Helen, a 59 year old woman, was self-referred to my women’s health clinic because she had a prolapsed bladder. She had researched conservative treatments for prolapse and learned that a pessary – a small medical grade silicone device – was 80% effective after trying up to three different types. Pessary fitting is an art, not a science. I fit many women of all ages for pessaries in my women’s health clinic.
Prolapse may occur during or after pregnancy, during peri-menopause or post-menopause. As part of the assessment, it is my practice to ask all of my patients if they are sexually active. When I asked Helen, she said that although she was married, she was not sexually active. I probed a bit further and she told me that she was not sexually active because she was on so many medications that decreased her sensation, so it was of no pleasure for her. Helen said she was on all of these pain medications for “leg pain syndrome” which began at age 53 during her menopause. I must say, I appreciated her self-interest, as many women place the focus of pleasure exclusively on their male partner instead of themselves! That said I suspected that her decreased sensation was due to decreased estrogen receptors in the vagina, which may lead to decreased sexual sensation. In addition to the decreased sensation Helen was experiencing, she also expressed that she had vaginal dryness, burning and itching – all of which are symptoms associated with Vaginal Atrophy, a condition that affects 49% of post-menopausal women.
I also thought Helen’s leg pain may be a menopausal symptom since leg pain is not uncommon during these years. I suggested that she see a North American Menopause Society (NAMS) certified physician to assess her leg pain to see if systemic hormones, like estrogen and progesterone for uterine protection from cancer, might help her pain as opposed to the high-power narcotics she was on now. Helen said she felt that her prolapse occurred because her vagina was so angry it wanted to scream out because she had been experiencing all of these symptoms for a long time, and trying to get the right help was a challenge. She said the lack of intimacy with her husband had impacted their relationship.
There are many treatment options for vaginal dryness and vaginal atrophy including:
- Personal moisturizers that are hormone free and available over the counter
- Such as RepaGyn, Gynatrof and DrUAqua
- Low dose localized or topical estrogen
- In the form of a cream, tablet or ring
Since Helen needed a pessary for her prolapse, her vaginal tissues were dry, lost elasticity and turgor, were quite thin and bled. She was also experiencing burning and itching. Her doctor prescribed a low dose localized estrogen cream.
I saw Helen two weeks after her pessary fitting – she was much happier because her pessary was working well and her vagina was feeling better! She had made an appointment with a NAMS doctor and after researching common menopause symptoms, was hopeful that her leg pain might be hormonal. She was optimistic that she would be getting back to the bedroom with her husband in due time.