At a time when men’s concerns around their aging penises get constant print and media attention, women are sometimes woefully unsure about the changes that are taking place with their genitals. They may see a diagram up on the wall in their gynecologist’s office illustrating a graying, slumped over woman with sagging skin and drooping breasts (where is the image of a 57-year-old Christie Brinkley when you need it?)—but that often serves as the extent of available insight and somewhat specious visibility.
Dr. Barbara DePree began focusing her practice on mid-life women eight years ago when she noticed that her intake questionnaire pointed to the need for a resource dealing with women who were having trouble with their sexual health. An OB/GYN doctor with a twenty-year track record, DePree is the Director of the Women’s Midlife Services at Holland Hospital. “Providers aren’t always up to date,” she told me in a telephone conversation. She added, “They also may not feel comfortable dialoguing.”
The topic in question? The medical term is “vaginal atrophy.” As DePree explained, “As a woman gets older, the vagina gets shorter and more narrow. The walls become thinner and more fragile—as well as less elastic. The color becomes a pale pink, which reflects a lack of blood supply.” Another way of referencing the situation is to say that a woman is “losing patency.” The biological definition of patency is “the state or quality of being open, expanded, or unblocked.”
It doesn’t have to be that way. DePree called up the adage, “Use it or lose it.” That advice was for women in relationships who were finding intercourse uncomfortable, as well as for single women who wanted to maintain optimum vaginal health so that their vaginas would be functional for future sexual activity.
Her four-point program and goals are simple. To increase a significant blood supply to the genital area in order to maintain vaginal health. She suggested:
· Vaginal moisturizers and lubricants to prevent dryness, keeping vaginal tissues moist and strong.
· Vaginal dilators to develop or restore the vaginal opening, and help keep vaginal tissues elastic and comfortable.
· Regular clitoral stimulation to maintain blood flow and keep the clitoris strong and responsive.
· Kegel exercises, which not only help women maintain strong orgasms, but help them retain urinary continence.
DePree supports the use of “localized estrogen,” because she maintains that it is well tolerated and “very effective in bringing more bloody supply to the area”—so that not only are tissues healthier but “it adds to arousal.” She did acknowledge that not all women were interested in using estrogen, and that there were other options to keeping the vagina "supple and moist.”
Michele Carelse, who heads up the Native Remedies’ Expert team, takes the naturopathic perspective—which is to look at the larger picture. Carelse believes in going beyond just the symptoms to see a broader context. Noting that a woman’s hormonal balance is constantly changing, she said, “Our point of view is to help the body to achieve hormonal balance. Look at the underlying imbalances, not just the symptoms.” Making clear that she was not in opposition to traditional medications, Carelse said that she encourages women to speak with their doctors and discuss the Native Remedies that they are using. She did, however, express a concern with “menopause being viewed as an illness” and “medicalizing a normal process and part of a woman’s life.”
A change in the vaginal cell walls, coming from an imbalance, can lead to inflammation, contractions, and a predisposition to urinary tract infections. Carelse elucidated that when pH levels have changed and there is dryness of the vaginal walls, it makes it easier for bacteria to enter those walls. Rather than turn to estrogen, Native Remedies offers a “natural vaginal lubricant” (no parabens, sodium laurel sulphate, or petrochemicals) that features the ingredients of wild yam, essential oils, and aloe.
Dr. Michael Wald, Director of Nutritional Services at Integrated Medicine, suggested via e-mail a series of alternatives for those women who are concerned about using synthetic estrogens and progestins. They included:
· Various herbal combinations such as red raspberry leaf, which is a uterine tonic that helps increase blood flow to the uterus and vaginal tissues.
· Vitamin A rich foods and vitamin A supplements, which can help vaginal atrophy. Vitamin A is required for the production of the specialized cells that line the vagina. No more than 15,000 IUs of vitamin A should be taken in the form of vitamin A supplements. Foods rich in vitamin A can be consumed liberally and include liver, potatoes, carrots, mangos, spinach, cantaloupe, dried apricots, milk, egg yolks, and mozzarella cheese.
· Zinc is absolutely essential for helping to reverse vaginal atrophy or to slow it down. Zinc is a mineral that helps to rejuvenate many different types of cells throughout the body, including the specialized cells that line the vagina. Zinc in the form of nutritional supplements should not exceed 75 mg per day. Zinc rich foods include: oysters, wheat germ, veal liver, sesame flour and Tahini (sesame butter), low fat roast beef, roasted pumpkin and squash seeds, dried watermelon seeds, cocoa powder and chocolate, lamb and peanuts.
· Indole 3 carbinol—A nutritional compound found in cruciferous vegetables (broccoli, cabbage, bok choy, cauliflower, eggplant) that helps hormone regulation.
· EPA/DHA fish oil, which helps improve tissue integrity throughout the body. A usual dose is 1-2 grams per day.
· Lactobacillus acidophilus in the form of a vaginal suppository, which is available at health food stores. It is also available in a dairy free form for those with dairy sensitivity.
· Gingko biloba—Improves blood flow to the vagina. The dosage should be the recommended dosage on the bottle or as directed by your health care practitioner
· Arginine—Improves blood flow to the vagina. The dosage should be the recommended dosage on the bottle or as directed by your healthcare practitioner
· Vitamin D—Helps cellular regeneration throughout the body. The dosage should be the recommended dosage on the bottle or as directed by your healthcare practitioner
In following up on DePree’s recommendation for vaginal dilators, I connected with Mark Carter, who has been a force in bringing resources and information about the medical condition of vaginismus to a population that he characterized as being “poorly served.” He discussed how the dilator set (five pieces which are graduated in size) can “gently stretch out the vaginal canal” which has lost its elasticity. He described the dilators as being made from the highest-grade medical plastic in a United Kingdom factory that is ISO-9000 compliant. In response to my questions, Carter confirmed that the dilators were PCB-free and without phthalates. The construction is seamless with a mirrored finish, and they are tapered at the front with a rounded tip.
Fighting back against the aging woman stereotype is not always easy. In the 21st century, women demanding information about their changing bodies shouldn’t have to encounter obstacles. As DePree wrote in a follow up e-mail, "As we grow older our vaginas change. It’s a natural part of the aging process, not something to be embarrassed about or intimidated by. The important thing is to be proactive. Using your vagina will help keep it elastic and comfortable for sex. We work hard after 40 to maintain our skin, hair, body, brain, and heart. Why not our vulvovaginal tissues too?”
For all those single ladies out there, her final sentence was, “Strong vaginas aren’t just for couples!"