I interviewed Cheryl Hines, who is an Emmy nominated actress best known for her comedic starring roles in Curb Your Enthusiasm and Suburgatory. Cheryl is currently the spokeswoman for a new campaign for AMAG Pharmaceuticals called “Painfully Awkward Conversations.” It’s for post-menopausal women who may be experiencing VVA – Vulvar and Vaginal Atrophy.
Dr. Marla Shapiro was also on hand to answer questions. She is a full Professor of Family and Community Medicine at the University of Toronto in Ontario, Canada
VVV causes painful intercourse in post-menopausal women. Other symptoms include vaginal dryness, irritation, and burning due to the loss of estrogen and other sex hormones.
Painfully Awkward Conversations (PAC) is a program aimed to empower women 50+ who may be experiencing painful sex due to menopause to speak up and take control of their condition (and maybe laugh a little along the way.
Interview with Cheryl Hines about Vulvar and Vaginal Atrophy and PAC
The first thing I asked Cheryl is what prompted her to get involved with the campaign. She told me she spoke to many of her friends who were going through problems with sex over 50 and they encouraged her to do it because it was something that needed to be discussed more openly. It will make it easier for women to talk about vulvar and vaginal atrophy with each other and with their health providers.
Listen to the Recording to hear Cheryl Hines and Dr. Marla Shapiro
To get the most out of this interview, I recommend you listen in. Both Cheryl and Dr. Shapiro offer a ton of useful information every woman in post-menopause should know. Click on the player below to listen in.
Takeaways from my interview with Cheryl Hines and Dr. Shapiro
Rebecca: What causes VVA?
Dr. S: With the absence of estrogen in women who have gone through perimenopause and menopause, the tissue without the estrogen gets very thin, very friable and atrophic. As a result, it leads to a whole host of symptoms including painful sex, dry vaginas, burning, irritation – there can be problems with the bladder as well.
Most women know that hot flashes and night sweats are part of losing your estrogen around the time of menopause, but don’t recognize, because it’s a few years later, that the vaginal dryness and painful you may be experiencing is the same cause. Unlike hot flashes and night sweats which usually go away, this is going to get progressively worse the longer you are in menopause which is basically the rest of your life.
Most women don’t understand that there are safe and effective treatments. It’s not just because of aging. They don’t make the association between menopause, loss of hormones, loss of sex hormones and vaginal atrophy as being all related. The fact is, there are safe and effective treatments.
Over 32 million women in the United States are dealing with this issue. Half of them are fearful of having sex. 25% say they’re never going to have sex again.
Rebecca: Just the name Vaginal atrophy sounds horrible!
Dr. S: Yes, it sounds like you’re just going to shrivel up and dry away! A few years ago, the North American Menopause Society and the International Society for Sexual Health in Women got together and came up with a new term that’s now being accepted called” genitourinary syndrome of menopause.” It pays attention to the fact that it’s not only the vagina that atrophies but a lot of the bladder, and the whole urinary tract.
Vulvar and Vaginal atrophy is thought of as being a subset symptom but most women don’t understand that dryness and painful sex impact self-esteem and intimacy is related to the same thing that leads to hot flashes and night sweats and that there are options out there. The best place to have that conversation is with your health care provider.
Rebecca: What can women do to prevent Vulvar and Vaginal Atrophy?
Dr.S: In terms of prevention, you have to understand that with the loss of the hormones, prevention becomes very difficult because that’s the cause of it. Maintaining your sexual activity will help and staying away from things that can dry the vagina out like taking antihistamines. Certain medications may be helpful as well as over-the-counter lubricants and vaginal moisturizers but it’s not going to address the underlying path of physiology of the loss of estrogen and other sex hormones.
We now have a lot of prescription alternatives in terms of estrogen, non-estrogen, local therapies, oral therapies that are SAFE AND EFFECTIVE.
Rebecca: I think sometimes people are afraid to take drugs because they feel they’re unsafe.
Dr. S: You know that the whole concept and the notion of hormones being unsafe and leading to all types of adverse outcomes come from a study that was done more than a decade ago. We’ve learned a lot since then and we also know that local therapies for this issue – particularly painful sex – are a low dose and they’re very safe, very effective, and well-studied. We now have non-estrogen alternatives in addition to estrogen alternatives – delivered locally to the area where there are issues. Oral medications are designed for this, so there are lots of options out there.
If you let fear and misinformation stand in the way of having the conversation, you’re not going to find that out.
Rebecca: Are there things women can do on their own, in addition to those options that will help them with this problem?
Dr. S: In terms of lifestyle, “Use it or lose it” is a phrase we use because we know that women who are sexually active are more likely to maintain the tissue. It can become a vicious cycle.
Certainly, over the counter lubricants and moisturizers are helpful, but they’re all not created equally. Some have additives or fragrances that can be uncomfortable for the vagina and the vulva. Often that’s a product that you buy at the pharmacy without any type of discussion with your healthcare provider.
I think the message here for women is, have a conversation. Don’t necessarily try and fix it yourself without understanding what’s caused the issue and what are all the different options that are available to you.
Rebecca: I think some older women are reticent to go to the doctor to talk about that. But there are certain types of doctors that specialize in that, right?
Dr.S: Well, I think it’s important to understand that this has to be part of your agenda. And if your health care provider dismisses it then I think you may need someone else you can talk to who will be more receptive. Healthcare is a partnership. It’s a collaboration.
Rebecca: Cheryl, do you have anything to say to all these women out there who are over 50 and experiencing this problem?
Cheryl: I want to encourage women to talk to each other about it and to DEFINITELY talk to their healthcare provider if they are having any sort of issue with vulvar and vaginal atrophy. That’s the whole idea behind this campaign. Everything we’re talking about is a natural, normal part of life. There’s no reason not to bring it up and not to talk about it. If you’re having painful sex, then absolutely talk to your healthcare provider about it and see what can be done about it.
Dr. S: I think we want to challenge the assumption that a lot of women have that just because their healthcare provider doesn’t bring it up that’s it’s not important. You’ve got to be your own advocate here. There are a lot of things that may be on your healthcare provider’s agenda that isn’t necessarily top and foremost in terms of talking about whether or not you’re having painful sex.
There’s that sort of hush-hush campaign that if you believe as a woman that there’s nothing that can be offered to you so you don’t bring it up. Your healthcare provider may be thinking “Well, my patient’s not bringing it up, so there’s no reason for me to bring it up.” It reinforces that there’s nothing to be done and that’s simply not true.
Rebecca: I think it’s important to go in and talk about it. And it could be other problems causing it to happen, right?
Dr. S: It’s always important to make sure you’re getting a look-see or having a physical exam. You’re having your Pap test when it’s indicated. You’re having someone looking at you appropriately. They’re examining your uterus and your ovaries. Absolutely there can be other issues. Women shouldn’t be abandoning their sexual health or their physical exams or the importance of maintaining their health simply because they think “Oh well, now, I’m a certain age or whatever it is they’re feeling. Women should really empower themselves by having a conversation.