Saturday, 16 March 2013

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 ...:-)