Wednesday Bubble me this: end the ‘silent suffering’

Posted by on Oct 20, 2010 in estrogen, sexual health, vaginal atrophy | 12 comments

Bubble me this. When you think “chronic health condition,” what do you think of? I think heart disease, diabetes, multiple sclerosis or cancer. I don’t automatically think vaginal atrophy. And yet, it’s what’s for World Menopause Day.

The International Menopause Society (IMS) joined forces this year with Novo Nordisk FemCare Ag (marketers of Activella®) to ‘end silent suffering’ and promote recommendations for the management of vaginal atrophy during the menopause. A key problem, they say, is that results of a phone survey show that women are not discussing vaginal atrophy with their practitioners, who in turn, are not openly asking questions about vaginal health.

Vaginal atrophy refers to the thinning of the vaginal and vulvovaginal tissues due to a decline in estrogen, and can lead to pain, burning and soreness during sexual intercourse. Recent estimates suggest that vaginal atrophy affects about 50% of menopausal women. Symptoms can be mild or  severe, and unquestionably, the more a woman feels pain, the more she is likely to be distressed during intercourse or lose interest in sex altogether. What’s more, according to survey results, the majority of postmenopausal women incorrectly attribute vaginal atrophy symptoms to urinary tract and yeast infections. More importantly, the report notes that roughly 63% of surveyed women did not realize that vaginal atrophy was “a chronic condition requiring ongoing treatment of the underlying cause.”

A chronic condition requiring treatment?

Granted, a chronic condition is defined as a health problem lasting three years or longer. And depending on how long a woman’s menopause lasts, well, vaginal atrophy theoretically fits into that category. But aren’t we being a bit alarmist about the ‘silent suffering’ of women with this chronic condition?

Mind you, I am not mocking or doubting the horrible impact that vaginal atrophy can have on a woman’s life. In fact, aging and its accompanying aches and pains aren’t fun. Neither are hot flashes, night sweats, mood swings or vaginal pain. And I am heartened to see that the IMS has published recommendations for recognizing and managing vaginal atrophy. They include:

  • Greater collaboration and open discussion with postmenopausal women about their vaginal health
  • Early detection of vaginal atrophy
  • The value of estrogen therapy in treatment, including HRT or preferably, vaginal tablets, cream or rings

According to these recommendations, lubricants and moisturizers are not universally recommended for use by themselves because they can be irritating and offer only temporary relief of symptoms. However, as Dr. Diana Hoppe points out in her book, Healthy Sex Drive, Healthy You, “to get the vagina adequately lubricated, I initially recommend lubricants [e.g. Replense or Astroglide]. If lubricants do not work to make sex more comfortable, I prescribe vaginal estrogen therapy, which comes in different forms.” The point that she makes is that it is important to consider lubrication issues (and the resulting atrophy) as something that can be addressed in a step-wise fashion. Nor does she discuss atrophy and dryness as if they are symptoms of a chronic condition. In fact, like Dr. Christine Northrup, Dr. Hoppe emphasizes that women’s health issues, in particular desire, are multifaceted and emotionally and physically related. Toward that end, is it possible that by focusing solely on the physiological aspects of atrophy, practitioners might miss other important factors?

The IMS recommendations also fail to mention selective estrogen receptor modulators (SERMS), which mimic the action of estrogen in the body but theoretically, without associated risks and side effects. Most importantly, while ‘localized’ estrogen (i.e. topically or vaginally applied) may have a better safely profile than systemic estrogens (which directly enter the bloodstream after being ingested or injected) it is not without risks; according to its package insert, Activella is associated with pain, headache, nausea, vomiting, irregular bleeding and thickening of the vaginal wall and and also has a boxed warning about heart disease, stroke and blood clotting.

There’s an inherent lesson here, which is why this piece is featured on Wednesday: by all means, seek help for vaginal atrophy but ask questions about the therapy your doctor or practitioner recommends. If your symptoms are severe, well, you might want to skip the lubricants and go for the big guns. And be sure to consider factors other than estrogen depletion that might be contributing to a declining libido. If there’s one thing that appears to permeate all women’s health issues, it’s this: nothing is as cut and dry as it seems.

I hardly believe that we’re on the verge of an atrophy epidemic or that we need to dramatize the “silent suffering” of countless women across the globe.

Bursting this one? Yeah, you bet.


  1. 10-20-2010

    I had never heard of vaginal atrophy until a girlfriend of mine told me her doctor “diagnosed” her with it. We laughed thinking it was from of a lack of “vaginal usage,” (no sex), which wasn’t the case at all. When I researched it and learned for myself, I was surprised and a bit scared.

    For so long, women’s reproductive health was part of our lot as women. We had to suffer with cramps; we had to suffer through childbirth and we had to suffer with menopause…it was our lot in life. I’m relieved and emboldened to read your post and learn that people are paying attention and something is being done.

    • 10-20-2010

      Thank you Shannon, for your comments. I agree; awareness is key. But medicalizing and fear mongering serve no one.

  2. 10-20-2010

    Libido and vaginal tissues are not necessarily the only elements affected. The urethra is also affected, making leakage more of a problem. The skin of the vulva (including the labia) can atrophy and develop lesions that sometimes bleed; during urination they cause pain, burning, and soreness.

    • 10-20-2010

      Phillapa – the question is, how many women actually suffer mild vaginal atrophy versus the severe atrophic vaginitis that you are referring to? To lump them under one category, thereby providing a rationale for unlimited long-term hormone treatment is irresponsible.

  3. 10-20-2010

    Stupid question. What test is required to diagnose vaginal atrophy? Having suffered with the pain and inflammation for a years now as well as systoscopy and colonscopy to rule out gastro issues, I’ve only been told by my urologist and gynecologist they don’t know why. I’m wondering if they haven’t considered this as a possible diagnosis.

    • 10-20-2010

      Steph – there isn’t a test per se, but there are specific signs. Best to speak to your urologist and gynecologist about this being a possible diagnosis.

  4. 10-26-2010

    Men have a vested interest in seeing this problem solved, because they won’t get much if it hurts. Maybe somebody should organize a footrace devoted to vaginal atrophy as the disease of the day.

    • 10-26-2010

      Let me know how that goes for your Charles.

  5. 10-26-2010

    I am a lay person who has successfully been on bioidentical hormone replacement therapy for over 4 years, including compounded estriol intravaginally for atrophy. I counsel women on how to find a qualified practitioner and/or compounding pharmacy in their area if they wish to explore bioidentical hormones. Of the approximately 1200 women I have corresponded/spoken with, at least half (conservative estimate) have told me that intercourse is painful, difficult, or impossible. Now,I know that many other factors play into a satisfying sex life than just physiological factors, but it is a problem and many of these women have told me that either their current doctors won’t talk about this, or they dismiss them with just using a lubricant (often times without even examining them).

    • 10-26-2010

      Thank you for you comment. I don’t dispute the existence of vaginal atrophy nor the trauma it can cause. But what I do object to is the disease/fear mongering of this particular campaign and the hormones as the end all to be all for managing VA. Some women have milder forms and can truly benefit from lubricants and moisturizers. To outright dismiss them is bad medicine.

  6. 6-13-2011

    I believe more research should be done to cure this horrible disease that relates commonly to menopause. I would like to know why 50percent of women suffer from this and not the other 50%. What have the other non atrophy vagina women done in their lives to avoid this? Is it their genes, diet, exercise, they never smoked, had fish oil tablets, soy and lentil products. Then again my cousin smoked and she is still sexually active and does not suffer from vagina dryness. However she has consumed a lot of fish oil tablets over the years. Do women who have this illness suffer from thyroid problems or are they slim build? With my personal research I have discovered that Middle Eastern women don’t have the problem as much as Westerners due to lentils in their but they have a higher percentage of diabetes because lentils are high in carbohydrates. That could be the reason why a large number of Middle Eastern people are obese. Soy is great for hot flushes as I had these products due to my menopause and I never had a hot flush. Japanese women have Tofu in diet which is a natural estrogens. Do they have atrophy vaginitis as much as other cultures? What saddens me is that I have heard many doctors state “oh it is part of nature and we have to accept it”. Unfortunately every disease is part of nature but most other diseases have more research, better medicines or cures that don’t promote cancer. When all these elements are explored perhaps early education in prevention will save a lot of heart ache later in life. After all, menopause is usually over by 55 years old but we live to 80 years old. Twenty five years is a long time to live with this horrible disorder. I would like you men go through it and then there would be a cure.

  7. 8-10-2011

    Thanks for taking the time to share your info

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