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Dr. Jones: Listen up, this is for ladies only. Gentlemen, kids, adolescents, go listen to stuff that is just for you. We're going to talk to ladies about vaginal dryness and pain after menopause. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Utah Healthcare and this is The Scope. Guys, change the channel. Ladies, plug in your earphones.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: There are many reasons why women are less interested in an intimate sexual relationship with intercourse after menopause, but one of the most common is that sex hurts. Menopause marks the end of significant production of estrogen by the ovaries. Estrogen production is linked to egg production, so it's a pretty good thing that we stop being fertile when we get to our 50s.

One of the prime targets of estrogen is the uterus, and after menopause the uterus gets smaller and the lining gets thinner and that's a good thing. That means there's less bleeding and cramping, in fact, if it goes as it should, no bleeding and cramping. However, the uterus is just part of the reproductive tract. Reproductive tract starts at the beginning of the vagina and those tissues get thin as well and sometimes they become very thin. They stop making as much fluids and the lining of the vagina can be painful and even bleed with intercourse. It only has to hurt a couple times and then women aren't so interested anymore. So what can be done about this?

First, how common is this? In a study reported in a menopause journal, 4,200 post menopausal women from Sweden, Finland, the U.K., Canada and the U.S. were surveyed about their symptoms and their knowledge. Thirty-four percent of Canadian women experienced symptoms with vaginal thinning and 43% of women in the U.S. noted symptoms, and two-thirds of them noted that the symptoms were severe and had a significant affect on their quality of life. That's a lot of ladies.

Fifty-one percent of American women didn't know that there was a local treatment for this problem, and 63% of women with symptoms had never been treated, but 67 of those who were treated had an improvement in their symptoms.

So what treatments are out there? Well, first, there's ordinary over the counter lubricants, slippery stuff. For some women, that's enough and it is safe and inexpensive. It's made by the same material that doctors use to make an internal exam more comfortable for women.

Second and most importantly, probably, is estrogen. Estrogen can be applied locally to the vagina twice a week in the form of pills or creams and this is very effective for the majority of women. There are many different ways to apply this local estrogen to the vagina. The dose is tiny and a recent study of half a million women in the Kaiser Healthcare system were studied to see if vaginal estrogens increased the risk of uterine cancer. They compared women who filled prescriptions for vaginal estrogens with women who didn't and the rates of uterine cancer were no different.

Women with a history of breast cancer are never supposed to use estrogens and they suffer, but there's no evidence that low dose estrogens increased the risk of breast cancer. Vaginal estrogen for women who've had breast cancer is controversial, but vaginal estrogen therapy's been used for decades for post menopausal vaginal thinning and pain with a terrific safety profile.

Third, DHEA, this is a weak adrenal male hormone that can be placed in the vagina and that can increase vaginal thickness and decrease pain. The trade name is Prasterone.

Fourth, Ospemifene, the brand name is Osphena. This is a pill that can be taken orally that isn't exactly an estrogen, but it does increase the thickness of the vagina and decrease pain.

So, why don't women get treated? I think we're in sort of a "don't ask, don't tell" situation here. Post menopausal women may not bring up the subject of pain within sex and doctors don't ask, but if there's evidence that sex is part of healthy aging, then doctors should ask and they should know the safety and effectiveness of treatments and, ladies, you should speak up. Sex doesn't have to be painful.

Now you can unplug your earphones and thanks for joining us on The Scope.

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