psychological. But there are ways to remedy its symptoms when you already have it, and also an interesting way to prevent them.
Estrogen issue
Although commonly known as vaginal atrophy, the medical term is genitourinary syndrome of menopause (GSM) because it includes changes to both the genitals and the urethra and bladder. In addition, it occurs more frequently during this period of a woman’s life.
It occurs when there is a drop in the estrogen level. This group of hormones is present in both sexes and is important for heart, bone and brain health, as well as a key factor in female reproductive health.
It is with the changes of the menopause when their number decreases, but not only at that moment. Stress can also be an important factor to take into account, because it “affects hormones and the normal functioning of the cycle”. “There may also be a drop in estrogen during lactation, when taking contraceptives and in patients who have had some type of gynecological cancer or other tumor with treatments that affect the drop in estrogen. But in menopause it will always happen… It will come to all of us, it is physiological”, explains Cámara.
A highly underestimated symptom
The sexologist explains that the most common symptoms are vaginal dryness and pain during sexual activity. In fact, the professional explains that 90% of the women with vaginal atrophy that she sees in consultation talk about pain. “The problem is that the pain during sex is very underestimated and hidden. There are many women having painful sex and unable to ask for help because, as we say, it is a very taboo subject”, she maintains.
Other symptoms may also appear such as insufficient lubrication during sexual activity, itching, irritation or post-coital bleeding and, among the symptoms that affect the urinary system, dysuria, that is, the difficult, painful and incomplete expulsion of urine, as well as urinary urgency and repeated urinary infections, according to the Spanish Society of Gynecology and Obstetrics (SEGO).
Another symptom is decreased sexual desire. And this is understood from the feelings that can appear in the woman with vaginal atrophy. “It is accompanied by frustration and anticipatory anxiety and this creates problems with the couple. When there is pain in sexual relations, the anxiety of the encounter is activated, thinking ‘this is going to hurt me’. It is hard to go from pleasure to pain”, says Cámara. The sexologist reiterates that, being a taboo subject, this pain takes a long time to be addressed: “sometimes women come to the consultation to say they have been feeling pain for years”.
A healthy life and…blood flow to the genitals
The drop in estrogen is something that, sooner or later, happens to every woman. For this reason, experts recommend some guidelines that can help alleviate the symptoms of vaginal atrophy.
SEGO first recommends lifestyle changes in the years before menopause to prevent and avoid menopause, including maintaining a proper weight, exercising regularly, and eating a healthy diet. Also, if it is done, it is important to quit smoking, since tobacco “increases estrogen metabolism”, says SEGO. That is, “if you smoke it is very possible that vafinal atrophy appears earlier and more symptomatic”, says Cámara. There is something else we can do to prevent it and it is about increasing the blood flow of our genitals.
And how do you get that?
SEGO responds: with sexual activity. “In other words, with self-stimulation, sex with a partner, the use of fantasies, the use of sex toys… Sexuality in the broadest and most diverse sense,” describes Laura Cámara.
This, in addition to increasing vaginal blood flow, provides oxygen and improves the elasticity and lubrication of the area. “It is not the same to have a relationship with someone with whom I get along well and I am able to talk about the difficulties, the pain that can appear, than to have a more complacent sexuality, dedicated to the other, without pleasure”.
What happens when it is already here?
As we have said from the beginning, few women talk about this and, therefore, when the first symptoms appear, few seek treatment. This means living with physical and psychological discomfort when there is a whole therapeutic scale that can alleviate them.
Vaginal lubricants and specific moisturizing creams for the genital area are, according to SEGO, the first line of treatment when mild and moderate symptoms appear. They are products without hormones, capable of accumulating water to later release it slowly, and are innocuous and safe for health. “We can start using them as soon as a slight dryness appears or if we are at an age where we can start to feel that way. In addition, it is something freely available, like a normal moisturizing cream for the skin”, says Laura Cámara.
The second step involves hormonal treatment and is given under medical prescription. They can be anything from estrogen creams to vaginal tablets or rings that are inserted into the vagina and release this hormone. To these more traditional methods, other methods like laser technology, the application of carbon dioxide, hyaluronic acid, and radiofrequency have recently been added to activate collagen and elasticity in the area.
But SEGO points out that both with the vulvo-vaginal laser and with radiofrequency, although there have been satisfactory results in various studies, there is still a lack of data on its long-term efficacy and safety. Therefore, he maintains, they need more evidence before recommending it. Laura Cámara is reluctant in this regard, not only because there is still not enough evidence, but also because, in her opinion, “it has a lot of marketing elements and vaginal rejuvenation squeaks (shocks) me. It seems that we always have to be young, beautiful and ‘fit’ for intercourse”.
Instead, she recommends a multidisciplinary approach that involves sexological support: “We reach menopause and we have deficiencies in this aspect, when we still have years ahead of us to enjoy sexuality. There is still a lack of sex education. It is something basic”.
