Love your Vagina...especially during the perimenopause and in the post menopausal years

Well it was only a matter of time before I got round to writing about the ‘V’ word, long overdue I know, but it’s hard to prioritise topics with the menopause, with so many symptoms…this is however always on the top of my agenda when giving talks as it has to be the one topic women are less likely to talk about amongst themselves!

Vagina - just the word makes some women visibly blush — seriously — I've been giving a friend of mine ‘vagina therapy’ so she can now say the word without blushing and hilariously has taken ‘the therapy’ a step further and into her own hands, so now finds it very amusing to send me images of contemporary vaginal art, of which there is bizarrely rather a lot — I know I couldn’t believe it either! Here are some examples... https://culturacolectiva.com/art/vagina-contemporary-art/

Moving on...

Why bring up vaginas in relation to the menopause…well, vaginal and bladder symptoms can be very common during any stage of the menopause...during the perimenopause or in the post menopausal years and can cause significant discomfort. Unfortunately they often go unreported and untreated, with women either too embarrassed to seek medical help or simply just not knowing what to do about them, what to look out for or knowing what is normal.

As a country (UK) we have historically tended to be ridiculously prudish about our ‘nether regions', which then has a knock on effect when something goes wrong ‘down there’.

The first problem - calling the vagina and vulva by different names - quite bizarre!

Admit it how many of you have names for your vaginas…one friend referred to hers as ‘Fi Fi’ years ago, which had hilarious consequences when one of my sons decided his first car would be called Fi Fi — dissolving into a fit of giggles when he told me, he found it so amusing the car remained as Fi Fi!

I will also never look at an orchid the same way again after a friend's 80 year old mother told us that orchids always remind her of vaginas! Sorry I digress...

Being ‘terribly British” is not, however, good for the care of your vaginas and vulvas! When giving talks and get to the ‘genitourinary’ symptoms it never ceases to surprise me how many women have absolutely no idea that their vaginas and their vulval area (external) will be affected during and after this transitional period.

The genitourinary symptoms differ slightly from the more commonly known symptoms like hot flushes as they are classed as some of the long term symptoms, whereas the majority of the other symptoms are classed as relatively short term symptoms. So, regardless of the varying different degrees of experiences which could potentially lie ahead, we all need to start paying a bit more attention to this area of our anatomy.

I often say we should give as much care and attention to our vaginas as we do our faces...I’m serious...how much do we spend on cleansers, toners and moisturisers and then there’s the time spent — unbelievable! I have a theory that what we can’t see we don’t worry about or pay attention to until something goes wrong. As with any health issue, prevention is better than firefighting so be prepared.

Firstly check out your vulva (external genitals) — know what is normal for you — yes I am absolutely serious no-one else is going to take responsibility or casually ask you over coffee how it is and there’s no point going on the internet they all look different! Look out for any discolouration of skin, lumps, swelling, anything which strikes you as not quite right and the only way you will get to know this is if you have a regular peek - at least once a month! I know, I know, you are going to have to contort yourself into odd positions but grab a mirror and off you go! Plus don't forget about those pelvic floor exercises. See previous post :

Ok, so what could potentially start going on when you hit the perimenopause…I thought a list to refer to would be useful, but please don’t get alarmed always remember everyone experiences these potential symptoms in different ways and to differing degrees so…you might hardly ever notice anything but then there are women who unfortunately get the kitchen sink thrown at them and experience extraordinarily severe symptoms.

Potential symptoms

• Vaginal atrophy (thinning and reduced elasticity of vaginal tissues)

• Vaginal irritation, dryness or soreness

• More infections due to changes in the acidity levels of the vagina - always find out if it’s a bacterial infection or a fungal infection, try not to be tempted to self medicate.

• Cervical secretions are decreased leading to reduced lubrication.

• Urinary problems include frequency, urgency, leakage or recurrent UTIs

• Overactive bladder

• Reduced sex drive & loss of libido

• Intercourse can be painful and uncomfortable

• Urinary and faecal incontinence

  
  

Managing symptoms...

Firstly find yourself a really good vaginal moisturiser and lubricant. Here lies the first stumbling block for some women — let’s face it, it’s the last thing you want to go and find on the shelves of your local pharmacy, plus there is so much choice - quite bamboozling. Fear not products are all available on-line, with some companies sometimes giving free samples if you're lucky.

As with any moisturiser it's a case of finding one which suits you, be patient and persevere.

The plus of these products being you don't need a prescription for them and you can use them as little or as much as required.

NB - please don't be tempted to slap on your hand cream, body lotion or facial products it's very sensitive skin in this area and requires the right type of product!

Vaginal oestrogen:

If you ask any pelvic health specialist they'd advocate prescribing vaginal estrogen to all women over 50 years. It's an extremely tiny amount of estrogen being administered and being localised treatment is going exactly to where it's needed. It has a high success rate and very low systemic absorption making it a very safe product to use.

There are different ways of administering...cream, pessaries — slow release vaginal tablets or a vaginal ring impregnated with estrogen which is inserted into the vagina and replaced after 3 months, slowly releasing oestrogen over that period of time (NB the ring can be changed by your nurse/doctor or you can change it yourself).

The amount of oestrogen used is very low, being between 7.5 & 10 micrograms in comparison to the 1 - 2 milligrams in systemic HRT.

NB: As with all medications there will be some people who find it doesn't work for them but that is the way of the world.

Summary:-

• Identify symptoms

• Manage symptoms using vaginal moisturisers / lubricants

• Or manage symptoms using prescribed vaginal oestrogen

• Or use both - it's very safe to combine the moisturisers alongside using vaginal estrogen.

• Don't forget to do your pelvic floor exercises!!

Some useful links

Women Health Concern : https://tinyurl.com/y888u6kd

Squeezy App : https://www.squeezyapp.com

Vaginal art! : http://www.artrepresent.com/flowers-of-democracy-3/