I’m 53, and I had a hysterectomy in my early 40s. I shouldn’t be surprised that I’m in menopause.
But here I am. My skin and hair are dry. I sleep poorly. I have night sweats. I forget things. And I have vulvovaginal atrophy (VVA).
Sigh.
I shouldn’t be here, I think. “Use it or lose it” should have prevented this! I DO use it. My blog isn’t going to research itself, after all.
VVA is the thinning, drying, and inflammation of the vulva and vagina (and often the clitoris as well). It can lead to vaginal tearing (leading to pain and infection), discomfort or pain with sex, loss of elasticity in the vagina, urinary problems, difficulty with sexual response, and more. You can learn more here (easier to understand for most of us) and here (more medical language style).
Because VVA results from a decrease in estrogen levels, estrogen is the most common way to treat it. System-wide estrogen replacement (pills or a patch that increase the estrogen level throughout the entire body) can help with some VVA. Or, local estrogen might be prescribed (estrogen tablets, creams, or a ring to increase estrogen in only the vulvar-vaginal tissue.)
However, estrogen replacement isn’t a good idea for everyone. (Talk with a medical provider about what is best for you and your own medical condition.) What can you do if you are concerned about using any hormones or if your doctor recommends against even local estrogen treatment? Or what if you use estrogen replacement and it isn’t as effective as you would like?
Does it mean that you are stuck with the demise of your vulvovaginal tissue?
Fortunately, there are some non-hormonal treatments that can help us.
Help without Hormones
I’ve done a bit of research on this. Some of this information came from a conversation with the nurse practitioner (NP) who is treating me. I also spent time at the HysterSisters, Mayo Clinic, WebMD, and the U.S. National Library of Medicine websites, as well as looking at research articles related to the ideas presented here.
I encourage you to read Help for Vaginal Dryness at Bonny’s OysterBed7. My friend Bonny not only talks about how DHEA (a supplement) can help with a variety of VVA symptoms, she also explains the biology of dryness.
MEDICAL DISCLAIMER: Talk with your own doctor about whether these treatments can work for you. This blog post does not constitute medical advice, but it can give you some ideas of what to ask about when you talk with your own doctor.
The information below includes affiliate links.
1. Check Your Medication
Although low estrogen is usually the cause of VVA, symptoms can be aggravated by some prescription medications. Talk with your doctor about your own medications. If any might be contributing to your symptoms, discuss alternatives. Discuss over-the-counter medications as well. Antihistamines and cold and allergy medications not only dry out your sinus tissue, they can also dry out your vaginal tissue. As someone with chronic sinusitis, I was not pleased to learn this—but it is better to know than not to know. A nasal spray or sinus rinse might be better options for you.
2. Use Artificial Lubricants
Don’t have sex without a lube. Just don’t. You may find that an initial burst of your body’s natural lubrication doesn’t last. Always have something quickly accessible.
Most drug stores carry a variety of artificial lubricants to use during intercourse. Avoid products that say they add warming or tingling, as it can irritate dry vaginal tissue. Otherwise, try a variety of products until you find something that works well for you.
Check out your grocery store, too. Many couples enjoy coconut oil or olive oil. If you are using condoms or sex toys made out of rubber or plastic, oil can lead to a breakdown of the material. If you are not using condoms or if you use only silicone toys, oil can be a great solution to a lubrication problem.
3. Moisturize, Moisturize, and Soothe!
Although vaginal dryness isn’t the only problem that comes with VVA, it certainly is a major one—and it isn’t a problem only during sex. Constant dryness can lead to itching and general discomfort as well as contribute to urinary problems.
Vaginal moisturizers can help by hydrating and soothing the vaginal tissue.
- Replens attaches to your dry vaginal cells to provide moisture until they are regenerated (every three to five days). Using it three times a week helps vaginal tissue become more hydrated and renewed. Several clinical studies have shown an improvement in vaginal moisture.
- HyaloGyn doesn’t appear to have as much research support behind it, but I’ve seen it recommended on several medical sites as a good option. HyaloGyn should be applied three times a week.
- Some women find it helpful to apply olive oil or insert a Vitamin E suppository that will be absorbed by your body overnight.
Healthier tissue can not only make sex more comfortable, it can help with sexual responsiveness and orgasm as well. What’s not to love?
Sometimes we need immediate relief. Vaginal moisturizer may not work right away, and if your vulva is what needs some soothing, vaginal moisturizer isn’t going to do much.
My NP said that she often recommends Herballove’s VRD Formula II and Creme Complete by Perrin Naturals. I have not been able to find out enough about either of these products to be able to tell you how they are applied, or whether they even can be applied internally. If you find yourself in need of something to help soothe inflammation related to VVA, talk with your doctor about whether these products might help—and be sure to ask how to use them.
4. Rejuvenate Your Vagina
The most effective way to treat VVA is through vaginal rejuvenation.
Vaginal Renewal™
Vaginal Renewal™ is an approach recommended by A Woman’s Touch Sexuality Resource Center in Madison, WI.
The Vaginal Renewal™ program promotes blood flow to the vulvar skin and to the vagina through 1) external vulva massage and moisturizing, and 2) internal massage with a vibrating wand. They recommend the FeMani® Vibrating Massage Wand Dilator Kit. If that is a bit pricey for you, a standard vibrator may work well. Click here for detailed instructions.
You’re Going to Do What to My Vagina?
I’d like to describe two other treatments that are effective in restoring vaginal lubrication and elasticity, improving urinary incontinence, and restoring sexual function.
The Mona Lisa procedure is an internal laser treatment that helps plump up tissue. The laser treatment essentially creates some cellular damage in the vagina in a way that forces new growth–and the new growth is healthy tissue. Mona Lisa apparently has great success rate, but insurance doesn’t cover it. Most places in the country will charge $1800-$3000 for it.
ThermiVa works by heating the vaginal tissues to prompt the formation of new collagen and nerves in the vaginal tissues, using radiofrequency energy. ThermiVa also can be used externally on the vulva to treat vulvar atrophy. ThermiVa costs from $2500-$3500 and is also not covered by insurance.
Studies show that both of these procedures are effective, although they do need to be repeated yearly. If you’d like to learn a bit more, check out these resources:
- ThermiVa vs. MonaLisa Touch, Integrity Medical Aesthetics
- Can a Laser Improve your Sex Life? Harper’s Bazaar
- Vaginal Lasers: What’s Happening in The Field, Women’s Wellness Institute of Dallas
I just want to know: who volunteers to be among the first women to test these treatments? Whoever these women are, I am grateful that they have helped us have new options to reclaim our sexual health.
Your Medical Provider
The most important thing you can do in addressing your VVA is to find good medical care.
As comfortable as you may be with your regular gynecologist, you might be better off with a vulvar specialist or someone who is a member of the National Vulvodynia Association. Ask your gynecologist for a recommendation.
These websites have good resources and have information that will help you find a provider:
- National Vulvodynia Association
- International Society for the Study of Women’s Sexual Health
- North American Menopause Society
You may also find these sites helpful, depending on your location.
- Berman Sexual Health (Chicago)
- Women’s Wellness Institute of Dallas
- The Centers for Vulvovaginal Disorders (Washington, DC, New York, and Santa Fe)
God designed women to enjoy sexual intimacy. Fortunately, we have options that can help us do so comfortably.
Even to your old age and gray hairs I am he, I am he who will sustain you.
I have made you and I will carry you; I will sustain you and I will rescue you. Isaiah 46:4
Previous posts about my journey to reclaim my sexual health during menopause
13 Things I Heard at a Sexual Wellness Class
An Embarrassing Post about Female Sexual Dysfunction (Plus 5 Tips!)
Image credit | Radfotosonn at Pixabay.com
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Thank you so much for the wealth of information that must have involved a great deal of time to gather! I am close to 48 and have recently been wondering what changes are going to happen physically in the next few years. I will want to avoid hormone treatment, so your research is encouraging.
My NP gets a lot of the credit, but this is all information I need for myself so I was going to do the research anyway. 🙂
Pardon my ignorance, but what does NP stand for?
NP=Nurse Practitioner
Thank you, Chris, for sharing this information. It helps me to understand part of my wife’s problem.
I’m glad it helps.
All of the females in my wife’s genetically-related family have a propensity for early menopause. However, several years back, when my wife was in her late 40’s, pre-cancer cells were found during her annual Pap-smear exam. Her doctor (a male) referred her to a surgeon (a female) and they, together, decided that my wife should have a total hysterectomy. Do note: my wife had never borne any children (her choice) and I had 3 kids from my previous marriage. So, my wife feels she gets all of the benefits of kids and grandkids without having had to go through the pain and discomfort of childbirth. LOL! Plus, she was very afraid of even a remote possibility of developing cervical and/or uterine cancer; for which, I can’t say that I blame her.
However, her surgeon recommended my wife begin HRT (hormone replacement therapy) as soon as possible. Now, I’m not a doctor, and, I’ve never played one on TV either, but, I have stayed at a Hampton Inn a time or two. That said, I will say that without the HRT, my wife would be a total “basket case,” emotionally and mentally, without it.
HRT, for her, is something we, both, can’t do without. Even she notices a change in her moods when she misses a dosage. Adding to this narrative, few years ago, before my wife retired from a very stressful job, I noticed she was becoming very agitated at even the slightest provocation. She came home crying and short-tempered with everyone. She constantly complained about her job and her “idiot-bosses.” (I knew them from my working at the same agency. They were and, are still, “idiot-bosses.”)
She was so close to retiring and she was seriously thinking of just quitting. I called our PCP and got her an appointment. While he’s a PCP, he’s also a specialist in hormone replacement and adjustments for men and women. He changed her HRT completely, saying that while the surgeon was right, initially, my wife’s HRT plan should’ve been adjusted after 6 months to account for her body’s own self-adjusting to the loss of hormone-producing body parts. Within just days of beginning her new regimen of therapy, she was behaving like her old self. (I’m not talking chronological age. I’m not stupid!)
My wife’s attitude about her job changed to one of, “Oh, I can put up with this for 18 more months.” Her reactions to issues around the house changed from its “Its everyone else’s fault!,” to “What can I do to help?” What I’m saying is that looking into traditional HRT could be a “good thing” for women needing help coping with menopause and it’s side-effects. Just be sure you go to a doctor that specializes in HRT and one that has a very good reputation.
This same doctor, who changed my wife’s HRT, helped me with mine, too. I discovered I had “low-T,” or “low testerone” levels on my blood. My sexual activities/performance were not where I wanted them to be. Friends, with whom I talked to said that, “it was just a part of men growing old.” Well, I wasn’t going to accept that. I talked to the doctor and he put me on a testerone cream, especially compounded/formulated to counter my body’s lack of testerone production. I have to say that, within just a couple of weeks, my sexual drive and performance was back to what it was like when I was in my 20’s and 30’s, as were the testerone levels in my blood.
Actually, my constant “badgering” my first wife for sex is one of the excuses my 1st wife used to divorce me. Too bad, this blog wasn’t around for her to read. Of course, she would’ve never read it because it would’ve shown her where she was wrong in so many of her actions regarding our sex life, and marriage in general.
You do us all a terrific service with your blog, Chris! Keep it up! May God bless you and yours for your ministry!
Hormone replacement therapy can be effective, and it is worth a conversation with the doctor. However, it might not be a good idea for all women because of different risk factors and medical situations. Even with HRT, some women may find that not all their symptoms are alleviated. It’s great to have some other options.
10 years ago I was where you are now, only my journey did not begin with a hysterectomy. Instead it began simply with the natural and normal menopause process (which ended up not being so simple for me). You are lucky – in that the medical community has so much more info about various options to deal with these issues and is so much more open minded about alternative fixes than they were back then.
When I first started having minor peri-menopause symptoms in my early 40’s, my OB put me on birth control pills. I was still on the pill when the really bad stuff started in my late 40’s In addition to many of the symptoms you mentioned, I also experienced painful reoccurring UTI’s because of the atrophy issue. I also eventually lost sensation in the clitoral area, which resulted in the inability to get aroused and to have orgasms. I wanted to have sex and was horny in my head – but my body just would not respond – no matter what we tried. MY OB (a different one at that time) was very unsympathetic and closed minded. She gave me antibiotics for the UTI’ which resulted in a yeast infection. Once I got the yeast infection treated, another UTI occurred shortly after – and the cycle began. This painful cycle continued for awhile and was one of the catalyst that prodded me to do my own research. She talked to me about the one size fits all HRT pill that they used back then – which basically gave everyone the same amount of hormones – no matter what their individual levels were. But – she said I was getting hormones from the pill so until I stopped having periods and was no longer able to get pregnant, I should just ride it out and stay on the pill. When the clitoral sensation decrease began – she brushed aside the sexual issue, literally saying – “Welcome to menopause”. I knew then that I had to find help elsewhere and ramped up my research efforts.
From my research, I learned that the pill most likely made my menopause symptoms worse than they would have been if I had never gone on the pill or any other hormonal birth control method because they threw my hormonal ratio balance totally out of wack. Hormones are important, but the correct hormone ratio balance – especially between estrogen and progesterone is even more important. I also learned that taking the one fits all HRT pill would not help either because the ratio would still be off. Ladies – if you are using any hormonal birth control – be warned – you may see very unpleasant consequences later down the road!!!
Long story short – I found the help I needed through lots of prayer and research. Info about Individual hormone testing and bio-identical hormones was just starting to surface back then and I stumbled onto an article about it. Remember Suzanne Somers? I couldn’t believe I was reading stuff from a ditsy Hollywood actress. lol Thankfully, she wasn’t so ditsy – about this issue at least. Something pushed me to explore bio-identical hormones further, .Because my insurance would not cover it, I ended up having to pay the total costs out of pocket when I found a doctor that would test my individual hormone levels and then work with me to get my hormones properly balanced again with the bio-identical hormones. It took me 2 years to find the help I needed, and another 2 years to balance my hormones to the point that I felt semi-normal again, not to mention the thousands of dollars I spent. Thankfully, we could afford the costs. I don’t know where I would be if we couldn’t. I had already exhausted most other avenues available to me that were non-hormonal treatments, including making life changes in my diet and exercise routines, and trying tons of supplements.
This journey was not only painful and uncomfortable physically but also was extremely distressing emotionally for me. A couple of years before these horrible symptoms started, I finally had begun to deal with my sexual repression issues and dysfunctional thinking process that had caused me to create a virtual sexual desert throughout most of my marriage. I had finally gotten to the point of really exploring and enjoying sex with my husband and then -bam – these menopause symptoms stole that enjoyment from me, from us. Because I had already seen the wonderful effect that a frequent, happy, and healthy sexual relationship had on our marriage and on our bond with each other – I was determined to keep our sexual relationship alive and to get my sexual function back.
Thankfully we did! As a side note – a couple years after getting things working again, I discovered I can have multiple orgasms, I was in my mid 50’s. when I made this discovery. You CAN teach and old(er) dog new tricks! lol As another side note, like Kevin, my husband also benefited in another way from my research when we learned that women are not the only ones with hormone issues as they age. Men also have a sort of menopause, called andropause and may benefit from their own HRT.
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I am glad you are talking about these issues and providing resources for others. I am also glad that things have changed for the better in the medical field. It’s not perfect and so much more needs to be figured out and changed – but, trust me, it is way better than it was 10 years ago! Good Luck on this “not fun at all” journey. I hope you find your own solutions so you and your husband can concentrate and continue on the “way more fun” journey of marital physical intimacy!! (Sorry about the long comment – your post brought back all the wonderful (not) memories.)
I, too, am glad that I had already experienced the good intimacy of a sexually healthy marriage before experiencing all this. It is what keeps me motivated! I have already experienced some improvement with my treatment. I’m glad you were able to find the right balance of hormones to turn things around for you–and that you discovered multiple orgasms!
I have done Mona Lisa, and it has not been that helpful. I have to
Have treatment FOUR times a year, not once like they say. It is not that great.
I’m really sorry to hear that. Thank you for sharing your experience. I wish it had been a better one for you.