Pamela was a newly divorced post-menopausal (no period for a full year) fifty-something physiotherapist in a relationship who presented to my clinic with vaginal dryness and pain upon penetration in the missionary position. She said when she and her new lover made love “doggy style,” the pain was non-existent.
Pamela wanted me to know that the source of her sexual pain was not the result of a sexually transmitted infection. Her boyfriend was not the type who had multiple partners, she said. I explained to Pamela that anyone who is sexually active is at risk for an STI.
When I did a limited internal examination on Pamela, I immediately saw that her labia was dry. I then noted several vesicles at the base of the opening to her vagina. I used a Q-Tip and pressed gently around the area where the vesicles were and asked her if this was painful. She said yes and confirmed that that was the area of pain upon penetration.
I explained to Pamela that I could not diagnose the vesicles by visualization and that she would need a sample to be taken of them to confirm the diagnosis. The result of Pamela’s swab was genital herpes and she was stunned. Most people with the Herpes virus do not show any symptoms and even without symptoms a person may transmit the virus to sexual partners.
She said she had never noticed any lesions on her boyfriend’s penis, but he was prone to cold sores. I explained to Pamela that oral herpes may become genital herpes during oral sex. Herpes is contracted via direct contact with an active lesion or body fluid of an infected person. Furthermore, Pamela was at greater risk of contracting herpes because of her vaginal dryness, thin vaginal tissues, and increased ph of the vagina, all which may increase susceptibility to infection.
There is no cure for herpes, but there are daily anti-viral medications may minimize “outbreaks” and reduce the risk of passing herpes to her lover. Living a healthy life and managing the stress in her life may also help to decrease herpes outbreaks which occur most frequently in the first year of diagnosis.
Pamela was devastated and thought her sex life was over which was not the case. It was important that Pamela inform her lover of her diagnosis and practice safe sex with him. I also explained to Pamela that herpes is characterized by remissions and exacerbations. In other words, I would not be able to treat the menopause associated vaginal dryness until her herpes cleared up.
It is important that, during the menopausal years, women ensure their vagina is as healthy as possible because vaginal dryness may lead to cracks in the vaginal tissue increasing the risk of transmission of a sexually transmitted infection.