As an OB/GYN, I hear all kinds of issues from my patients—from painful intercourse to vaginal discomfort—especially when there are questions about the way the female body ages and what to expect. Having practiced as a gynecologist for over 40 years, I've heard and seen it all.
And the more open our society has become, the more comfortable my patients have become asking me personal and important questions about the changes in their bodies over time. On the other hand, I still find myself surprised by how many women feel uncomfortable talking about these topics.
Many women are ill at ease discussing the physical changes they'll undergo, specifically after menopause, for reasons we can all relate to: They're embarrassed or feel that their health care provider, or partner, or close friends may not understand.
But let me remind you how normal and important it is to discuss anything you might be struggling with. You're not alone, and there's no need to suffer in silence.
I want to shed light on some of the most common concerns and questions my postmenopausal patients have asked me and will provide recommendations for approaching your health care provider to start this seemingly tough but important conversation.
1. Is any stage of menopause related to loss of libido?
Often my patients will note that they have been experiencing a low sex drive. As I continue the conversation I often learn they are actually experiencing painful intercourse due to vaginal dryness.
Women may feel embarrassed and avoid talking with their partners about vaginal dryness, and rather than bring up the uncomfortable topic, avoid intimacy altogether. While each patient will require a unique treatment based on their medical history and symptoms, once a patient is in treatment, these uncomfortable urinary or vaginal symptoms may be relieved.
2. Is vaginal dryness a normal symptom of postmenopause?
Yes, up to 40 percent of postmenopausal women experience vaginal atrophy, and painful intercourse is a common symptom. While most women are familiar with and talk about hot flashes and night sweats, fewer women are aware of these vaginal symptoms or may not connect them to a treatable, medical condition called postmenopausal vaginal atrophy. Postmenopausal vaginal atrophy is caused by lack of estrogen, which can lead to atrophy, or thinning of tissue, of the vagina and lower urinary tract.
Symptoms may include vaginal burning, itching, and dryness. Other symptoms include urinary symptoms such as urinary urgency and painful urination. There are a number of FDA-approved treatments currently available including a ring, vaginal tablet, pill, and topical cream or gel. It's important to work with your health care provider to find a treatment option that's right for you.
3. Why doesn't my health care provider bring up menopausal symptoms during my visit?
There are a number of reasons health care providers may not bring up menopausal symptoms during your annual visit, and I can't stress enough—you are not alone. There's generally a checklist of items health care providers are interested in learning about during any average annual visit—all of which they need to address in a short amount of time—allowing important topics such as sex during and postmenopause to slip to the back burner as the checkup and medical history usually take priority. On top of that, patients may not be aware that symptoms such as painful intercourse and vaginal dryness are part of a treatable medical condition.
A recent survey of women who experienced vaginal dryness showed that only 7 percent of women had health care providers who actively inquired about postmenopausal vaginal atrophy symptoms. That is just not enough!
4. How can I initiate a conversation about postmenopausal symptoms and my sex life?
The best way to ensure you are getting what you need from your health care provider is to step up to the plate and start the conversation. Come prepared to your appointment with questions or topics that have caused a concern for you. By having your questions written down, you may feel more at ease, and if you are still nervous about discussing the symptoms or your sex life with your health care provider, bring a partner or close friend who may help you feel more comfortable during this conversation.
As the conversation progresses, if your health care provider seems a bit distracted or if there is not enough time to discuss everything you'd like, feel empowered to make a separate appointment to specifically discuss the menopausal changes you may be going through. You can find additional resources to help guide your conversation by visiting talkchange.com.
Of course, it's important to note that not every patient–health care provider relationship is perfect. If you feel that your health care provider may not be the right fit for you, I encourage you to find a menopause specialist at the North American Menopause Society (NAMS)'s official website, where you can search for a NAMS-Certified Menopause Practitioner (NCMP) in your area. When you find a health care provider that is right for you, phrases such as "painful intercourse" and "vaginal discomfort" should be open, comfortable topics. And that's something to celebrate!