At age 65, Betsy presented with recurrent urinary tract infections and vaginal dryness. She also leaked urine when she coughed or sneezed. She had been waiting for an appointment with her gynaecologist for three months. Her GP had no idea how to treat her. She kept prescribing antibiotics but there was one problem. Her urine for culture and sensitivity came back negative. Betsy was frustrated.

Lucy was diagnosed with lichen sclerosis, a skin condition of the vulva that results in pain and itching not to mention scarring of the vulva. This not only was uncomfortable and embarrassing, it impacted her self-esteem. She was offered cortisone cream as a treatment by her doctor but she feared that it would thin her skin and make matters worse over time. She hoped for a more permanent solution.

Lichen Sclerosis is a skin condition that creates patchy, white skin that's thinner than normal. Lichen sclerosus can affect skin anywhere on your body. But it most often involves skin of the vulva or around the anus in women.

A woman’s sex life and/or self-esteem needn’t suffer because of any of the above conditions which are quite common in women. Vaginal dryness which is often the cause of painful sex is the hallmark symptom of Genitourinary Syndrome of Menopause (GSM) (formerly called Vaginal Atrophy), a condition that affects women during the menopausal years. Vaginal dryness, leakage of urine, recurrent urinary tract infections are all common symptoms of GSM along with thin watery discharge, post-coital bleeding, painful sex and itching.

Estrogen is the hormone regulator of the vagina and is what keeps the vagina in balance and well lubricated. Lubrication is why sex doesn’t hurt. Estrogen also accounts for the elasticity of the vagina and it is those reasons prevent sex from being painful.

When estrogen decreases in the vagina, the vaginal walls may become dry, lose elasticity and predispose a woman to recurrent urinary tract infections. The treatment for GSM has historically been hormone-free personal moisturizers and/or hormone treatments such as a tablet, cream or a ring that are inserted into the vagina. Both are local therapies and typically doesn’t cause any side effects.

The down side of localized estrogen therapy is that it has to be taken for your entire life twice weekly if you are using a tablet or cream form. If you are using the ring, then this must be inserted and removed by a health care professional every three months. If you stop using localized estrogen therapy your condition will rebound. This is the only symptom of menopause that typically doesn't go away. These therapies are lifelong.

Although localized estrogen therapy is low dose, many women especially those who’ve had breast or uterine cancer are uncomfortable with any amount of it no matter how small. Although localized estrogen typically doesn’t cross over into the bloodstream, we don't really know for sure because some women do experience breast tenderness.

When estrogen levels decline after menopause, many changes occur and women may suffer as a result. They needn’t. You’ve heard of laser therapy for the face? Now there’s laser therapy for the vagina. Enter Mona Lisa Touch a new novel fractional CO2 laser therapy for vaginal health. It is being used to treat vaginal dryness, painful sex GSM (vaginal atrophy), leakage of urine and may even help some women with lichen sclerosis.

Many women have called this new laser treatment life changing. Others have said it brought them back to their youth. The Mona Lisa Touch laser therapy is a simple procedure that takes less than five minutes. Typically, a woman will need 2-3 treatments and many women report symptom relief after the very first treatment and even greater improvement after the second and third treatments.

The Mona Lisa Touch is convenient, performed in the doctor’s office, requires no anaesthesia, has minimal side effects and requires no downtime. The Mona Lisa laser probe is inserted into the woman’s vagina and delivers laser pulses. The total procedure time is less than five minutes and is virtually painless.

Some women may experience mild discomfort with the laser probe tip insertion during the first procedure if there is sensitivity. Many women report instant relief and provides lasting results. A once a year single treatment is recommended after the first series of treatments to maintain symptom relief.

Ladies, don’t let vaginal dryness, painful sex, leakage of urine and/or lichen sclerosis get in the way of your life or worse your love life. There are lots of treatments available including laser therapy such as the Mona Lisa Touch which I'm happy to report, we are now offering for women in my clinical practice. Mona Lisa Touch

Maureen McGrath is a women’s health expert and hosts the Sunday Night Sex Show on News Talk 980 CKNW. She is creator of the blog 50ShadesofPink.ca and has a clinical practice in North Vancouver, British Columbia. For more information about Mona Lisa Touch, visit Mona Lisa Touch

To that end, few women realize the impact this may have on their vaginal and sexual health and how this will impact her libido or sexual desire. When a woman goes into early menopause, her estrogen receptors (which are the hormone regulators of vaginal health) decrease.  This means the pH of her vagina may be imbalanced (too alkaline) which places her at greater risk of infection.

In addition, because of the decrease in estrogen, she may experience vaginal dryness which can lead to painful intercourse and low sexual desire.  The result may be a negative impact on her relationship. But many people don’t realize the benefits of a great sex life. This is an area of health where the discussion may not arise.

It is important that women realize it is fine to continue an intimate relationship during or after cancer treatments. She defines that intimate relationship. She may decide to focus on cuddling or just spending quality time with her lover when she is feeling well.  She may want more, like petting and fondling.

For women who choose to continue with sexual intercourse, but are experiencing vaginal dryness and/or painful sex, personal moisturizers like RepaGyn, a hormone free ovule inserted into the vagina regularly, will not only ease the pain, but will increase personal moisture.

Speaking with a woman’s partner about these changes in physical condition is key.  In addition to RepaGyn, foreplay cannot be underestimated for its ability to increase a woman’s natural moisture. Lubricants, along with vaginal dilators, may help women to gently stretch their vagina prior to intercourse.  For women who have scars or body image concerns, lingerie may be just what the doctor ordered to increase sexual desire.

Sexual connection and intimacy is important at any time during a woman’s life, but especially when breast cancer strikes. So get backtothebedroom.ca with Repagyn and more!

Christina was uncomfortable using estrogen of any kind, even low dose localized estrogen (which is safe for many women), given her breast cancer diagnosis. She had tried Replens® but found that this made her itchy and did not help with her vaginal dryness.  I suggested that Christina use RepaGyn® for moisturization and to help heal the dry and cracked vaginal tissue since she had experienced a dry vagina for four years. RepaGyn® is a hormone-free personal moisturizer available as an ovule that is inserted into the vagina. She used it for 8 days in a row and then two or three times a week for two months. Christina later contacted me to let me know that it had helped her tremendously and she was feeling so much better.

Christina mentioned that many of her friends were going through the same things she was, suffering from vaginal dryness which had impacted their relationships because sex was painful. I encouraged to share her new-found knowledge with her friends and that it is important that women have these conversations. She agreed; she said that the value of education could not be overstated and so many women suffer in silence because we don't talk about these issues with each other.  I suggested she she tell her friends to check out my website and blog anytime.

Hot Flash in the City Event

I mentioned to Christina about Ladies Night Out, an educational event series that I will be hosting in November 2015 in and around Vancouver called, “Hot Flash In The City.” It is a fun, educational women’s health event about peri-menopause and menopause and more! I also told her that there would be lots of talk about vaginal dryness and sexual desire.

Everyone is welcome; ladies, health care professionals, anyone interested in women’s health, and of course men are welcome too!  With increased knowledge and understanding, a cocktail, some appies, the hilarious movie Hot Flash Havoc and a health presentation with a Q&A period, women are sure to get back to the bedroom once again!

For more information about the events go to: EventBrite.ca/HotFlashInTheCity