Menopause: treating atrophic vaginitis and complications

In the last post I alluded to my recent long running and distressing genital issues. In short, I was sore and very red and very, very worried about it all because of a) the discomfort and b) the inability to enjoy sex.

I share this information to help other women and their partners because the problems I experienced are rarely discussed. Everyone will expeience some problems over time, but only a smaller proportion experience the chronic issues I've experienced so early.

I believe I’ve suffered a number of interacting conditions, so it was hard to solve the problem – atrophic vaginitis, bacterial vaginitis, thrush, vulval eczema etc. Plus of course the effects of ill-conceived remedies based on my own ignorance!

I normally use Ovestin cream on my private parts to overcome the negative impacts of menopause.

Doctor Dan prescribed a steroid cream to treat the inflammation and told me to avoid everything else besides warm salty water! The steroid cream settled my inflammation within a week, but it had the potential to mask any other issues such as allergic reaction and infection.  

Without oestrogen cream (I use estriol cream) my genital tissues become less robust and my vaginal pH became less acid.  Hence without hormone cream I suffer pain upon intercourse and am prone to microbial imbalances, thrush etc. The condition is called atrophic vaginitis with overlain infections.

But wait …one of the most common side effects of Ovestin cream is skin irritation…. The gynaecologist recommended stopping all treatments for a week … where upon I contracted a bad case of thrush because without hormones, I am hugely prone to infections! Thereafter followed 2 courses of Canestin cream!

Now I needed quick access to a topical source of non-irritating oestrogen. The only option easily available in Australia is a compounded cream. I found a pharmacy and they conferred with my doctor to formulate a cream. More delays!

The pharmacist asked me to trial some cream bases to see if they irritated me. A reliable trial was very difficult. I chose the base which did not irritate my face and which did not appear to irritate my private parts (I just tried a small patch).

Eventually I got my cream. I applied the cream almost every day until the yellow discharge (from cervical atrophy which occurs without topical oestrogen ) went away. However, I was still a little sore. I could not see the white cottage cheese like material that is characteristic of thrush and there was no bad smell, yet my inner labia and associated areas were mottled red. I could manage sex only once a week.

I am prone to skin irritation and allergies, so I concluded I may be irritated by something. Also irritated skin is easily colonised by microbes which makes things worse.

One option was the cream was irritating me – yet an alternative would be difficult to find. Hence, exploring other causes seemed like the best thing to do.

I cut back on soap and shampoos and rinsed with warm salty water acidified with plain vinegar. I figured this would tend to soothe and also knock back infections. I also applied steroid cream daily after my shower. I mixed in Vitamin E hoping that would promote healing.

Importantly I could not associate any worsening in my condition with these treatments – if anything makes things worse one must stop IMMEDIATELY.  

Knowing that female genital tissues take a long time to react to treatments, I waited patiently and things did seem to be good some times. However, I was still sore at times.

I tend to suffer skin infections in parts near my private parts – thrush and the like.  I guessed these might be transferred to my private parts, so now I treat any parts that might become infected everyday after my shower with vaginal Canesten or even with dilute hydrogen peroxide.         

My partner’s female doctor suggested that the henna I use on my hair and any soap could be irritating – in fact, some women apply henna to their pubic hair and consequently experience irritation of the mucus membranes.

So .... currently I am obssessively protecting my private parts from all shampoo, soap and hair treatments. I wash my hair over the sink. If I use soap on the upper part of my body, I wipe it off many times with a wet flannel before taking my shower.

Finally I seem to be getting some control and needing the steroid cream less. I will need a few more weeks before I know things are working well.

The lesson: keeping one’s post-menopause genitals in working condition requires careful management of a whole system of matters and influences.  Medical advice and pharmaceuticals are important, but in the end, one’s personal management is the key to success.

Menopause: further changes in the vagina

Something no one talks about is that menopause and aging inevitably leads to deterioration of the female genitals. I cannot make too many general statements because I am only an expert on myself, but I hope what I have to share may help.    

Many women just accept genital atrophy and get on with putting up with the discomfort and not having sex. I imagine that is one of the reasons many single older women choose not to find a new partner.

I also imagine genital atrophy is a reason married women give up on sex. Pain combined with lack of hormonal driver (i.e. lack of libido), dissatisfaction with partner, fatigue and beliefs that older women don’t have sex could make it easy to just avoid sex.    

One of the first signs of atrophy can be pain on intercourse or other sexual activities. There might also be chronic inflammation of the genitals. Another sign is malodorous yellow discharge (or indeed just yellow discharge).

I started off with yellow discharge plus a moving feast of different distressing smells. After my hormones stopped I started to feel pain upon intercourse, possibly due to lack of lubrication and more fragile tissues.

Ovestrin cream alleviated my genital atrophy problem for about a year, then the irritation and pain upon sexual activities including .intercourse began again. <sigh>

At first I put up with the pain and soreness after sex. My partner travels a lot for business and is very considerate, so I had time to recover in between. However, the problem became worse and my ability to have sex decreased.

I tried all sorts of remedies that had worked in the past – yogurt, probiotics and even some aggressive treatments that worked on fungal / microbial infections on other parts of my body. BIG MISTAKE!!!! Things that work with robust pre-menopause private parts may not solve post-menopause problems and make things much, much worse!!!.    

Eventually my vagina and surrounding area was flaming red and very sore. POOR ME!

SOLVING THE PROBLEM TOOK MANY MONTHS. This is something hard for men to understand. It was also hard for me to understand. Awesome commanded “see the doctor and get it fixed”. This started months of experiments. Thank goodness he is patient! 

Please see the next post for the management system I've devised ...:-)

Menopause - be part of the solution

As a woman approaches menopause she may be less able to cope with her home duties and workload. Brain fog, fatigue and anxiety can really reduce her ability to reach the standards she sets for herself and those set by others. As a consequence she may become unhappy, frustrated and irritable. Peri-menopause can become a nightmare for all involved when it could be at least tolerable and perhaps even leveraged for positive change.

I’ve wanted to share this case study with you for sometime. This really happened and I am sure in some years time there will be a husband complaining that his wife does not care for his needs etc….and he will have no idea why that happened.

Sally (not real name) complained of fatigue and difficulty coping. A traditional woman, she does all the housework, works full time at a demanding job and does all the bookkeeping for the family. Her two teenage children study full time and one holds down a job as well. Her husband has a demanding job.

I explained how menopause was contributing to her mental and physical condition and strongly suggested it was time to recruit the family to help.  

Consequently she lined the family up one weekend to spring clean a major room in their lovely new home. In our climate a thorough clean is required every year as dust can collect and mould grow on walls etc. Pest insects can also move in if cleaning does not occur.

The husband and kids stood at the door and she explained the steps in the project – move furniture, wash walls, dust furniture, clean floor, replace furniture.  If they all helped, 2 hours, on her own 1 day. The kids piped up – “we don’t wash walls”. The husband agreed. “We’ll come back when you have washed the walls”.

Sally had really taken a risk by asking for help. The emotional cost was high. She was left feeling totally abandoned, powerless and disrespected. She did the job herself including moving the furniture while the rest of the family watched TV.  

So now she knows her husband will not support her when she really needs him.  

She knows the only way to get help is nagging and nastiness like dumping clothes left around the house in the garage. Her family think she has turned into a bitch.

The husband needed to support his wife. He had a chance to be part of the conversation, to be part of the solution. He could have attended medical appointments and helped work out strategies to solve the challenges of menopause including change in libido.    

Now Sally needs to solve her own problems and is very resentful - does he really think sex for him will be on the top of her agenda when she faces decreasing libido and vaginal atrophy?

The lesson for husbands – be ready to step up and support and protect your wife during peri-menopause. You can come out of this the hero with an efficiently running household and a happy marriage or you could drive your wife into depression and nagging. I doubt it is possible to be really close after betraying your spouse in her time of need.      

Menopause – plan to make it easy

I’ve wanted to write this for a while, yet have lacked the creative energy and time to do so – which I feel is a common issue for peri-menopausal and to an extent post menopausal women.

We all slow down with age and can manage less. However, women may experience a much more acute onset of body limitations than do men.

Fatigue, brain fog, anxiety and lack of the emotional energy necessary to persuade others to help out are common issues faced by women during menopause. Things get a bit better after menopause but it’s likely one will never be the same again. For example, working over night to get a job done will be harder and recovery from loss of sleep will take days.  

Medical, nutrition and life style solutions are important and need to be considered at leisure rather than in emergency situations, but they will not magically put things back the way they were and anyway, one is slowing down due to age anyway. Strategic change is essential.

Obviously, one needs to plan for menopause and mobilise the family to get things done and maintain standard of living etc. Study of likely issues, risks and solutions thereof is obviously very important.

You need to be ready to identify the problems and start implementing no regrets solutions before peri menopause starts. A woman experiencing a bad menopause may not have the emotional or physical strength to insist on help, especially if a partner and children are righteously antagonistic and aggressively ensure that “cranky bitch” does not impinge on their good life.   

Ideally one should go into menopause with grown children, a low care garden and a well maintained home with labour saving devices.

Now is the time to hire a cleaner for the house to lift the burden of heavy and time consuming housework. A woman who has worked, raised children and supported her husband definitely DERSERVES support and time off at this time. It’s not a gift, it should be a right.

Ideally also the husband will have advanced well in his career and the house and other large expenses will already be paid off (e.g. car, house renovations, children’s education etc). Hence, the family could afford a reduction in working hours of the lady experiencing menopause – even a year or two off work during the worst of it would be nice depending on symptoms and career.

If time off work is not possible, then the family should chip in to shoulder part of the home-work load of their wife and mother. Usually women my age work and do most of the housework. This cannot continue. Rather than solve (or not solve) the problem through fighting and agrimony, the family should sit down together and decide who does what, when and how. The male leader of the household will then need to oversee the solution so that the lady does not suffer undue stress dealing with reluctant helpers and thus just withdraw to suffer alone.

The above woud have helped in my situation. I’m sure other people can adapt or improve on the advice.. The basic concepts are awareness, planning, support, generosity and goodwill.

Mid life and illness - Advice when considering an affair ....

A reader left the following comment on Why an affair might be justified ...and I present my humble advice here:

I am struggling with this very issue right now. I am a 46 year old male with many health issues but I want to have the sexual intimacy that my wife cant give me because of health issues on her part. We have been married for 10 years now, and I love her very much, I don't want to devorce her, and she loves me as well. We have been through so much together. But my heart is divided with someone else and I just don't know what to do.

I understand your situation – very upsetting and seemingly no way to resolve the situation win-win. Sadly, many of us have been there. I offer this rather long advice in the hope you will find something that helps.

With regard to your current situation – when in doubt don’t. Wait a while and see how things go. The high that comes from falling in love lasts about 2 years. You’ll see more clearly then.  I’d also suggest stepping aside from your own emotions and rationally evaluating life with the second lady vis a vis your current life and perhaps who you could attract as a free man. Perhaps a trusted friend would help you think it through?

Often the person you fall in love with first is not the one for your whole life, but someone who is there and is willing to have a relationship with a married person. Has the lady perhaps been trying to trap herself a good catch? Is she willing to sacrifice her own feelings and wait for you?    

Another word of caution – as told by a divorce lawyer – many people divorce and remarry to find themselves in the same situation.  The exciting girlfriend changes into the cranky wife who does not want much sex, but the man has lost his family and is much poorer.  Hence, the wise man may choose to work on his current relationship or recruit a secret girlfriend and continue to enjoy the comfort of his home and family as he gets older.  

That said, I think of my friend Clarissa who has stuck by her sick older husband over many years and has therefore foregone family, a comfortable life and sex. There will be no comfortable home or grandchildren. They loved each other once, but now hate each other and her chances are gone. She’s just a source of money and housekeeping and occasionally dodges flying crockery and accusations she ruined his life. Obviously she should have jumped ship when she was younger.    

Advice assuming no current outside attachment -

Becoming attached to a new sex partner is a natural result of having sex.  I’d suggest if your primary aim is to find sexual intimacy without leaving the marriage, you need to back off quickly when you meet someone that seems like a soul mate. Also, make it clear to any new sexual partners that you are not looking for an exclusive relationship. Many men run long term relationships parallel to their marriage, but they need to control their own emotions and avoid women who are looking to nab themselves a good catch.  They also need to control their exposure to sexually transmitted diseases – so really safe sex, no playing outside the relationship/s and tests for everyone before getting close and personal.

So due to this and also due to moral issues and issues of unintended entanglement, I’d suggest trying to work out the health and sexual issues first before seeking sex outside marriage. I’m convinced many people forgo sex and intimacy and even affection because of health issues that could be solved and because they are unwilling to think outside the square and innovate.  I think the biggest barriers to sexual happiness lie in our lack of knowledge and our assumptions and our unwillingness to really work on solving problems and building sexual happiness.

The first thing to know is that sex issues cannot be solved with ultimatums or overnight – you make take time to grow in knowledge and to work out how to interact.  Set some milestones for evaluation of progress. If a spouse is truly not interested, don’t make a nuisance of yourself by demanding sex. Perhaps you are meant to be brother and sister rather than a married couple? Don’t sentence each other to hell on earth as you struggle over unmet needs.    

At some stage recruit your wife to support and take part in the project – but expect her to need convincing and maybe take some time to come on board. This is normal, especially if one feels very run down. You will probably have to lead and if you want success you will need to make some changes in yourself – these changes I suggest will be useful whatever you do and whoever you are with.   

Start right now working towards being the best possible person you can be – see Athol Kay’s Married Man Sex Life blog for the married man action plan. Get fit, be well groomed, take care with washing and basically be a good, functional, positive, assertive happy person. Your wife will be more attracted and more likely to make an effort and less likely to be put off by things like unwashed private parts. If you do decide to find a new partner, you’ll find a better one.

Study up on sex, intimacy and relationships. There is heaps of stuff online and even checking out porn sites is useful (tho I soon bored of it). Keep an open mind and see what other people do, why people do things, what motivates them and so on. Your wife may be facing menopause soon, so research that as well. Knowledge is power!

Armed with your new knowledge and viewpoint, ID all the barriers to wonderful intimacy and think of solutions. It is obvious you need to improve your health as much as you can. You may need to solve some health issues with the help of your doctor, but don’t go for heroic solutions that involve massive surgery, drugs with nasty side effects etc. For example, if the lady’s libido has disappeared, ask the doctor to check out her hormones and possibly prescribe something. If a man cannot maintain an erection or indeed if he can and the lady cannot orgasm or accomodate a penis in her vagina, he might buy a smallish, well made vibrator from an adult shop or online.    

You may need to redefine what you mean by sex and reassess what you consider normal and acceptable.  I’m reliably informed people who are paralysed enjoy sexual encounters, but perhaps not the way the able-bodied can. You simply need to work with what you have. Within this context I’d seriously suggest massage as a way of connecting and building intimacy. Just cuddling and caressing each other is very pleasurable. Also, hand jobs and oral sex are great ways to release sexual tension and don't require a working vagina.

Sometimes I cannot have sex due to health issues and I am so happy Awesome is satisfied with lots of cuddles and oral sex only. I make sure I do my best for Awesome and he in turn accepts my efforts in good grace – in fact, he enjoys himself very much! If sex is off the menu altogether I’ll offer a shoulder or foot massage.  

I also need to point out sexual response of many women is responsive rather than spontaneous, so you need to start foreplay before they want to have sex. Hence, agreeing just to start with something enjoyable may create the opportunity to escalate. For me this is especially so if I am unwell.

I hope this has helped. Please feel free to ask for more advice or to let us know how you went. Good luck with resolving your issues.