mature couple happy in bed

The "Silent Symptom" of Menopause

Editor’s note: October 18th is World Menopause Day. Here, to help you celebrate, is the information you need to keep the loving alive and well as you experience “the change.”

Although peri- and post-menopausal women talk about night sweats and hot flashes as symptoms of menopause, fewer bring up the “silent symptom” of vaginal discomfort. Many women believe that vaginal dryness or pain with sex is a natural part of aging after menopause and that it is normal to endure these symptoms. Not so, says Dr. James A. Simon, past president of NAMS (North American Menopause Society) and a board member of the International Society for Study of Women’s Sexual Health. “It is a totally and completely treatable problem, universal to all menopausal women, and one that only gets worse as women age,” says Simon.

Vaginal atrophy — thinning and inflammation of the vaginal wall due to a reduction in estrogen levels that affects the elasticity of the tissues around the vagina and production of vaginal fluid – can be managed with a simple treatment that has been around for decades. Low dose local estrogen products that are put in and around vagina can restore normal, premenopausal health and the structure of the vagina.

So why are so many women clueless?

A global survey of post-menopausal women and their partners presented by Dr. Simon at the NAMS Annual Meeting this October concludes proper treatment can end needless suffering from vaginal discomfort and atrophy. Findings presented by Dr. Simon are based on the CLOSER Survey (CLarifying Vaginal Atrophy’s Impact On SEx and Relationships), sponsored by global healthcare company Novo Nordisk. The survey was conducted between December of 2011 and February 2012, with results from 4,167 menopausal women between 55 and 65 who had experienced vaginal atrophy, and from 4,174 male partners of post-menopausal women with vaginal atrophy. The respondents were from nine countries: U.S., UK, Canada, Denmark, Sweden, Finland, Norway, Italy, and France. A sub-analysis, called The Partners’ Survey, is based on U.S. respondents only (about 500 female and 500 male subjects).

The large sampling highlighted two issues. One is the significant impact vaginal symptoms have on menopausal women’s partners and relationships –the first time this has been studied, according to Dr. Simon, who was heartened by male partners’ concern and willingness to talk about the problem. The other is how women must start talking about their symptoms and asking their physicians for treatment since doctors seem just as reluctant as women to talk about vaginal discomfort.

Some findings from the surveys:

*More than half of women reported that they avoid being intimatewith their partner.

*65 percent of women reported that they have lost their libido.

*A third of women claimed that they no longer feel sexuallyattractive
andthat they have lost confidence inthemselves as a sexual partner.

*60 percent of women found post-menopausal sex less satisfying – and they are not fooling anyone in bed since 50 percent of male partners thought it was less satisfying for women, too.

*65 percent of men worried that sex would be painful for their partner.

*56 percent of U.S. women who had tried local estrogen therapy (LET) and 57 percent of their partners reported that sex was less painful.

Compared with other countries surveyed, U.S. women experienced higher rates of vaginal atrophy-related consequences on sexual health and interpersonal relationships. This is probably due to the message women received in the last few decades that estrogen related to hormone replacement therapy to ease menopause symptoms was dangerous and could contribute to cancer, strokes, and heart attacks.

Local estrogen therapy is not the same thing, points out Dr. Simon; LET treatments are often low dose creams administered inside or around the vagina that are affordable and accessible, although there are several other modalities as well. After the problem is stabilized, women don’t need to use the treatment every day, but go into maintenance mode, with fewer applications.

How can something as common as vaginal atrophy not come up in the doctor’s office?

A full 70 percent of women say their healthcare professionals have only rarely or never raised the subject with them. Women may not discuss the condition with their healthcare professionals because they think vaginal atrophy is a natural part of growing older and that nothing can be done about it.“Vaginal discomfort has been identified as a silent symptom for many, many years,” says Dr. Simon. Besides the embarrassment for some women of even mentioning their vagina, if a woman is not in a relationship or not having sex, she’s not likely to complain of pain or dryness with intercourse.

In addition, “physicians may not be properly trained to evaluate the problem; a high percentage of internal medicine doctors don’t even have stirrups for doing pelvic exams,” notes Dr. Simon. “Plus they have incredible time pressures, and sexual health falls to a lower tier when other issues like obesity and diabetes are at the top.” But it must become a dialogue.

Visit to assess symptoms and get tips on how to speak with your physician.

What is needed to bring treatment for vaginal and vulvar atrophy into the spotlight is something like what happened when Senator Robert Dole erased the stigma of impotence in men by speaking about his own erectile dysfunction and the solution of Viagra. Is there a post-menopausal female celebrity spokesperson who is willing to speak out about vaginal atrophy treatment? Jane Fonda? Cher?

Judy Kirkwood provides content for Facebook entries (with a specialty in positive affirmations); writes articles for print and web publications – national, regional, and local; is a contributing writer to Simply the Best magazine in South Florida; and plays on the beach and in the pool year-round. Please visit

Judy Kirkwood is’s Contributing Writer and Forum Director.

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