The blue pill for men has been widely known about, prescribed, used and marketed for years. And, while there are risks to any medication, it's good that men have that option available to them to improve their quality of life, relationships, and self esteem. It's a good thing.
But what about women? Why do their symptoms remain untreated?
One of the biggest complaints and changes for women in their perimenopause and menopause years, is what is known in the medical world as the Genitourinary Syndrome of Menopause (GSM). According to the Menopause Society, "The genitourinary syndrome of menopause is defined as a collection of signs and symptoms associated with estrogen deficiency that can involve changes to the labia, introitus, vagina, clitoris, bladder, and urethra."
In addition to dropping estrogen, women also experience a decline in dehydroepiandrosterone (DHEA). DHEA is produced in the adrenal glands and is a precursor to estrogen and testosterone.
While not all women will experience symptoms, an October 2022 research report entitled "The Silence and the Stigma" by the Menopause Foundation of Canada showed:
57% of women surveyed reported vaginal dryness/burning/itching
57% reported low libido
34% reported pain with intercourse
34% reported incontinence/leakage
Yet many women remain untreated for various reasons.
they may not realize their symptoms are a medical condition that can be treated effectively
depending on cultural or religious beliefs, it may be difficult to talk about the symptoms
healthcare providers may feel uncomfortable discussing the symptoms
healthcare providers may not feel they have the adequate knowledge to address the symptoms
there may be feelings of shame, embarrassment or fear of safety preventing women from discussing symptoms with their practitioners
What is so important for a woman to understand here, is that while many other symptoms of perimenopause or menopause resolve or settle post menopause, the symptoms of GSM can get worse if left untreated. We will talk about treatments, but first:
What's happening to us that's causing these symptoms?
In our perimenopause and menopause years (can be as early as in your 40s) women begin to lose estrogen production from their ovaries. While this is a natural transition that all women will go through if they live long enough, the impact of declining estrogen can affect women in various ways.
Estrogen plays a role in almost every system in our body. When it comes to vaginal and sexual health:
There are estrogen receptors throughout the vagina, vulva, urethra, and in the trigone of the bladder
Estrogen’s role is to maintain blood flow to the vulvovaginal tissue, the collagen within the epithelium, and the hyaluronic acid and mucopolysaccharides within the moistened epithelial surfaces
Estrogen plays a role in supporting the microbiome and protecting the tissue from pathogens
Estrogen deficiency can lead to:
Vaginal dryness
Burning
Itching
Frequent urination
Burning with urination
Vaginal discharge
UTIs
Urinary incontinence
Bleeding after sex/penetration
Pain or discomfort during sex/penetration
Decreased vaginal lubrication
So what can women do about it?
Talk to a medical health care professional
There are a number of hormone therapies that can be prescribed vaginally that directly treat symptoms of GSM; including vaginal estrogen (in the form of creams, rings or tablets), or vaginal DHEA for vaginal dryness or pain with sex.
There are also medications that can be prescribed for urge urinary incontinence.
In either scenario, it is important to have a discussion and examination by a trusted health care professional to ensure there are no other underlying reasons you may be experiencing these symptoms (for example some cancers).
Pelvic Health Physiotherapy
Pelvic health physiotherapy can be a game changer for a woman. Pelvic health therapists are specialized practitioners that can provide expert assessment and treatment in the areas of pelvic or vaginal pain, urinary incontinence and pain with sex (amongst other symptoms). They are educated in exercises and tools/toys that can help ease the pain, promote healthy sexual relationships, and improve the function of the pelvic floor. They can also make appropriate referrals for counselling (as can other practitioners) if there is a psychological reason or trauma related to the pain.
Lubricants and Moisturizers
Vaginal (and surrounding tissues) moisturizers used as needed or directed, support the moisture of the tissues. You can use a clean organic coconut, mineral or olive oil, or there are some great companies like Feel Amazing that offer a great Canadian based product.
Using lubrication during sex, penetration, or self pleasure will also create a more enjoyable experience for both you and your partner and reduce any tissue aggravation or friction. Canadian based company Intimate Wellbeing offers some great products.
For both lubricants and moisturizers be sure they are free from scents or ingredients that can cause irritation.
While on the topic of sex - intimacy, regular sex, pleasure and care is important to maintaining tissue health. So let go of any shame or fear you may have around that and go have some fun.
Hygiene tips
Other ways to maintain vaginal tissue integrity, reduce incontinence, avoid UTIs, and improve symptoms of vaginal dryness or itching include:
avoid scented soaps or detergents
avoid scented tampons or pads
avoid scented lubricants or moisturizers
wash/shower with water and pat the area dry vs harsher wiping
wear cotton or breathable underwear/ clothing
be sure to wipe from front to back after urination
void after intercourse
eat a healthy diet (avoid insulin spikes, encourage healthy microbiome)
Summary
The GSM includes many symptoms ranging from incontinence, to vaginal dryness, to pain with sex. The loss of estrogen and DHEA during perimenopause and menopause are directly related to these symptoms. Unlike other menopause symptoms such as brain fog, mood swings, hot flashes or weight gain that settle post menopause, the GSM if left untreated, can get worse. Early assessment and intervention key. There are a number of treatments and self care strategies that can help you within weeks to months, and can dramatically improve your quality of life, relationships, self esteem and comfort.
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