Below The Belt

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We were both waiting at the gate waiting for our connecting flights and connected on designing educational programs. She then asked me what I did and I told her that I was an RN who treated women with "below the belt" issues.

What happened next is not uncommon because intimate health issues are so common. She started telling me about hers.

Given her 50 something age, I guessed, vaginal dryness.

She said, "No, I have the opposite. Apparently, I have an aging vagina," her doctor said." I couldn't disagree with her but I must say it's such a disrespectful way to talk about female vaginal health.

It denotes she's all dried up. Done. Suggesting, no more sex for her. And nothing could be further from the truth. But the truth of the matter is that a healthy vagina is important for women at all times of life, but especially at the menopause.

She said she'd been treated for 7 days with an antibiotic on two occasions because her vagina had bacteria in it. Newsflash. The vagina has bacteria in it. It's supposed to. Vaginal flora, vaginal microbiota or vaginal microbiome are the microorganisms that colonize the vagina. The primary colonizing bacteria of a healthy individual are Lactobacillus, and the lactic acid they produce protects against infection.

After the antibiotics, she is now treating a yeast infection and her thin watery discharge persists. She has to change her underwear twice a day. Then she was told, "you're just built this way" by her doctor. Um, no.

Thin watery discharge is a symptom of a very common women's health condition known as Genitourinary Syndrome of Menopause or GSM. It used to be called Vaginal Atrophy.

Vaginal dryness is the hallmark symptom of GSM but there are others; burning, itching, spotting after intercourse, pain or burning with urination, urinary incontinence, increased frequency of urinary tract infections and of course, THIN WATERY DISCHARGE.

A vaginal inspection/internal exam is needed as you may also have pale tissues, thinning of the vaginal walls and/or shortening and tightening of the vaginal canal.

There are treatment options. Antibiotics are not one of them. Low dose localized vaginal estrogen is. This comes in a cream or a ring and requires a prescription from your doctor. It can be compounded as well.

This woman told me she was already on hormone therapy and it wasn't helping her vagina. Hormones prescribed for menopausal symptom such as hot flashes and night sweats often do not work on the vagina.

There's is vaginal tablet but I find it doesn't work as well for most women with moderate GSM because the dose is too low or the the dry tab does't get absorbed by the dry vaginal tissues.

It's important to treat GSM as women are at greater risk of recurrent urinary tract infections when their estrogen receptors are low in their vagina. And women over the age of 65 who get urinary tract infections are at risk of urosepsis (overwhelming infection), hospitalization and even death.

Not all physicians are educated about GSM in part because they do not receive this education in medical school and many doctors focus on obesity and hypertension.

So don't accept nebulous excuses ladies for issues like GSM that will impact your quality of life and relationships.

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