Medically reviewed by Sheryl Kingsberg, Ph.D.
If you happen to’re over 50 and intercourse has change into much less pleasurable, and even painful, you’re not imagining it — and also you’re removed from alone. In response to Sheryl Kingsberg, Ph.D., chief of behavioral drugs 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 in all probability 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 have an effect on extra than simply vaginal tissue — and it’s quite common throughout menopause.
Between 55% and 70% of ladies expertise GSM after menopause. However, as a result of it may be troublesome to convey up sexual signs with healthcare suppliers (HCPs), associates or relations, it’s usually misunderstood. Kingsberg spoke with HealthyWomen to deal with our fears, appropriate our assumptions and make clear this under-discussed subject.
And the subject needs to be mentioned, Kingsberg mentioned, as a result of the most important delusion about vaginal atrophy is that ladies need to undergo by means of it. “GSM could be handled successfully,” Kingsberg mentioned. “This doesn’t need to 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 have an effect on the entire pelvic space, together with the vulva, clitoris, vagina, bladder and urethra. The situation describes the adjustments 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 reason for GSM?
GSM is attributable to the lack of estrogen at menopause. The drop in estrogen causes vaginal tissue to change into thinner and vaginal dryness to happen. Lack of estrogen additionally adjustments 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 normally seem a number of years after menopause. The situation can have a giant impact on sexual exercise. Many ladies first discover vaginal dryness. This could trigger ache and even bleeding throughout sexual exercise. Some girls expertise adjustments in sexual enjoyment and hassle having an orgasm. These signs are attributable to:
- Lack of elasticity (the flexibility 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 move to the vagina and clitoris throughout intercourse
Girls with GSM could get extra frequent urinary tract infections or, in some circumstances, develop incontinence — the shortcoming to regulate once they urinate.
Can I stop GSM?
Sure, you possibly can stop GSM with native hormone remedy (which could be prescribed primarily based on age or early signs) and common stretching of the vulvovaginal tissue by means of common sexual exercise or by utilizing a dilator. In case you have signs of GSM and will not be but postmenopausal, you possibly can focus on these therapy choices together 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 (sizzling flashes and evening sweats) and sometimes will sufficiently deal with GSM. Nevertheless, for some girls systemic HT is not going to be enough and native vaginal HT needs 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 comfy.
- Vaginal moisturizers are lotions that you just apply frequently, two or 3 times per week. You don’t use them throughout intercourse.
- Lubricants could assist with vaginal dryness throughout intercourse. There are a variety of choices to select from. Your finest wager is to make use of a lubricant with:
- A pH degree 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 checklist this, it’s in all probability too excessive.
- As few elements as attainable. The cleaner, the higher!
- Pelvic ground bodily therapists focus on offering specialised bodily remedy when there may be pelvic ground dysfunction. GSM may end up in ache throughout intercourse and consequently, vaginismus—the involuntary tightening of the pelvic ground muscle tissues attributable to anticipatory anxiousness and worry of penetration. Vaginismus is a standard situation for girls to expertise.
- Pelvic ground bodily remedy to enhance vaginismus could contain growing consciousness of pelvic muscle tissues, studying leisure methods, growing 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 cut back the worry and anxiousness of penetration by progressively stretching the vaginal tissue and selling pelvic ground muscle leisure.
Who can I communicate with if I believe I’ve GSM?
If you happen to’re experiencing ache throughout intercourse and assume you might need GSM, communicate with somebody who has experience in treating girls who’re menopausal or postmenopausal. You may go to the North American Menopause Society to search out an HCP who makes a speciality of menopause-related points like GSM.
