Maintaining my vital parts post-menopause

Deterioration in private parts due to menopause can have a huge influence on the ability and desire to have sex. Without the hormonal imperative, pain and other negative impacts have the potential to totally put someone off having sex at all.

I’ve had huge issues maintaining my private parts starting with late peri-menopause and this has impacted my ability to have sex and also my motivation to do so.

My journey

It has taken me some years, but I’ve finally hit upon a system which is effective and enables me to have gentle penetrative sex a few times a week. The following documents my journey to a solution.

During late peri-menopause, as my estrogen levels waned the acidity level of my vagina dropped and unwanted microbes started to grow. I struggled constantly against a yellow discharge, bad smells and infections such as thrush. Tests did not show any STDs or major culprits, but I was frequently smelly and sore.

Estrogen cream was a magic solution. Not only did my private parts become soft, moist and healthy, but my sensations were enhanced back to normal. However, after some months I developed a common side effect – rashes. So I had to give up using them.

Without estrogen my vagina and in particular perineum became less flexible and as menopause impacted, as well, I often suffered chafing and stretch injuries from sex. Added to this, were various degrees of irritation (or infection) indicated by red inflamed mucous membranes.

Bathing my privates with warm salty water to which a little plain vinegar was added was soothing and non-irritating, but not a powerful solution.

Anti-fungal and anti-bacterial creams from the chemist shop helped only so far and after a few applications my private parts started to be irritated by them.
Yoghurt helped control infections, but was not the entire solution to the irritation and painful sex.

Cortisone cream could quieten the irritation, but needed to be used sparingly as it could mask an infection.

The solution

It became clear that there were no quick fixes and I needed to put in a lot of work to maintain my private parts in working order.

Also, I have found that if I am treating a problem, I need to visually inspect the area with a mirror daily in order to closely monitor and adjust treatments.

Here is my protocol to treat an inflammation or infection:

• Check daily using mirror. Use observations to inform treatment decisions. 
• Don’t have sex involving private area. Treat and rest until it returns to normal.
• Control infections using Chlorsig (kills both fungi and bacteria) ointment for a few days. It is very powerful yet non-irritating as it is not a stabilised cream. 
• For mild infections or further control after Chlorsig use Canesten for a couple of times.
• If necessary use a little cortisone to control inflammation but not for more than a couple of applications. This can be combined with Canesten. 
• Use yoghurt or vitamin E/coconut oil as very mild treatment for infection or for further control.
• After treatment continue to rinse with salty water and avoid all irritations to allow the inflammation to settle.

Prevention is a huge part of my strategy:

• I frequently apply Canesten to my anal area to stop thrush from starting and travelling downwards.
• I apply oestrogen cream to my perineum every second or third day. This almost totally stops tears and chafing from penetrative sex but does not irritate nearby mucous membranes.
• I use personal lubricant for penetrative sex. 
• I apply live high quality plain yogurt (or Canesten) to my private areas every now and again, particularly after sex or if there is an unwanted smell. This helps control the microbial balance and avoid an outbreak.

Tactics during sex are also important but the subject of another post.

How to remain STD free

Remaining sexually transmitted disease (STD) free is a key consideration when dating in middle years and later. The two main issues I see are mistakenly believing one is STD free and being infected before one becomes savvy enough to protect oneself. 

The facts one should know

 There is no such thing as safe sex where genital herpes (herpes simplex virus HSV) or genital warts (human papillomavirus - HPV) are concerned. There is also no complete cure - an infection is likely to be life long, even if that is a life without further symptoms.

Both HSV and HPV can infect the face, mouth, nose and genital areas. Both can be transmitted via exchange of infected bodily fluids and skin contact with an infected area.

As a result of the places infected, STDs can be caught from kissing, intercourse, sharing sex toys and sharing eating utensils as well as touching infected areas.  

The range of activities that can present a risk of infection mean you may become infected long before you actually have sex and condoms simply do not cover enough of you to ensure you don’t become infected if your partner is shedding viruses, either through a lesion / wart or bodily fluid.

A person can be infectious even without visible lesions / warts because either the lesions / warts are tiny or hidden or they are simply shedding in their bodily fluids. Hence, even if you are careful, use condoms and inspect each other, you still might become infected.

Infection is so prevalent in the community - you simply cannot take chances if you want to remain STD free. Approximately 1 in 8 people in Australia are HSV positive. Most people that are sexually active will contact HPV sometime in their lives. In fact, around 50% of sexually active people with have HPV antibodies by the time they are in their late 40s / 50s. 

Only people who have never had intimate contact with another person (including kissing) or who have only had intimate contact with another person similarly STD free are likely to be STD free. 

What you can do

If you are HSV / HPV free and wish to retain this very desirable state, you don’t have the opportunity to make even one mistake – one kiss (even on the cheek), sex with a condom or even sharing a towel could end your STD free status.  

Here are recommendations based on science and my experience:

Recommendation 1: Don’t take chances. Educate yourself and decide on a strategy before you start dating – even before you kiss anyone or have protected sex.  

Recommendation 2: Check you are actually STD free. Seek the best medical advice and have the best tests for all STDs. HPV is mostly diagnosed through visual inspection and pap smears. There is no definitive test routinely available, seek the best service you can obtain. 

Recommendation 3: Keep your test results. When someone suspects they have an STD (and this is very common) they start looking for sources of infection. Your results are your defense.  

Recommendation 4: Be immunized against HPV – this will not cover all strains, but will reduce your chances of contracting the main ones that cause cancer. Don’t be put off by being outside the recommended age group.

Recommendation 5: Don’t commit your heart or even kiss until you are sure of the STD status of the prospective partner – then make an informed decision.

Recommendation 6: Don’t accept assurances that a person is STD free or that tests have proven them STD free - see next recommendation..

Recommendation 7: Have a reputable doctor test both of you and report back to you both.   

    

Recommendation 8: Ensure your new STD free partner is as dedicated as you to remaining STD free.   

Menopause and older men - a wonderul relationship opportunity

Older men represent an attractive relationship opportunity for women aged 50+. There are a significant number of nice, interesting, kind, loving and good looking men running around free.

For a woman going through menopause, a supportive partner who has "been there before" can be a great asset.

From my experience, older men also tend to be thoughtful and gentle lovers. This is a great advantage to the post-menopausal woman who may suffer from less robust private parts and appreciate skill and understanding.

I also appreciate the wisdom and knowledge picked up over a lifetime doing interesting things. His Awesomeness is my most treasured mentor.  

So how to attract these wonderful older men?

• Be young at heart, positive and happy. 

• Be as fit and healthy as possible.

• Make the best of yourself in terms of presentation. 

• Be an interesting person to talk to.

• Be companionable and willing to join your partner in their favourite activities, e.g. boating, traveling.

The older men I know (except my ex) still have healthy libidos and want to enjoy intimacy including wonderful sex. Hence, an interest in and general open-minded attitude to sex is likely to trigger the attention of older men.

Of course, you need to think carefully about a relationship with an older man, especially if he is not able to support himself financially or has medical conditions which could lead to you being his long term carer (and payer of expensive medical bills).

Nevertheless, there is a very great opportunity to have a really wonderful man in your life if you consider someone 60+.

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.