July 2, 2001 -- Four years ago, at age 44, Seattle resident
Caroline Scott Brown underwent a hysterectomy with removal of ovaries.
"Immediately after recovering from the surgery when I found
out it was OK for me to start back having sex, I realized that it didn't feel
comfortable," Brown says. "I was dry as a bone. It was awful. I was
actually irritated just from touching my underwear, and I was avoiding sex.
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Brown was suffering from atrophic vaginitis, a condition in
which the vagina becomes dry and overly delicate in response to declining
levels of the female hormone estrogen, says Andrew Kaunitz, MD. This decrease
in estrogen happens naturally around menopause and temporarily while nursing a
baby. But the hormone also drops off quite sharply in women who have surgeries
like the one Brown had, especially when their ovaries, the glands that produce
estrogen, are removed.
The changes women will notice are quite visible, says Gloria
Bachmann, MD, associate dean for women's health at the Robert Wood Johnson
Medical School in New Brunswick, N.J.
"One of the first signs one sees on pelvic examination is
that the vaginal area is very dry, it's very pale, and it loses the wrinkling
that most younger women have," she says. "As it progresses, the vaginal
area gets thinner and smoother, and it easily bleeds. ... The degree of it is
sometimes variable. A 50-year-old who comes in today to see me may have
horrible symptoms, whereas another 50-year-old may not be at that point and may
still have some lubrication."
All these changes can make atrophic vaginitis, "a very
important but frequently not discussed caused of female sexual
dysfunction," says Kaunitz, professor and assistant chairman of the
department of obstetrics and gynecology at the University of Florida Health
Science Center in Jacksonville and director of menopausal services for the
University of Florida Medical Women's Center.
'Not an Automatic Thing'
Atrophic vaginitis occurs to a certain degree in all women as
they age and their estrogen declines. Even women taking hormone replacement
therapy are not immune because it is not always enough estrogen to keep things
And fortunately, not everyone will have the most troubling
symptoms, which can have a major impact on quality of life, especially sex
"It's not an automatic thing," says Susan Love, MD, who
specializes in women's health and is the author of many books on the topic,
including Dr. Susan Love's Hormone Book. "In studies, only about
10%-20% of all women will get vaginal dryness [after menopause]. There are
Seeking Help and Staying Active
But for those women who are affected, many are embarrassed to
discuss vaginal discomfort with their physician. Others feel that uncomfortable
sex is a natural and unavoidable aspect of getting older. But nothing could be
further from the truth, says Kaunitz.