By Camil Marrero MD, MPH, FACOG
During the menopausal years, women are typically upfront to discuss hot flashes, night sweats, and mood changes with their gynecologist. However, most patients avoid talking about pain during intercourse, a condition known as dyspareunia. Patients should not feel embarrassed to address this issue with their doctors and should know that they are not alone.
The American Menopause Society reports that 17-45 % of the patients have dyspareunia during menopause. Symptoms include pain in the vulvar area, in and out of the vagina, dryness, burning sensation, itchiness, increase in urinary tract infections, and bleeding or tears after having sex.
After menopause the vaginal cells lose water, the tissue gets thinner and lacks elasticity. These changes are known as Vulvar and Vaginal Atrophy (VVA) and are caused by decreasing estrogen levels. Although it seems as if nothing can solve the issue, some treatments are available that may help.
Lubricants and Moisturizers
For those women who prefer a non-hormonal therapy, lubricants and moisturizers can be used. It is important to understand that this method only provides short term relief and does not work in improving the VVA symptoms.
Intravaginal hormonal formulations
Low-dose topical estrogen therapy is applied directly in the vagina and in this way the systemic absorption is minimal. Multiple vaginal estrogen products are approved by the FDA with comparable efficacy in improving the thickness and elasticity of the vaginal tissue. Intravaginal estrogens are available in creams, rings, or vaginal tablets and suppositories. Another option is a synthetic drug named Prasterone which stimulates estrogen and testosterone production in the vaginal tissue. This medication does not increase systemic hormone levels and as a result it may be a safer therapy for patients with contraindications for estrogen.
Systemic hormonal formulations are available in pills, patches, sprays and topical gels. These preparations are usually reserved for women with more bothersome symptoms including hot flashes and night sweats as they are absorbed throughout the body which increases the possibility of other side effects.
Selective Estrogen Receptor Modulator (SERM)
This non-hormonal oral pill works to act like the estrogen hormone in some parts of the body to induce changes to the vaginal wall thickness. The daily medication must be taken with food and could be an option for women who do not want or are unable to use estrogen.
Patients should understand that dyspareunia is unlikely to improve without treatment. Those with symptoms are encouraged to visit their gynecologist where a comprehensive medical history and pelvic examination should be performed. The patient and her doctor will discuss the treatment options and possible medication side effects. Treatment selection should be based on a woman’s medical history, preference and ability to take the medication as prescribed. Patients with a breast cancer diagnosis should discuss this with their doctor before using estrogen in any form.
- Dr. Marrero is Board Certified in Obstetrics and Gynecology and an active staff member in Plantation General Hospital; with expertise in Minimally Invasive Laparoscopic Surgery including the Da Vinci Robotic System. Dr. Marrero has a complete scope of knowledge in Obstetrics and Gynecology including cancer screening, vaginal deliveries, cesarean sections, colposcopies, open and laparoscopic hysterectomies, open and laparoscopic myomectomies, STD testing, ectopic pregnancies, menopause symptoms, vaginal dryness. Born and raised in Puerto Rico, Dr. Marrero speaks both English and Spanish. For all her incredible dedication, hard work, and love for her work, she was selected for inclusion into the Leading Physicians of the World. Camil Marrero MD, MPH, FACOG Obstetrics and Gynecology is located at 1200 North University Drive, Plantation, 33322. For more information or to schedule an appointment, please call 954-474-2229 or visit marreroobgyn.com.