Chocolates and Sex, The Wrong Gift for Valentine’s Day
07 Feb 2008
“What did your husband give you for Valentine’s Day?” I jokingly asked a 55 year old patient. She replied, “He brought home the usual gift, chocolates, but that won’t solve my pain with sex. Nor can my own doctor, as he never talks about sexual matters.” This is a scenario I often see in my office and it’s time to break the hush that so often surrounds this problem.
This woman had started into menopause at 50 years of age, suffering from flushes, insomnia and increased irritability. These symptoms had gradually faded without any treatment over a two-year period. But slowly she noted that sexual intercourse was becoming increasingly painful. And by Valentine’s Day this year it was causing problems in her marriage.
What had gone wrong? She had developed a thinning of the vaginal lining called, atrophic vaginitis. And expecting her to enjoy sex was like asking a singer to perform with a sore throat.
This patient’s discomfort was due to a series of errors. The stage was set for a problem several years previously. In 2002, a U.S. study called, The Women’s Health Initiative, reported that postmenopausal women who had been using hormone replacement therapy (HRT) longer than four years had an increased risk of breast cancer, heart attack and stroke.
This report made headlines around the world, frightening many women, and it was easy to predict the outcome. Doctors stopped prescribing HRT for any length of time. Many patients also decided on their own to run for the woods.
But some conclusions didn’t add up. I wrote in dissent at that time that estrogen had been used for 60 years by millions of women. Good sense should tell researchers that if estrogen was a major risk factor for breast cancer, there should be a raging epidemic by this time.
The study was also a statistical one and it’s been aptly said that there are three kinds of lies, “lies, damn lies and statistics”. One of Harvard’s most distinguished researchers once remarked, “If you have to prove something by statistics, it’s usually wrong.”
Researchers also failed to stress that the risk of cancer and heart disease was extremely rare. For instance, there were eight cases of breast cancer and seven more cardiovascular problems for every 10,000 women per year of use.
As well a price was paid for tossing HRT down the drain. I’ve always remembered how it affected one patient. As a high school principal she needed a constitution of steel to handle her job. But shortly after she stopped taking HRT, she burst into tears in my office. She claimed she had lost total control of her emotions. A few weeks later she was back on HRT and functioning normally.
But there’s a difference between menopausal symptoms, such as hot flushes, and atrophic vaginitis. Flushes can strike within the first weeks of menopause. But it usually takes a few years before women become aware that sexual intercourse is steadily becoming more and more painful.
It is a tragedy when I see couples in my office who have not had sex for several years because of this curable symptom. The once daily (or nightly) insertion of “Vagifem”, an estrogen tablet, for 14 days is the regimen to treat symptoms of atrophic vaginitis and restore the vaginal lining to its normal thickness. Then to prevent a recurrence it can be used once or twice a week.
Unfortunately today common sense in treating menopausal problems is an uncommon commodity. I see menopausal women being prescribed anti-depressant drugs for atrophic vaginitis when they have absolutely no effect on this gynecological condition. Moreover, this medication causes complications as long as your arm.
I congratulated this patient for seeking help for her problem. Today there should be open discourse about sexual matters between doctors and patients. It would ensure that more women could enjoy both chocolates and sex with their husbands on the next Valentine’s Day.
