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Menopause, Estrogen, sexual intercourse

Sex without Estrogen can be dangerous

 By Dr. Gifford Jones  Wednesday, September 1, 2010

What was the diagnosis? No one was sure when they asked me to see a 57-year-old year woman in a state of shock. She had been brought to the emergency at 1:00 a.m. with no explanation as to what had occurred. It was only after an emergency operation and a talk with her husband I understood the cause of her distress.

Mrs. X had started menopause at 45 years of age. But long before the recent report that estrogen was associated with an increased risk of heart attack, stroke and breast cancer she had decided not to take estrogen.

For many years she believed this was the right decision. But then slowly she developed increasing pain with sexual intercourse. Finally at 55 years of age, sex was no longer possible.

On their 25th wedding anniversary the patient and her husband shared a romantic evening with wine, soft music and low lights. The inevitable happened. But sexual intercourse was immediately followed by severe pain and heavy bleeding. It was only after his wife drifted into shock that the husband frantically raced her to the hospital. At surgery a long laceration along the vaginal wall required numerous sutures to stop the bleeding.

A report from the Royal Alexandra Hospital in Edmonton shows vaginal lacerations occur more often than we would expect.

Dr. Carlissa Wittner reviewed the hospital records from 1995 to 2000 and found 17 cases. Add up the hundreds of other hospitals in this country and it’s obviously a significant problem.

What causes these lacerations? The lining of the vagina maintains its normal thickness during youth and middle age due to an adequate supply of the hormone estrogen. But at menopause the production of estrogen by the ovaries gradually decreases causing a slow thinning of the vaginal lining.

Doctors call this problem atrophic vaginitis. Luckily, this condition normally does not result in vaginal lacerations. But it can trigger a good deal of discomfort, discharge, spotting following sex and at times even marital stress.

Atrophic vaginitis, which affects 75 percent of postmenopausal women, initially goes undetected as there’s no discomfort for months or years. Then when pain starts some women are too embarrassed to discuss it with their doctor. Or a busy family doctor fails to do a pelvic examination or overlooks the problem during examination.

I’ve had to reassure more than one husband that his wife’s frequent “headaches” were not related to marital infidelity or that she didn’t love him. Rather, his wife’s vaginal lining appeared as if it had been scraped by sandpaper. And I’ve reminded him that if Madonna is unable to sing with a sore throat, it’s also impossible for his wife to have sex with an irritated, raw vagina.

Fortunately, there’s a simple solution for this disorder. The nightly insertion of a vaginal estrogen tablet “Vagifem” will quickly restore the lining to its normal thickness. Then to prevent a recurrence a vaginal suppository can be used once or twice a week.

Vagifem is therefore a great option for women who for one reason or another want to stop HRT. Moreover, the results are excellent. I’ve often told patients, “If Vagifem could restore other tissues the way it quickly restores vaginal tissue we would never age.” The speed at which a severely inflamed vagina becomes normal has always amazed me.

Over the years I’ve seen many women who have been treated for breast and pelvic cancers, but who are unable to have sex due to atrophic vaginitis. They have been advised not to use any estrogen by their cancer specialists. It’s an illogical decision when a small amount of vaginal estrogen could have cured their problem. Patients faced with this dilemma should always obtain a second opinion.

What about safety? Several years ago, while seated at dinner with Queen Elizabeth’s gynecologist, he and I discussed this problem. He agreed that no study had ever implicated vaginal estrogen as a cause for cancer as only minute amounts of vaginal estrogen are absorbed.

Today many aging males are using Viagra to ensure a healthy sex life. Vagifem also guarantees that women will maintain good vaginal health. After all, as they say, ” what’s good for the goose is good for the gander”.

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Dr. Gifford Jones  Bio
Dr. Gifford Jones Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He’s been a ship’s surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: http://www.mydoctor.ca/gifford-jones



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