Vaginal Atrophy: The Fate of Our Vaginas As We Get Older.

Vaginal atrophy
The fate of our vaginas as we get older.

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They say the Devil's best trick was to convince the world that he doesn't exist. So he can always cause mischief hidden. If there were a devil in the health of female sexuality, it would be vaginal atrophy in the eyes of gynecologist Sheila de Liz. She explains what is behind it in her book "Woman on Fire".

by Sheila de Liz

Vaginal atrophy is popularly referred to by the comparatively harmless and completely misleading term vaginal dryness. But there is much more to it than that. Vaginal atrophy affects at least 70 percent (!) Of all women beyond menopause – i.e. almost all of them – and has been hushed up for decades. Even the gynecological societies and the pharmaceutical industry ignored vaginal atrophy.

Vaginal Atrophy: What Exactly Does It Mean?

Like almost all postmenopausal diseases, vaginal atrophy is a creeping process that can drag on for months and years. It is caused by Lack of estrogenwho is first and foremost in a Thinning of the mucous membrane at the vaginal entrance makes noticeable. On all sides of the entrance there is an area that reacts most intensely to the hormone deficiency; From your point of view, when you look down, this is the lowest point of the entrance, at the transition from moist to dry skin. If you look at the vulva from the front, this area is also called 6 o'clock.

Why always here first?

It is the case that the vagina is most intensely and densely populated here by receptors, the docking stations for hormones. On the one hand, this means that we are most sensitive to sexual activity at the entrance, but on the other hand, we also feel the lack of hormones there first. The vaginal mucous membrane can actually serve as a kind of hormone level indicator during the examination and thus assess how well the body is generally supplied with hormones.

How does vaginal atrophy show?

  • Vaginal atrophy is going through Itching, burning, or pain during sex, and yes, dryness in general and during sex in particular noticeable.
  • The skin no longer looks like the pink panther, but rather pale pink on the sides like a ballet shoe or dark pink, going into Bordeaux. Right at 6 o'clock. one often sees very fine vessels that one would otherwise never see because they lie deep in healthy mucous membranes.
  • Over the years it will the skin becomes thinner and more sensitive.
  • The vagina increasingly loses elasticity and no longer likes to stretch.
  • The Entrance begins to tear apart with every sex. The dam also often becomes rigid and less yielding. At some point, the entrance eventually begins to shrink, making any penetration very difficult – with both a penis and a dildo. Women who have not used their vagina for years often only have a very small entrance that can only accommodate a little finger or, in extreme cases, a cotton swab.
  • The Skin becomes tissue-thin and burns when touched and often when peeing.
  • Many women can no longer wear tight jeans or sit longer, which makes cycling, horse riding or movie nights impossible.

Why is that so?

So now we know: vaginal atrophy is no small matter. She means one progressive breakdown of the vaginal mucosa and with it the slow decline of the vagina as a sexual organ. Later on, there are urethral complaints that are not initially associated with a hormone deficiency, as well as frequent urinary bladder infections and increasing incontinence. Many women believe that it is normal to have these symptoms and, like hot flashes, they are temporary. In advertising, lubricants and vaginal care creams are offered, which supports the fatal misunderstanding that the skin is simply dry and needs care. But women who try creams often get frustrated sooner or later because they still have pain during sex, often hell. At this point I would like to remind you that. I emphasize this because countless women come to me who have been told in other practices that sex shouldn't be important anymore. Many women who ask at the age of sixty what they can do to save their sex life are ridiculed.

Is there anything you can do about vaginal atrophy?

For the sake of your own urogenital health, but also for a fulfilled sex life in the future and relationship hygiene, I would not only say that you can do something, you have to do something. The very first and foremost measure is to regularly use a vagina and vaginal entrance Hormone ointment to treat. This hormone ointment contains estriol, a very weak type of estrogen. The ointment is designed to work only on the mucous membrane and not to pass into the rest of the body. Estriol nourishes the vagina and makes it moist, soft and resilient again. The pH value becomes acidic again, the bacteria community normalizes. It no longer burns and pain during sex is significantly alleviated, if not eliminated. Another thing you can do is get the vagina with you CO2 laser to treat. This is a relatively painless procedure from the USA in which the cells in the uppermost layers of the mucous membrane are stimulated by means of a CO2 laser to produce more moisture and to divide more frequently; Healing processes are triggered and blood circulation improves. In fact, the first data from larger studies are available that show that both the oestriol ointment and the CO2 laser help and the combination of both is unbeatable. Sometimes, however, the vaginal skin is so damaged by the hormone deficiency that nothing can be used, because every ointment or cream stings too much. If this is the case, I recommend first building up the skin using the CO2 laser and then using the oestriol ointment to keep the skin of the vagina healthy.

Better safe than sorry – even down below

I always recommend early with the evening ointment treatment to begin – preferably before the symptoms start! During the gynecological examination I can see whether the estrogen deficiency has already set in, and even if there are subtle changes, I advise you to incorporate the oestriol ointment into your evening routine. Which is actually quite logical, but this type of prophylaxis still the absolute exception in German practices. Even if they are already beginning to see signs of atrophy, most gynecologists rarely explain what vaginal atrophy is and what happens if it is not treated or prevented in time. Instead, the status of vaginal health was similar to that of dental health in 1950: Back then, you first went to the dentist with a toothache, not before. It is all the more important to continue educating women.

Vaginal Atrophy: In a Nutshell

  • The lack of estrogen makes the skin of the vagina thin and vulnerable.
  • Over time, it continues to degrade, which can result in pain during sex, burning, discharge and itching.
  • As a long-term consequence, vaginal shrinkage and tears can occur during sex.
  • An estimated 70 to 80 percent of all women get this!
  • The gynecologist sees the changes. Before you can feel them as affected.
  • A consistent and permanent treatment with estriol ointment can
Gynecologist Sheila de Liz: "Those who have sex don't age so quickly"

© Gaby Gerster

Dr. med. Sheila de Liz, born 1969 in New Jersey, came to Germany at the age of 15 and studied medicine in Mainz. Since 2006 she has been working in her own practice for gynecology and obstetrics in Wiesbaden.

There is much more worth knowing about menopause and women's health in her current book "Woman on Fire". It was published by Rowohlt-Verlag and costs 16 euros.

Book cover

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