Purpose Statement

This blog is intended to educate women on issues that affect women. Although we are all healthcare professionals, we are not here to give medical advice. Rather we hope this will encourage women knowing that help is available and give them the courage to seek help.

Saturday, October 29, 2011

Vaginal Atrophy

You were prepared for the hot flashes, night sweats, and mood swings that accompany menopause.  Your mother, sister, friends, and even complete strangers have all shared their stories of menopause.  However no one prepared you for the vaginal dryness, irritation, and pain with intercourse that can occur. 
Vaginal atrophy is the lack of vaginal estrogen that leads to thinning and inflammation of the vaginal tissue.  This can lead to decreased vaginal lubrication, vaginal shortening and tightening, and loss of vaginal elasticity.   The structure of the vulvar tissue can change as well as thinning of the labia and fusion of labial tissue.  The bladder and urethra also contain estrogen receptors and can be negatively impacted with the loss of estrogen.    

Symptoms of vaginal atrophy include:

Vaginal dryness

Vaginal or vulvar burning

Vaginal or vulvar itching

Pelvic or vaginal pressure or pain

Pain with intercourse

Bleeding with intercourse

Urinary frequency

Urinary urgency

Leakage of urine

Pain or burning with urination

Recurrent bladder infections


Decreased vaginal estrogen can occur in the years leading up to natural menopause (perimenopause) or after menopause.  Other causes include surgical menopause (removal of the ovaries), chemotherapy and/or radiation treatment for cancer, breastfeeding, and medication induced ovarian suppression.   Smoking also can contribute to atrophic changes by impairing blood circulation and causing oxygen depletion to the tissue as well as reducing the effects of naturally occurring estrogens.

Treatment of vaginal atrophy includes non-hormonal and hormonal therapies.  If you prefer a non-hormonal option there are many over the counter products vaginal lubricants and moisturizers available.  It is best to try a sample size initially to determine if it will cause irritation.  If you desire a hormonal approach, this needs to be discussed with your provider to discuss your options.  If you are experiencing any of these symptoms, please see your provider for an accurate diagnosis and discussion of available treatment options including risks and benefits of each. 

Sunday, October 2, 2011

PAINFUL INTERCOURSE AND THE ROLE OF PHYSICAL THERAPY

Sex was intended to be enjoyable, not painful, but for many women that is not the case. Many women silently suffer with a condition called dyspareunia. Dyspareunia is pain before, during or after intercourse. It can have a significant negative effect on the quality of life and may affect as many as 20-50% of all women. Some of the common causes of dyspareunia are injury to the pelvic region during childbirth, endometriosis, pelvic inflammatory disease, infection, adhesions and interstitial cystitis. Psychosocial factors such as depression or abuse can also be causes. Musculoskeletal dysfunction and specifically muscle pain and overactivity of the pelvic muscles is another cause. Overactivity means the muscles do not relax completely. Overactive, nonrelaxing muscles are painful to touch and may lead to spasms preventing intercourse entirely. Pain may be experienced as ache upon penetration, burning or tearing sensation. Depending on the causes, symptoms may be felt at the vaginal opening, inside the vagina or deep in the pelvis.

Treatment for dyspareunia depends on the underlying cause. When pain is caused by a musculoskeletal dysfunction physical therapy can help reduce the symptoms. The pelvic floor muscles and other muscles around the pelvis and abdomen often tighten in reaction to pain. This sets off a cycle that is difficult to break. It hurts, so you tighten up, you tighten up and it hurts more. The goal of physical therapy intervention for dyspareunia is to reduce vaginal pain by reducing overactivity of the pelvic muscles. Treatments may include external and internal pelvic floor muscle massage, relaxation training, strengthening and home exercise program.

Do you avoid intercourse because you know it is going to hurt? Do you suffer through intercourse because you don’t want to disappoint your spouse but never enjoy it like it is intended because it is too painful? If you are one of the many women who suffer from dyspareunia, talk to your doctor so you can discover the underlying cause and get the help you need and deserve. Don’t continue to suffer in silence.