“You’ve gotta dance like there’s nobody watching, Love like you’ll never be hurt, Sing like there’s nobody listening, And live like it’s heaven on earth.”
― William W. Purkey
What is menopause, and what can I expect? My vagina and vulva hurt and burn. What can I do?
In menopause, a woman does not have a menstrual cycle for 1 year. A woman may go through natural menopause, where her cycles stop spontaneously, usually around age of 51 years. Natural menopause is as a result of a variety of factors such as genetics, smoking, and age of first menstrual cycle.
Chemical menopause occurs when the woman has received chemicals (like chemotherapy) or medications that temporarily or permanently stop her menstrual cycles.
Some prescription medications, such as a gonadotropin releasing hormone agonist, shut down her pituitary gland and ovaries, decreasing the signaling hormones, like follicle stimulating hormone and luteinizing hormone, which stimulate the ovaries. This may thereby create a menopausal state. Surgical menopause is when both ovaries are removed; thus, hormones are no longer produced.
In the menopausal transition, the vulva and the vagina can change in overall appearance and texture. The menopausal period is often accompanied by vaginal dryness and other changes in the perineal area. The vulva, vagina, and clitoris can become very dry, irritated, and even sore as a result of falling estrogen levels. The vagina may become frail, pale, and less elastic; urinary tract infections may become more common. Other women may also complain of increased time to achieve orgasm or decreased orgasmic intensity. To prevent or minimize pain, itching, redness, or burning, skin care of the vulva is important. Changes can be minimized, and minor alterations in perineal and vulvar hygiene can help prevent further damage to the sensitive area of the pelvis.
Breathable clothing (e.g., cotton) should minimize vaginal or vulvar irritation. At home, some women may prefer not to wear underwear at all. Wear thigh- or knee-high hose instead of pantyhose. If you must wear pantyhose, try cutting out the center of the crotch because tight-fitting underwear can cause increased discomfort. Choose loose-fitting pants or skirts, and remember to remove wet bathing suits and exercise clothing promptly.
Some suggestions to help maintain healthy vulvar and vaginal health are listed here:
Use only mild detergents to wash
• Undergarments and underwear. Double rinse underwear and any other clothing that comes into contact with the vulva. Do not use a fabric softener. Minimize the amount of chemicals that are left over in any clothing.
• Use soft, white, unscented toilet paper. Pat the vulvar area dry with light pressure only. Do not rub; this can create a scratching irritation.
• Some women use lukewarm or cool baths to relieve irritation. Fill your bath with only 1 or 2 inches of tepid water. Adding four to five tablespoons of baking soda, colloidal oatmeal (such as Aveeno), or even chamomile tea bags to the water may help reduce itching and irritation. Abstain from a perfumed bubble
• Bath, creams, sprays or soaps, and feminine hygiene products. Avoid lotions in the pelvic area. Do not spray perfume in the genital area.
• Use a soft cloth or your fingers to cleanse the vulva. Wash the vulva with cool to lukewarm water only. If you feel you must use soap, use soap for sensitive skin that is mild and unscented. Pat the area dry gently with a soft towel. Some use a cool hair dryer at a distance from the genital area to help keep the area dry.
• Rinse the vulva area completely after urination (possibly with a small spray bottle filled with cool tap water). Urinate often before your bladder is completely full.
• If you are menstruating, be sure to use 100% cotton menstrual pads and tampons. Caracara and Organic Essentials may be helpful, but others may also be on the market.
Be careful when shaving or trimming pubic hair. Sometimes ingrown hairs or the act of shaving, waxing, or cutting hair can increase the irritation in the genitals.
Be especially careful at menopause when the vaginal and vulvar regions are extra sensitive.
This list contains a few tips that you can follow to help you maintain vaginal health:
• Avoid strenuous exercises such as bicycle riding and horseback riding that can put direct pressure on the vulvar tissues. Be careful to change your clothes after the activity, and try to limit the time you are engaged in these activities.
• Limit any intense exercise that creates a lot of friction in the vulvar area, especially those that cause the labia majora and labia minora to rub against one another. Attempt to slow the intensity of exercises such as walking.
Use a frozen gel pack (or • maybe even frozen peas in a plastic bag wrapped in a towel) wrapped in a towel to relieve symptoms after exercise. Wash and dry the genitals completely after vigorous exercise and perspiration.
• Enroll in yoga to learn stretching and relaxation exercises.
• Limit the time you spend swimming in highly chlorinated pools, and avoid soaking in hot tubs or very hot baths. After swimming, be sure to shower after a swim or soak to limit exposure to harsh chemicals.
• By drinking plenty of fluids, you will help keep your urine diluted and less likely to sting or irritate the vulvar area.
• Ask your healthcare provider whether you should use a foam rubber donut if you are sitting for long periods.
• If you must sit all day, try to alternate periods of standing and exercise throughout the day.
Dry Vagina
Vaginal tissues naturally become dry as a woman’s estrogen levels decrease. This can lead to itchiness, burning, irritation, and often painful intercourse. Luckily, many methods can treat the symptoms of vaginal dryness or vaginal atrophy. As women age, the vagina becomes dry and less elastic. Cancer treatments can hasten these changes. Some women can take estrogen either by a pill, patch, cream, ring, or gel to prevent these changes; however, these may not be safe options for many women who have had breast cancer, especially those with hormonally sensitive cancers. Review the suggestions with your healthcare provider before considering estrogen therapy.
Many products on the market may help maintain your vaginal moisture. A simple vitamin E capsule can be punctured with a pin and then inserted into your vagina.
(If you insert the entire capsule into the vagina, the gel cap will come out in time.) You can also empty the capsule’s content onto your finger and insert vaginally. Replens, Me Again, and Feminease can be purchased over the counter and come with easily filled applicators. You can use any of these moisturizers two to three times a week. These and other moisturizers are readily available without a prescription in most drug stores or via the Internet.
Remember that you may need to wear a panty liner. If you also use a vaginal estrogen product, alternate the days you use a moisturizer. For example, use the moisturizer on Monday, Wednesday, and Friday and the local estrogen product on Tuesday, Thursday, and Saturday. Some of the moisturizers contain bactericides, spermicidal components, colors, flavors, and other additives that irritate the sensitive vaginal lining. Avoid additives such as parabens and glycerin, which promote infections and in some cases act as drying agents. Vaginal moisturizers should be used on a regular basis, independently of sexual intercourse, as they hydrate the vaginal lining and restore vaginal elasticity.
Vaginal lubricants (Slippery Stuff, Hydra, YES Eros Woman, Astroglide, and KY Jelly) are typically used to make sexual intercourse more pleasurable. Organically made choices are Good Clean Love and Almost Naked. These are made with natural ingredients and are quite comfortable and effective. These are organic, free of parabens and glycerin products, and extra gentle for the delicate vaginal and vulvar tissues. For more information on their products contact www.goodcleanlove.com.
A good lubricant is water based and compatible with diaphragms or condoms. Once applied, they stay moist without becoming sticky, goopy, or gummy. They are typically easy to apply and easy to clean. Because each has a different consistency, experiment with different types to determine this feels best during intercourse.
Many can be purchased at your local grocery store or over the Internet. Menopausal women with severe vaginal atrophy and thinning of the vaginal lining should avoid irritating additives such as colors, flavors, spermicidal additives, bactericides, or warming ingredients. Mineral oil, petroleum jelly, and edible oils or other liquid food products can sometimes be effectively used on the vulva but should be generally avoided within the vaginal canal. Oils can upset the delicate balance between the good and bad bacteria and thus possibly result in vaginal infections. Also, these products have also been known to reduce the safety of condoms.
Local vaginal hormones come in a variety of different application methods. Creams, gels, rings, and tablets are the most common. Vaginal and vulvar creams like Premarin Vaginal Cream (Pfizer Pharmaceuticals) or Estrace Cream (Warner Chicott) are typically applied to both the interior of the vagina and exterior of the vulvar vault.
Premarin Vaginal Cream recently became the first and only medication that is Food and Drug Administration (FDA) approved for the treatment of moderate to severe painful intercourse. Premarin Cream contains conjugated equine estrogens and is readily available; new lowered doses demonstrate excellent safety on the endometrial lining. Estrace Cream contains estradiol, which is also helpful for treatment of vulvovaginal atrophy and sexual pain. Many women find these especially soothing, and those with extreme vulvar atrophy and shrinkage may benefit from these. Creams are helpful when consideringtreatment for vulvar dryness and clitoral shrinkage and atrophic changes. Both Dr. Kellogg Spadt and Dr. Krychman have used this medication when women with breast cancer complain of orgasmic changes, as ultra small amounts of cream can be rubbed into the clitoral area with substantial orgasmic changes. Of course, estrogen use in women with breast cancer or a history of a hormonally sensitive tumor is controversial and should be discussed with their healthcare team.
The ring, Estring (Pfizer Pharmaceuticals), which is used within the vaginal vault for 3 months and then is replaced, does not work as a medical device used for pelvic floor defects and does not help with urinary incontinence. Some women use the ring because they do not have to remember to use a product on a daily basis and it is minimally absorbed; however, others find it uncomfortable, and some partners feel the ring during intercourse.
Minimally absorbed vaginal tablets, Vagifem (NovoNordisk Pharmaceuticals), are another type of vaginal hormone replacement. Vagifem tablets are contained in a plastic disposable applicator. Insert a tablet it into your vagina every night for 14 days; then insert it twice a week at bedtime. This medication contains 17 Beta-estradiol and comes in convenient prefilled, biodegradable applicators.
A small and controversial study in the United Kingdom reported increased estradiol levels in the women using Vagifem. Many women prefer Vagifem because there is no mess or leakage, and it is easy to use. The long-term safety for minimally absorbed vaginal estrogen products needs to be further studied, especially in larger populations. A new effective ultralow dose of Vagifem is also available.
The safety of minimally absorbed local estrogen products in the breast cancer population appears (but has not beenproven) to be good. The need for a progesterone agent if you are only on a minimally absorbed vaginal product is controversial. Some healthcare providers advocate a progesterone agent in women with an intact uterus. Of course, any abnormal vaginal bleeding should always be reported, and an immediate comprehensive workup (may include a transvaginal ultrasound and or endometrial biopsy) should be performed. Ask your doctor, nurse practitioner, or other sexual medicine specialists, and make an individualized personalized treatment plan for your vaginal and vulvar dryness.
Terms:
Meditation – A complementary medicine practice of concentrated attention toward a single point of reference.
Yoga – The spiritual practice aiming to unite the consciousness with universal consciousness to achieve harmony.
Perineal area – The genital area between the vulva and anus.
Labia majora – Outer vaginal lips.
Labia minora – Inner vaginal lips.
Vaginal atrophy – When the vaginal tissues decrease in size and become pale or dry without lubrication, this is a result of decreased hormonal levels in the woman’s body. The tissues can become sensitive, and often vaginal atrophy is associated with painful intercourse. This is commonly seen in chemical or natural menopause.
Estradiol – The predominant sex hormone present in females.
Progesterone – A hormone that is secreted by the ovary and placenta (during pregnancy). It is necessary for pregnancy and has been implicated in female sexual function.
