Medically reviewed by Sheryl Kingsberg, Ph.D.
In case you’re over 50 and intercourse has turn out to be much less pleasurable, and even painful, you’re not imagining it — and also you’re removed from alone. In keeping with Sheryl Kingsberg, Ph.D., chief of behavioral medication within the OB-GYN division at College Hospitals Cleveland Medical Middle and a member of HealthyWomen’s Girls’s Well being Advisory Council, that is most likely vaginal atrophy, which implies thinning or lack of vaginal tissue. Vaginal atrophy (additionally typically known as atrophic vaginitis) is now known as genitourinary syndrome of menopause (GSM) as a result of it could actually have an effect on extra than simply vaginal tissue — and it’s quite common throughout menopause.
Between 55% and 70% of girls expertise GSM after menopause. However, as a result of it may be troublesome to carry up sexual signs with healthcare suppliers (HCPs), buddies or relations, it’s usually misunderstood. Kingsberg spoke with HealthyWomen to deal with our fears, appropriate our assumptions and make clear this under-discussed matter.
And the subject ought to be mentioned, Kingsberg mentioned, as a result of the largest fantasy about vaginal atrophy is that ladies must endure by means of it. “GSM will be handled successfully,” Kingsberg mentioned. “This doesn’t must sign the top of your intercourse life.”
What’s GSM or vaginal atrophy?
The time period vaginal atrophy was modified to GSM as a result of it could actually have an effect on the entire pelvic space, together with the vulva, clitoris, vagina, bladder and urethra. The situation describes the modifications that happen in any of those areas due to lack of the hormone estrogen that occurs throughout menopause. Estrogen helps our sexual and vaginal well being.
What’s the explanation for GSM?
GSM is attributable to the lack of estrogen at menopause. The drop in estrogen causes vaginal tissue to turn out to be thinner and vaginal dryness to happen. Lack of estrogen additionally modifications the vaginal pH, inflicting a lower in good micro organism (lactobacilli) and an overgrowth of micro organism that may improve the danger of urinary tract infections. Estrogen additionally impacts a variety of different pelvic features.
What are the signs of GSM?
Not all girls will develop signs of GSM, but when they do, the signs often seem a couple of years after menopause. The situation can have an enormous impact on sexual exercise. Many ladies first discover vaginal dryness. This could trigger ache and even bleeding throughout sexual exercise. Some girls expertise modifications in sexual enjoyment and bother having an orgasm. These signs are attributable to:
- Lack of elasticity (the power of the pores and skin to return to its authentic form after being stretched) within the vagina
- Narrowing or shortening of the vagina
- Lack of blood circulation to the vagina and clitoris throughout intercourse
Can I stop GSM?
Sure, you possibly can stop GSM with native hormone remedy (which will be prescribed primarily based on age or early signs) and common stretching of the vulvovaginal tissue by means of common sexual exercise or through the use of a dilator. You probably have signs of GSM and will not be but postmenopausal, you possibly can focus on these therapy choices along with your healthcare supplier).
What are some therapy choices for GSM?
Proof-based therapies for GSM embrace:
- Hormone remedy
- Systemic hormone remedy is used to deal with vasomotor signs of menopause (scorching flashes and night time sweats) and infrequently will sufficiently deal with GSM. Nonetheless, for some girls systemic HT won’t be ample and native vaginal HT ought to be used.
- Low dose native hormone therapies embrace quite a lot of estrogen supply choices — vaginal lotions, rings, tablets and inserts. The dose of hormones could be very low and will get hormones simply to the vulvovaginal tissues.
- Moisturizers and lubricants
- Moisturizers and lubricants don’t deal with the underlying subject — the dearth of estrogen — or the prevailing tissue harm, however they can assist maintain you snug.
- Vaginal moisturizers are lotions that you simply apply recurrently, two or thrice every week. You don’t use them throughout intercourse.
- Lubricants could assist with vaginal dryness throughout intercourse. There are a selection of choices to select from. Your greatest guess is to make use of a lubricant with:
- A pH stage of three.8 to 4.5 (this matches the pH of your vagina)
- An osmolality (a flowery phrase for what number of particles are within the lube) decrease than 1200 (too excessive and it truly pulls moisture out of the tissue). If the label doesn’t record this, it’s most likely too excessive.
- As few substances as attainable. The cleaner, the higher!
- Pelvic ground bodily therapists focus on offering specialised bodily remedy when there may be pelvic ground dysfunction. GSM can lead to ache throughout intercourse and consequently, vaginismus—the involuntary tightening of the pelvic ground muscle tissues because of anticipatory nervousness and worry of penetration. Vaginismus is a typical situation for ladies to expertise.
- Pelvic ground bodily remedy to enhance vaginismus could contain rising consciousness of pelvic muscle tissues, studying rest methods, rising vaginal elasticity and tone, and offering methods to stretch the vaginal opening. Pelvic ground bodily remedy could also be mixed with using vaginal dilators. Vaginal dilators can assist scale back the worry and nervousness of penetration by progressively stretching the vaginal tissue and selling pelvic ground muscle rest.
Who can I converse with if I feel I’ve GSM?
In case you’re experiencing ache throughout intercourse and assume you might need GSM, converse with somebody who has experience in treating girls who’re menopausal or postmenopausal. You possibly can go to the North American Menopause Society to search out an HCP who makes a speciality of menopause-related points like GSM.