By Ty Wenger
Fifteen years ago, I found myself in a romantic pickle: Cheryl, a woman I
had been dating for about three months, was nearing her 25th birthday. The
birthday gift in any three-month-old relationship is a dicey one, and I
deliberated over it for weeks. Too big too soon and it could look like I was
trying too hard. Too little and I might appear indifferent. Too romantic and
I'd run the risk of setting the bar too high.
And so it was with great enthusiasm that I finally unveiled...
"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
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
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.