Last year, Huffington Post commissioned me to write a story on how women can successfully broach the topic of vaginal dryness with their partners. They published it as a service piece in a series of slides which was a good summary of what the experts I interviewed proposed. I thought you might be interested in reading my original draft because it includes additional information not included in the slide show. I have also included links to some interesting research at the end.

The Original

Vaginal dryness caught Barbara by surprise. Recently married for the second time and in her early forties, she was having sex with abandon. “It was fantastic,” she recalls. “There was no trouble with any aspects of sex.” But several years into her marriage, sex became very painful. “I was quite worried but I didn’t attribute the pain to natural aging or hormones, or to vaginal dryness.”

 

Vaginal Dryness Gets Worse

 

Though vaginal dryness is common—30% of perimenopausal and 50% of post-menopausal women experience vaginal symptoms—most women lack a general understanding. Sadly, as Toronto physician Dr. Anne Madigan observes “women feel responsible, embarrassed and shy, when it’s just a fact of aging.”

 

Dryness happens when ovaries stop producing estrogen during menopause.  Dr. Madigan explains, “estrogen maintains normal vaginal tissue and the clear lubricating fluid which makes vaginal intercourse comfortable. The vaginal tissue becomes thinner, and there is less blood flow to the area and less secretion.”

 

While other menopausal symptoms typically resolve after the menopausal period, vaginal dryness often persists and worsens. This comes as unwelcome news to women who are living longer and healthier lives, and have greater expectations of sexuality.

 

 

Vaginal Dryness – The Taboo Topic

 

Most women don’t talk about vaginal dryness—not even with their doctors, who are generally not well trained or comfortable talking about it either. Dr. Madigan says, “I always ask my patients, ‘how is your sex life?’” She observes, “Women will talk about hot flashes, insomnia and irritability. They often talk about memory loss in a funny manner—but they don’t talk about vaginal dryness.” She notes that if women are not talking about vaginal dryness with health practitioners, “it’s unlikely they are discussing it with their partners.”

 

Chia Chia Sun, CEO of Damiva, a company that makes all-natural products for menopausal health, agrees there is a need for more straight talk about menopause. Damiva’s campaign “Enough beating around the bush. Let’s talk about your vagina” recognized the need to “normalize” women’s experience.

 

Damiva’s research and conversations with women led Sun to conclude, “This was a topic that no one wanted to talk about.” In fact, women are much less willing to talk about their own vaginal dryness than they are about their male partner’s erectile dysfunction. Sun notes that “the promotion of big brands like Viagra and Cialis have actually opened the door for more frank discussions.” Dr. Madigan wryly observes, “We don’t have many ads for vaginal dryness on television. The message is that it is really important for men to have sex, but what kind of message is there for women?”

 

 

 

Opening the Door to Greater Intimacy

 

Sun says she once tried to give a sample of lubricant to a woman who said, “I can’t take that, he’ll think it’s my fault.” She observes, “It is your issue but it’s not your fault. If you feel it is your fault you can’t even open the door to talk about the issue.”

 

Toronto relationship therapist Susan Valentine says that talking about vaginal dryness is an opportunity to increase connection and intimacy, and something a couple should deal with together. “It is difficult to talk about issues that make us feel vulnerable,” she says, but “part of what ends up disconnecting couples is the withdrawal and other defenses that arise in trying to protect oneself from shame or embarrassment.” Dr. Madigan explains that because it hurts to have sex with a dry vagina, women can become withdrawn. “They are not less interested in their partner, but the partner can feel they are not interested in them.”

 

Valentine says it is important for a woman to share what she is experiencing physically and also emotionally. “When women raise the issue of vaginal dryness, we are essentially expressing vulnerability and requesting reassurance that we will be loved through these changes and challenges, and as we age.” She adds, “Learning to talk about our fears and vulnerabilities with our partners strengthens our connection and overall relationship. It provides our partner with the chance to listen to our concern, validate it, and offer empathy.”

 

 

Your Vagina Still Works. It’s Just Dry

 

The good news, according to a global survey, is that the vast majority of men want their partners to share their experiences.

 

Barbara originally hid the pain from her partner: “I didn’t want sex to be unsatisfying for him, to the point that I was experiencing bleeding.” After opening up, he tried to help. “He came home one day with a bunch of lubes, and said ‘let’s have some fun’ which was awesome but every one caused terrible irritation.” As Barbara discovered, not all products are created equal and additives like warming, flavours, and colours can be irritants. Products may be labeled “natural” even if there is only one natural ingredient among many.

 

Beyond moisturizers and lubricants, which Dr. Madigan says is “like moisturizing your face,” other options like low dose estrogen cream or tablets that are not HRT (which more and more women avoid) can help vaginal walls be less dry. Vaginal dryness can be addressed. Dr. Madigan points out, “It’s not like your vagina doesn’t work. It’s not like it can’t be helped. It’s dry.”

 

While women may avoid sex because of pain, abstinence is not the answer. Dr. Madigan says “regular sexual activity or vaginal stimulation with or without your partner increases blood flow in the area. If you don’t have sex for three months it can feel uncomfortable so ironically it can help to have regular sex to cause secretions.”

 

Sexual intimacy is not only good for the vagina, it is good for the relationship. Barbara says, “sex and love-making helps you bridge the gap that dialogue can’t. Our emotional needs are often met through non-verbal communication.” She thinks, however, that there is too much societal pressure towards penetration when “there are so many other acts.” She adds, “guys are so sensory and I think men have sex with their eyes.”

 

But for sexual intimacy to happen at all, women need to understand, accept and talk openly about their physical changes and emotional needs. Their romantic partners need to provide empathy, reassurance and support. And there needs to be more talk between women and their doctors, and in society in general. Attitudes are starting to shift.  Damiva’s Chia Chia Sun says, “We are on the cusp of breaking taboos.”

 

 

Research Sources

 

The CLOSER (CLarifying Vaginal Atrophy’s Impact On SEx and Relationships) survey: implications of vaginal discomfort in postmenopausal women and in male partners.

http://www.ncbi.nlm.nih.gov/pubmed/23809691

 

Management of Menopausal Symptoms

http://www.nejm.org/doi/full/10.1056/NEJMcp054015

 

International Menopause Society calls upon medical community to improve the vaginal health of postmenopausal women

http://www.eurekalert.org/pub_releases/2010-10/eh-icu100610.php

 

Atrophic Vaginitis: An Undertreated Epidemic, Part I (Slides With Video)

http://www.medscape.org/viewarticle/577629

 

 

Your Aging Sex Drive: What’s “normal” after menopause

http://www.medicaldaily.com/your-aging-sex-drive-whats-normal-after-menopause-272816

 

 

 

Photo credit: Unsplash-Nathalia Bariani

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