Many women suffer in silence when it comes to sexual health

The men in Viagra commercials certainly look satisfied. Their partners? That’s another story. While there are a variety of treatment options to address men’s sexual health concerns, many women are still wondering: “What about me?”

Overall, experts say it’s a good thing that more men are talking to their doctors about their sexual health issues. More people know about erectile dysfunction (or ED for short), and some of the taboo surrounding the subject has lifted. But while men head to their doctors to discuss “little blue pills”, experts worry that cultural values, embarrassment and lack of awareness have many women suffering in silence with their symptoms. 

Consider the closest counterpart to ED among women: vaginal atrophy (or VA) — a condition where the vaginal walls become thin and inflamed due to a lack of estrogen. VA can affect women at any age, but is most common after menopause when the body stops supplying as much of the hormone. Symptoms don’t “go away” with time, and can even get worse if left unaddressed.

Not familiar with the term? You’re not alone, according to new data from the Vaginal Health: Insights, Views & Attitudes (VIVA) survey published in a recent issue of Climacteric and presented at the Society of Obstetricians and Gynaecologists of Canada (SOGC) Annual Clinical Meeting last month. The survey polled over 3520 postmenopausal women ages 55 to 65 living in Great Britain, Sweden, Denmark, Finland, Norway, the United States and Canada. The survey found that while VA is fairly common, many women are woefully uninformed about the condition and potential treatment.

The results revealed that about half of all postmenopausal women experience symptoms of vaginal atrophy. (That proportion is comparable to the number of men who experience erectile dysfunction during their lifetime.)  However, while most people are familiar with erectile dysfunction, only 4 per cent of participants could name vaginal atrophy. Nearly two thirds of women didn’t know vaginal atrophy was a chronic condition — though more than half of the participants who experienced symptoms had grappled with the condition for three years or longer.

The majority of participants were able to understand the impact of vaginal atrophy: about 75 per cent of women agreed that the condition would have a negative impact on their sex lives — and nearly 40 per cent felt it would impact their ability to have a loving relationship.

However, the effects of vaginal atrophy go beyond pain, bleeding or discomfort during sex. Other symptoms impact quality of life too — like burning, dryness, incontinence, more frequent urinary tract infections and burning or urgency associated with urination. Three quarters of women felt vaginal atrophy would affect their ability to do what they want, when they wanted.

Among Canadian women who experienced vaginal atrophy, top symptoms included vaginal dryness (reported by 88 per cent), pain during intercourse (49 per cent) and involuntary urination (37 per cent). Women also reported vaginal itching (29 per cent), soreness (19 per cent), burning (18 per cent) and pain upon touch (13 per cent).

Vaginal atrophy isn’t just physical — it affects how women feel about themselves too. One third of women claimed these symptoms made them “feel old”, and more than a quarter said VA affected their self-esteem.  About 12 per cent said it affected their social life.

What about seeking help? The survey also found that one third of women suffering from VA waited a year or more before seeing a doctor. In Canada, nearly 40 per cent of women said they would be hesitant to discuss this sensitive topic with their doctors.

Worse yet, most doctors aren’t asking the right questions. In Canada, nearly 60 per cent of participants claimed their doctors had not raised the topic of post-menopausal vaginal health with them. In most countries, less than half of participants felt that there was enough information available about the issue.

It’s no surprise that experts are warning physicians to broach this taboo topic with their patients.

“Knowledge of vaginal atrophy is low in Canada and the symptoms can affect a woman’s overall health, sexual intimacy, relationships and self-confidence,” Dr. Rossella Nappi, co-author of the VIVA Survey and Associate Professor of Obstetrics and Gynaecology at the University of Pavia in Italy, said in a recent press release.  “We are calling on healthcare professionals to routinely raise the topic of vaginal health with their postmenopausal patients and to discuss appropriate treatment options to improve quality of life.”

What about treatment? The survey reported that most women who experienced symptoms turned to over-the-counter treatments, even though these treatments don’t address the underlying cause. (A recent article in the New York Times reported the same trend.) In Canada and the U.S., about half of respondents reported being unfamiliar with common treatments for VA such as local (or topical) estrogen therapy or low dose estrogen therapy taken orally.

Overcoming the taboo?

Do the results surprise you? Think of what medications like Viagra and Levitra have done for raising the profile of erectile dysfunction. When these drugs first came out, there was a lot of debate about the “medicalization” of female sexual dysfunction — and critics wondered if drug companies would soon be offering women pills as a quick fix for their sexual health concerns. 

So far, there’s no widely accepted “female Viagra”, but the debate continues. Some critics have even gone to far as to argue that female sexual dysfunction is just “disease mongering” on the part of “big pharma.” (Like this 2006 article in peer-reviewed journal PLoS Medicine.)

Moreover, other experts warn that the availability of medications, over-the-counter treatments and sexual enhancement products (some of which aren’t safe) are putting unrealistic expectations on people to perform. A pill or a cream may just be a “quick fix” for more complex issues and adds its own dimension to relationship dynamics. ED medications were initially met with controversy, and we can expect more of the same as women seek some satisfaction too.

We might be right to be wary of where our information comes from. (If you read the Climacteric article, you likely noticed the VIVA study was funded by pharmaceutical company Novo Nordisk, which makes a treatment for VA, and the authors have financial ties to the company.)  However, experts warn that too much scepticism adds another layer to the taboo.

“To say that women are complaining about their sex lives because pharmaceutical companies told them to is really insulting to women,” warned Dr. Bat Sheva Marcus, clinical director of the Medical Center for Female Sexuality in Manhattan and Purchase, N.Y, in a recent article in the New York Times.

In other words, the danger is that some women won’t discuss their health issues lest they be seen as being manipulated by drug companies. Embarrassment — whatever its cause — can be a barrier to discussing important issues with a doctor.

It’s important to be aware of both sides of the debate, but the overall advice regarding women’s sexual health is the same as for any other condition. Experts still advise to talk to your doctor if you’re experiencing any symptoms that worry you or affect your daily life. Marketing aside, it’s up to the patient and doctor to discuss possible treatment options — including the potential risks and side effects.

Sexual and vaginal health isn’t always an easy topic to discuss — you may even have felt a little squeamish just reading this article — but that’s all the more reason we should be talking about it.

ON THE WEB
Want to know more about the VIVA survey? You can download the the SOGC 68th Annual Clinical Meeting abstracts (PDF) and read the study here.

For more information about vaginal atrophy, see The MayoClinic.com and MedicineNet.com. For suggestions on how to broach the subject with your doctor, see TheBigOw.ca.

Additional source: The Ottawa Citizen

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