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Vaginal atrophy - Lets mention the unmentionable

185 replies

roseenglish1969 · 20/11/2018 12:28

So, it happens to 50% to 60% of women at or around menopause time yet very few women approach their doctors about it suffering in silence with painful sex and all of the other horrible symptoms.

The sad thing is once the damage is done you can’t reverse that damage and your bits do shrink.

The clitoral hood often shrinks back exposing the clitorus which can lead to extreme pain and sensitive as you walk about or move. So tight jeans are a no no.
The inner labia shrinks sometimes to nothing and the inner labia has glands which provides moisture to the outside of the vagina. So no labia no moisture equals dry itchy broken skin. Pain in and outside the vagina, burning to the skin around the vulva and bottom,.
VA also affects the bladder causing leaks, urgency, increased frequency and nighttime trips, so Tenna pads ARE avoidable, we don’t have to accept incontinance as part of getting old.

The difficult part is getting your doctors to
a) understand what your symptoms are
b) give a damn
c) prescribe it as they think vagifem is HRT. It isn’t

Most GPs know next to nothing about VA or menopause so it’s up to you to take some printed information off and ask for vagifem.

A years worth of vagifem amounts to just two full HRT tablets. That’s how little oestrogen is in it. And most of that is absorbed by your reproductive organs as it’s a pessary not a tablet and designed that way for that very reason.

What are your symptoms?

I do wonder if some women are confusing increased libido (sex surge) with VA, I know I did, I thought the sudden sensations to my vag was some new meno symptom which it was but it was because my skin below was thinner and the nerves more exposed and sensitive. I felt arousal below out of the blue, no thoughts of sex at all and it was a very confusing time for me. It’s not a common symptom and I fell into a rabbit hole of health anxiety which I’m still not over... I thought I had some rare nerve disorder that effects the vagina. I literally wanted to die rather than live with the condition. Thanks Google.
Videos of women having 100 involuntary orgasms a day haunted me and I was sure that’s where I was heading.
As I say, still very raw to me as I’m trying to accept I don’t have the condition and have VA.

So I wanted to reach women who perhaps had symptoms and were too afraid or shy to ask,
Pm me if you wish .,,

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QueenoftheNights · 20/11/2018 12:43

Have you come across this rose?
It's been on another forum as well as on Twitter.

It's written by an 'ordinary woman who was on another meno forum.

www.amazon.co.uk/ME-MY-MENOPAUSAL-VAGINA-Vaginal/dp/1916446701/ref=sr_1_1?keywords=my%20menopausal%20vagina&ie=UTF8&qid=1542717536&sr=8-1&tag=mumsnet&ascsubtag=mnforum-21

I think many drs are happy to treat VA but women need to ask for help. There are some drs who are not up to date with the treatment and think a) it has a time limit of a few months and b) it's not suitable for some women . A quick online search will bring up the NICE guidelines on this and it's easy to print them off.

Sadly, some women do not understand or recognise dry vagina- because either they arne't having sex and don't notice, or they don't appreciate the itching etc can be VA- the think it is thrush.

And at its worst, VA can mean a very copious watery discharge so women think they are not dry.

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roseenglish1969 · 20/11/2018 12:50

Just wanted to add.

Getting a diagnosis on VA is very rare. Here are the physical symptoms doctors are looking for

On physical examination, the vagina is dry, with pale, frail tissue, and lacking the normal mucosal ridges and folds. The expected elasticity and pliability associated with a well estrogenized vagina maybe absent. There is minimal lubrication due to decreased vaginal blood flow, and the tissues are easily traumatized with digital or pelvic examination. There may also petechiae or small hemorrhages on the vaginal lining. The vaginal introitus may be narrowed; the epithelial surface is typically very friable and may be ulcerated.[5] Vulvar tissue may appear diminished, obliterated, or even fused, and irritation and erythema evident. Pubic hair is often diminished and there can be clitoral tissue shrinkage; pelvic organ prolapse is not uncommon

The problem is by the time it’s reached the above stage the damage is ver advanced. It’s very much a “hidden” condition. We can’t see the bladder after all. We can’t see the skin inside our vagina and dryness is not as obvious to feel as you think.
I for example am not dry as such but my discharge is watery and thin these days which amounts to the same issue, lack of lubricantion keeping the skin protected.

VA is very individual to each of us. We will each have different symptoms. Some may find a lack of sensation during sex or maybe even unable to achieve orgasm anymore... others may find an increased sensitivity...

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roseenglish1969 · 20/11/2018 13:00

Yes, I chat with the author, am a member of her Facebook page, and own the book.
She did have PGAD (persistent genital arousal disorder) and was diagnosed with pudendal neurologica for a while.
PGAD was caused by her the shrinking of her clitorus hood..
Her VA was advanced and yet her doctor told her “it looks fine”
Most do.
Thankfully for Jane, she’s much much better thanks to local estogen and HRT.

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QueenoftheNights · 20/11/2018 13:58

Getting a diagnosis on VA is very rare.

I'm sorry but it's not. I don't think it's a good idea to say this here as it will make women assume they are going to have a battle on their hands when they see their GP.

What makes you think it's 'very rare'? There are thousands of women using topical treatment for vaginal dryness and atrophy.

All you need to say is
'I think I may have vaginal atrophy. I have soreness/ itching/ painful sex/ need to loo a lot at night/ have symptoms like a UTI but not quite the same/ have peri meno symptoms like irregular periods....

AND I'D LIKE TO TRY SOME TOPICAL ESTROGEN CREAM/ PESSARY TO SEE IF IT HELPS.

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roseenglish1969 · 20/11/2018 15:26

I think the whole point of my post is to encourage people to go to the doctors and take some printed information because getting a general practitioner to diagnose vaginal atrophy is rare. I never said they won’t get treatment, I just said they’re not likely to diagnose it.
Not least because most GPs don’t have time to to a pelvic exam and even if they did one they would be looking for the classic physical signs of atrophy which if visible means it’s quite progressed. I also explained VA is very much a hidden condition we can’t see the bladder for example and that we have to go off symptoms rather than physical symptoms.
I’ve had two gynaecologist and a pelvic therapist with 30 years experience tell me I don’t have VA bc my skin isn’t shiny or pale.
The author of the book you linked to also goes into this as even with her exposed clitoris a gyno told her “it looks fine”

My messages was to NOT be fobbed off by being told “looks fine”:bc they’re probably likely to be told this.

Only a vulva dermatologist would spot the signs of visual VA.

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VictoriaBun · 20/11/2018 15:36

Interesting read. Thank you. I am 58 and still have an active sex life , but would never attempt it without lubrication. I have taken a look today and the area is definitely a lot paler in colour and I have noticed my clitoris has shrunk over the past few years. I do find it harder to orgasm these days but incidentally I also orgasm a lot more during dreams /on waking.
I went through a very early menopause ( late 30s) so I wondering if I would benefit from topical estrogen cream ?

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roseenglish1969 · 20/11/2018 15:47

I used to orgasm during dreams too..I used to put that being due on my period.
You have absolutely nothing to lose is in trying it and so much to gain. The longer we allow atrophy to progress the harder it is to treat,
It’s the lack of oestrogen that causes it.
It was a shock to me that our bits shrivel up but they do sadly.
Please DO go see your gp explain your concerns and ask for Vagifem
They may suggest you try it for 3 months and once things improve, stop using it,
Please know VA is something that needs treatment for life. As soon as you stop local estrogem things will go back to how they were.
Good luck!

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ErrolTheDragon · 20/11/2018 15:49

I must have been lucky. One of the female GPS mentioned I might benefit from some sort of local oestrogen when I went in for my first (and only, touch wood) bout of cystitis for decades, and then on a later appointment with a different GP about something else I mentioned a bit of dryness and that the other GP had mentioned oestrogen, and he prescribed vagifem, with a little discussion on its low risk but advised to read the leaflet in the pack to make sure I was happy about it. No physical exam, no actual diagnosis of VA afaik. It really seems to do the trick for me.

Take QueenOfTheNights advice and ask!

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ErrolTheDragon · 20/11/2018 15:50
  • They may suggest you try it for 3 months and once things improve, stop using it,
    Please know VA is something that needs treatment for life*

    I think I'm on the correct regime which was one pessary a day for the first couple of weeks then every 3 days.
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QueenoftheNights · 20/11/2018 17:33

Errrol yes that is correct.

However you have to use it forever. If you stop the symptoms return. This is noted in the NICE menopause guidelines.

There are still GPs around who only prescribe it short term (thinking it will cause endometrial overgrowth) or who won't allow it for women using systemic HRT as well. (Both incorrect.)

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QueenoftheNights · 20/11/2018 17:36

VictoriaBun If you had such an early menopause you really need a DEXA bone density scan as you are at a very increased risk of osteoporosis. Ask your GP to arrange it or pay for it yourself if they won't- it's really very important.

Lubricant helps with sex but it won't change the structure of the cells and help create a normal healthy vaginal pH and your own lubrication.

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roseenglish1969 · 20/11/2018 18:12

It’s worth noting that the leaflet that comes with Vagifem is the same template they use for standard HRT which has worried a lot of women.
Please know the leaflet is not really applicable for Vagifem and they should really create one that is more in keeping with the dose used as well as the fact the 10mg of oestrogen is mostly absorbed by the reproductive organs hence the delivery being a Pessaries rather than patch or tablet.

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vivariumvivariumsvivaria · 20/11/2018 18:15

How do you get it to stay up? My friend (honest guv) says it dribbles down - any tips I can tell her?

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ErrolTheDragon · 20/11/2018 18:18

I find it stays put fine - I think it takes quite a while to dissolve and be absorbed.

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vivariumvivariumsvivaria · 20/11/2018 18:23

Maybe she needs to sit down for a while and let it absorb.

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QueenoftheNights · 20/11/2018 18:27

use it at night? The instructions for Ovestin say use it at night.

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DramaAlpaca · 20/11/2018 18:27

Thank you for this useful post roseenglish & for your advice too, Queen.

I am lucky enough to have a very clued up GP & I had no trouble getting her to diagnose VA from a description of my symptoms and to prescribe Vagifem. As Errol says there was no need for a physical examination. I was prescribed Vagifem pessaries to be used daily for two weeks, then twice to three times a week as needed.

It's made a huge difference to how I feel.

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ErrolTheDragon · 20/11/2018 18:28

Oh, I do usually use it at night come to think.

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DramaAlpaca · 20/11/2018 18:30

I use it at night too.

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Destinysdaughter · 20/11/2018 18:36

Can anyone advise, if you get HRT will it help with VA or do you need to get something that is specifically for it?

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roseenglish1969 · 20/11/2018 18:45

Viva
As advised alresdy, use it at night.
I’ve heard of it falling out which took me by surprise so I always insert at night .
Do try and insert it as high as possible, go slowly and gently till you cannot push it higher and then click the end to dispense it.
Lead down it should be absorbed better

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NottonightJosepheen · 20/11/2018 18:48

This reply has been deleted

Message withdrawn at poster's request.

elephantoverthehill · 20/11/2018 19:36

I think this thread has come at just about the right time for me. I have been feeling uncomfortable for about a month. At first I thought it was a bout of cystitis but it is not nearly itchy enough. It is not horribly painful just a dull ache and an awareness that something is not quite right.

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elephantoverthehill · 20/11/2018 19:42

*thrush not cystitis although a few twinges of that as well.

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EllenRipley · 20/11/2018 19:43

I totally sympathise with that awful hypersensitive feeling OP, I think it's the same as you've described. Like arousal but def not. Mine seems to come on if I get inflammation in or around the urethra. I've been using Ovestin (estriol) which has solved a lot of problems, but the cream instead of the pessary which I think makes it easier to target the problem area(s). This thread has reminded me I need to order some more from the doc. I stopped using it regularly as my periods reappeared (after a six month hiatus) which made me wonder if my estrogen levels were on the up but have noticed some of the old problems returning. I'm assuming it's ok to use if you're menstruating. Think I should probably ask doc if I need to do the loading dose again. Have also read that it you don't need to stop using after three months.

@QueenoftheNights has always been very helpful so recommend taking her advice.

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