• Painful Sex Due to Vaginal Atrophy- Why Does It Happen and How Can Your OB/GYN Help You?

    on Apr 17th, 2018

Recurrent or persistent pain with sexual activity that is perceived as a personal cause of distress affects an estimated 10-20% of women in the US. Discomfort during or after sex can significantly alter a woman's perspective and perceptions about her sexuality, as well as negatively impact her body image, mental and physical health, create intimacy issues between her and her partner and impact efforts to conceive when pregnancy is desired.

Most common cause for painful sex around or after menopause is Vaginal Atrophy.

Painful sex that develops later in life - during peri-menopause (the years preceding menopause when the sex hormones start to decline) or after menopause (total loss of sex hormones produced by the ovary) is very bothersome and it is caused by vaginal atrophy and/or vaginal dryness. 

Vaginal atrophy is a medical term used to describe the changes that happen to the vaginal mucosa due to the loss of the sex hormone called estrogen. The vaginal mucosa becomes thin and very dry and looses its elasticity. Most women start to use various lubricants over the counter to allow vaginal intercourse to happen normally and enjoyably. Eventually, the lubricants use is not enough and discomfort sets in. Due to the loss of elasticity of the vaginal mucosa sex becomes painful, and women start to avoid it and enjoy it less and less until it becomes so painful that they stop having sex completely. If a woman stops having vaginal intercourse the opening of the vaginal canal can actually start to narrow and will make penetration even more difficult, especially if the partner has difficulty achieving a full erection. Any further attempts at vaginal intercourse become frustrating, more and more painful and if the woman does not seek help and address this issue promptly than fear of pain during sex can cause a tightening of the outer muscles surrounding the vaginal opening, making any vaginal penetration almost impossible. This condition is called vaginismus and it can also be treated - it requires the use of vaginal dilators, personal time and dedication to use the dilators regularly as well as a patient and understanding sexual partner. Addressing any of these issues promptly with an OB/GYN specialist can prevent permanent or difficult to treat vaginal health issues.

Vaginal atrophy can be easily treated with hormones or what is most commonly known as Hormone Replacement Therapy. Some women achieve good results and are happy with local estrogen suppositories, creams or an estrogen ring but many women require systemic hormone replacement therapy to treat vaginal atrophy for example oral estradiol or patches, compounded hormonal creams or pellet therapy. Hormone replacement treatment needs to be individualized and the woman needs to be informed about risks versus benefits, possible side effects, need for regular check-ups. Also, hormone lab tests might be required regularly. Most OB/GYN physicians and trained and comfortable with Hormone replacement therapy, but some offer only patches and oral estradiol, some offer compounding creams only and some only pellet therapy. An OB/GN specialist trained and experienced in all these Hormone replacement treatments will be able to give you options and allow you to choose the therapy that feels right for you or fits your lifestyle, goals, and needs.

For women who do not wish to or cannot use hormone replacement therapy (example Breast Cancer Survivors) Monalisa Touch Laser therapy guarantees results and significant improvement and resolution of vaginal dryness and atrophy.

What is Monalisa Touch? It is a fractionated CO2 laser that creates micron size very small injuries to the vaginal mucosa that are perceived as vibrations or puffs of air. There is no bleeding as the laser also coagulates the tissue. The body responds to this micro-injury by healing - that means blood vessels will form and bring moisture, and the body will also bring elastin and collagen as part of the normal healing response, which over the next few weeks causes the vaginal mucosa to become more moist, more elastic and thicker. After fractionated CO2 laser therapy the vaginal mucosa becomes healthier and vaginal itching and chronic infections that might have been common before the laser treatment become more infrequent and stop happening. Monalisa Touch also helps urinary problems like mild incontinence with sneezing or coughing, frequent desire to use the bathroom, helps alleviate difficulty holding the urine and the sensation you need to run to the bathroom due to a strong urge to void.

Usually, 3 treatments sessions are required and they are scheduled 6-8 weeks apart. Depending on the age of the patient and the severity of the condition more treatments might be required to achieve goasl. An annual maintenance single session therapy is usually needed to maintain vaginal health and it is usually scheduled at 6 - 12 months depending on the age of the patient and the severity of her condition. 

This laser therapy is different than all the other devices currently available on the market that claim to address vaginal atrophy. It is the only therapy that has clinical studies to back up its claims, it is safe, well tolerated and ensures excellent results.

Monalisa Touch is done in an OB/GYN physician office, requires no anesthesia and no downtime. It usually is no more uncomfortable than a Pap smear and lasts 5-10 min. Most doctors will apply a local numbing cream and you will wait 10-20 min until ready so that there is min to no discomfort during the procedure. You should expect to be in the office for no longer than 1 hour, including the time you need to fill in paperwork and have the medical assistant prepare you for the procedure. 

The Monalisa Touch procedure is not currently covered by Medicare or other insurance companies. The cost varies depending on whether you wish to pay each treatment as you go or select a prepaid package. 

A routine OB/GYN office visit might be required to determine if you are a candidate. There aren't any real contraindications unless you suffer from severe systemic illness and your immune system is severely impaired, you have an active vaginal infection or you experience vaginal bleeding around the time of the planned procedure.

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