Vaginal atrophy is a topic we often get calls about at Good Clean Love. I remember the first time someone called with a question about this condition that I didn’t yet know had a name, or worse still, was a syndrome that remarkably impacts at least 50 percent of post-menopausal women. Its prevalence is hard to track as is the impact it has on couples’ lives, because most women won’t discuss it, even with their physicians. Chronic and progressive vaginal atrophy has been referred to as “the 21st century health issue impacting women’s quality of life.” You would think the fact that millions of women and couples deal with this issue would make it a more accessible topic, or at least one that merited researching solutions.
Many of the symptoms that culminate in vaginal atrophy begin in perimenopause. This is the time when many women experience pain with sex (dyspareunia) caused by thinning, shrinkage and inflammation of the vaginal walls due to a decline in estrogen levels as women age. The predominant treatment modality for this condition is hormone replacement therapy, as well as the use of vaginal moisturizers and lubricants. I know these symptoms intimately myself, as it was my inspiration to start Good Clean Love.
Unlike men, who are generally much more invested in maintaining their sexual capacities for years, which speaks to the extensive funding and research on male sexual functioning, many women give up too easily on their sexuality. The significant hormonal drop that accompanies menopause takes with it not just internal vaginal moisture and elasticity, but also much of the drive and internal signals that women associate with feeling aroused.
Many doctors treat vaginal atrophy as though it is inevitable. The belief that the condition is progressive, chronic and incurable impacts the women being treated as much as the limited, mostly topical options presented. It is true that the more that a woman ignores the issue and retreats from sex, the more that her vagina shrinks and closes up. If the maxim “use it or lose it” applies anywhere, it is here. Although, it is also true that setting penetration as a goal in itself is both unrewarding and hard to comply with when burning, bleeding and sharp pains are the result.
What is critically absent from most discussions about female sexual functioning is that the arousal mechanism is triggered first in the limbic brain. Building and maintaining a relationship to your erotic self is the doorway to working with the changing genitalia. Unfortunately most women do not have a strong sense of their erotic selves even at the height of their sexuality. Shame and guilt can and do cloud our willingness and capacity for pleasure. Fantasies, which are the fuel for our sexual identities and pleasure pathways are more often repressed than explored.