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Menopause Q+A

  • KRISTIN, 58 | SIMI VALLEY, CA What do sexually active menopausal women need to know about STDs?

    The reality of being single and sexually active as a menopausal woman is that the rules have changed quite a bit. Communication between you and your new partner is so important and it’s best to have the serious sex talk before getting into bed together. I would suggest you talk about your sexual histories, if your new partner has any sexually transmitted infections (STIs) and if he or she is monogamous. Your new male partner must wear a condom during vaginal or anal intercourse. Safe sex would also include your male partner wearing a condom during oral sex. Women really have to be knowledgeable and aware. They have to carry condoms in their purse and insist that they are used.

    You should ask if your partner has ever had any STIs which include chlamydia, herpes, gonorrhea and human papillomavirus (HPV). The human papilloma virus (HPV) is the most commonly passed STI and condoms do not completely protect against its transmission.

    Recent studies have revealed statistics that might shock you:

    • The rate of STIs in those over the age of 45 has doubled.
    • One in five sexually active singles reported using condoms regularly. Only 12 percent of men and 32 percent of women said they used one every time.
    • Those over the age of 45 had the lowest rate of condom use.
    • Older immune systems are less effective at fighting infections, which can increase the risk of STIs.
    • Older women have less natural lubrication and thinning vaginal tissue, leading to tears, which then create a higher risk of transmitting STIs.
    • The number of older people diagnosed with HIV has nearly doubled. Fifteen percent of new diagnoses of HIV were in people over the age of 50.
    • Delays in diagnosis and treatment are more common in the older population, allowing infections to become more advanced and harder to treat.
  • SANDRA, 54 | SANTA MONICA, CA How can I enjoy sex while in Menopause?

    The bottom line is that quality of life, especially in the bedroom, is incredibly important and should be a priority. Expect the unexpected as your body transitions into menopause, Vulva-Vaginal Atrophy (VVA). Menopause is a natural process and everyone goes through it differently. Take good care of yourself through diet and exercise. Communicate openly with your partner so they know what you are going through. If you are physically suffering with painful intercourse don’t be afraid to use vaginal estrogen. VVA does not have to ruin a sexual relationship with your partner

  • CAROL, 59 | ONTARIO, CA Will my vagina ever be the same after Menopause?

    Many women suffering from vaginal atrophy have usually not had regular vaginal penetration. That lack, combined with VVA, can result in a shrinking of the vaginal opening, which may be combatted with the use of a vaginal dilator. A survey found that 45% of women have never actually had an honest conversation about their vaginal dryness with their health care provider. They may have resigned themselves to sexual intercourse only once or twice a month or on “special occasions,” giving the term “birthday sex” a whole, new despairing meaning.

    To begin the process of opening up again, literally (and perhaps figuratively), vaginal dilators may be employed to stretch the vaginal opening. Usually the process involves use of a dilator for 20-30 minutes, three to five times weekly, gradually increasing the size, with the goal of making vaginal penetration easier on the tissue. Used in combination with weekly estrogen cream therapy, symptoms related to vaginal atrophy may be reversed, allowing painless (and, with luck, enjoyable) intercourse. As long as you’re at it you might try soaking in an Aveeno bath for 20-30 minutes a day as a pampering addendum to treating dry skin, not only in the vaginal area, over your entire body.

    Alternatives to conventional dilators can be found not only at a local sex toy store in the form of dildos and vaginal vibrators, they’re also at your local farmers market, in the form of cucumbers or zucchini. If you do however choose a ubiquitous form of produce, make sure you use a condom on it to avoid unwelcome bacteria. A pea-size dollop of topical lidocaine applied to the entrance of the vagina also helps in avoiding pain when introducing anything into a sensitive vagina, be it vegetable or mechanical. Because some of my shyer and less adventurous patients don’t know where to begin, I have gone online in my office with them in order to scroll through dildos on goodvibrations.com, a great, accommodating online sex store that caters to women. While we’re perusing the endless array of toys, I ask these shyer patients of mine to try and approximate their husband or partner’s “size.” I tell them to decide on a color—No, what color do you prefer? I ask them to choose a special lube, to pick a vibrator. “What else?” I ask. “What else is on your wish list here?”

    I’m glad to say that most of these patients report back with promising results after conventional vaginal therapy combined with a little fun (perhaps in the form of a classic purple dildo). Realize that when you enter Menopause it’s not just the vaginal pain and dryness that can ruin a perfect date night, it’s the worry of vaginal collapse from infrequent intercourse. If you are having problems not only with dryness, but vaginal shrinkage and pain, please talk to your health care provider. Keep in mind that creative strategies are not only fun, but may be a necessity!

  • SONIA, 61 | West Hollywood, CA How will the Mona Lisa Laser help my menopausal Vagina?

    Meet the Mona Lisa Touch Laser Treatment, the newest kid on the block to combat vaginal atrophy. An Italian-built laser device, the Mona Lisa Touch Laser holds tremendous promise in treating a vagina that has been transformed in Menopause. Once you’ve had a pelvic exam to assure that you are an appropriate candidate, a physician trained in the use of the Mona Lisa—which is actually, a small vaginal laser—inserts the device into the vagina during three one-minute sessions, six weeks apart. Many women report positive changes after just the first one-minute treatment, which involves removing the dried skin inside that vagina, thereby stimulating collagen production and allowing vaginal revival. The end result is a vagina makeover—a new lease on a vagina, if you will—with more elasticity and natural lubrication of the tissue inside the vagina. Although it may sound too good to be true, the results are proving to be a game changer in the way vagina atrophy is being treated—without hormones—which is a relief to many women and their partners.

    Mona Girl is ideal for the woman who cannot take estrogen due to a personal or family history of breast cancer or for those who are unhappy with the side effects associated with HRT.

    The success of the Mona Lisa Touch Laser is undeniable. Many satisfied customers are singing its praises, claiming that they are not only able to have sex again for the first time in ages, they are actually enjoying it. Seemingly, the post painful part of the procedure is the cost, which runs about $1000 a session and is most likely not covered by insurance.

    Bottom line: Quality of life, especially in the bedroom, is incredibly important and should be a priority. VVA does not have to ruin you and your partner’s sexual (or emotional) relationship. A vaginal preparation used two to three times weekly, at bedtime, can reverse any of the aforementioned disruptive symptoms associated with VVA without an increased risk of breast cancer and the side effects related to long-term hormone replacement therapy. Don’t hesitate to discuss this common problem of VVA and its possible treatments with your healthcare professional. No more suffering in silence, please.

  • JONNA, 58 | WEST HILLS, CA Is Menopause just a phase I will pass through?

    Here’s the thing, Menopause is the next chapter of your life, not a phase that you go in and out of like puberty. Many women believe that once the obvious and most common symptoms of Menopause lessen—such as hot flashes, sweating, insomnia, depression, anxiety, apprehension, weight gain or loss, fatigue, poor concentration, memory loss, heart palpitations, exacerbation of migraines and vaginal dryness—Menopause is done. Not so, rather, it may be just the beginning of your new “normal.” Yes, many of these symptoms do improve over time, but knowing that doesn’t help when you’re at the height of discomfort. All of these symptoms can disrupt the quality of life, but they can be lessened and, in some cases, eliminated with simple medication and lifestyle modifications.

  • TAMMY, 53 | NORTH HOLLYWOOD, CA Will HRT make me fat?

    Not. Look, weight gain in Menopause is a reality for many of us, but it is not the HRT that will make you fat! Many women over 50 and on HRT tend to blame their weight gains on the therapy, but that is not the cause. Plain and simple, as we age it is harder for us to lose weight. The hormonal upheaval of Menopause tends to make weight gain in the usual places—abdomen, thighs, hips and buttocks—a common complaint. That upheaval, along with aging, genetics and lifestyle choices, makes losing weight all the more challenging. Some believe that you need to eat 200 to 300 less calories to maintain your current weight once you hit 50, but the main focus for women should be on eating a healthy, well-balanced diet, regular exercise and limited alcohol consumption.

  • AMANDA, 55 | Santa Monica, CA Are bioidentical hormones a safer form of HRT; are they safer than traditional HRT?

    Okay, as a teenager I loved the TV series Three’s Company as much as the next person, but Suzanne Summers would not be my go-to gal on the merits of bioidentical hormones. First of all, the FDA, an independent group that regulates and tests for safety and efficacy of medication, has not approved bioidentical hormones, and many health insurance companies do not cover them. In contrast, medications that Western doctors prescribe have been properly tested in reliable medical studies, proving their safety and efficacy as per the FDA. Compounded bioidenticals have also not been tested in clinical trials in the same manner as hormone replacement therapy. Then there’s the question of what is “natural?” Are biodenticals more “natural?” They’re made from plant products such as soy and yams, but they still need chemical processing to become active in the body. In truth, many estrogen pills, patches, gels, creams and sprays are also bioidentical, so just because hormones are termed bioidentical, it doesn’t mean that they are more natural.

    My point is that if you do choose to use bioidentical hormones, it’s important to understand that they are not proven to be any safer than hormone replacement therapy.

    In Gretchen’s case, she was given too much estrogen and, as a result, developed pre-cancer cells of the uterus. As for the monitoring of her estrogen, salivary testing has not been shown to be a reliable way of testing estrogen levels in the body. The good news is that pre-cancer cells are a medically treatable condition, but one that could have been prevented if Gretchen had been prescribed a safer, lower dose of HRT.


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