Shirley (Silver She Is) is a mother, grandmother, and business owner whose personal experience with vaginal atrophy led her to the edge of her pain threshold and back again, now with a story to tell. Shirley shares her tale with Nyssa and across her social media platforms as Silver She Is in an effort to create more awareness on this very taboo subject, and help other vaginal atrophy sufferers in their journey to recovery.
I am an ordinary woman. I’ve just turned 58 with 2 kids, 2 grandbabies, I’m a bit overweight, a business owner, have been in perimenopause for around 8 years, and I have vaginal atrophy.
I am going to take a guess - you’re thinking ‘TMI!’ but are now wondering what vaginal atrophy is and probably thinking it sounds horrible? Well surprise surprise...it is! It might also shock you to know that if you are in perimenopause or post menopause, you may unknowingly have it too.
I was in my mid-forties when cystitis started to make a regular appearance. Up until then, I used to get a UTI once or twice a year, usually when dehydrated or after an enthusiastic sex sesh. By the time I was 50, I was having a UTI every other month. By 52, it was on a 3-week cycle.
"I was suicidal. I couldn’t work properly, attending anything was a nightmare, and having a normal sex life with my partner was just out of the question."
As I’d had cystitis over the years, I knew the signs, but this was nothing like before. It was relentless, painful, and it affected my life to the point where there were days (and nights!) that I could not even leave the toilet. Antibiotics didn’t help, only copious amounts of water, a peri bottle, and constant co-codamol. After a year of this, I was suicidal. I couldn’t work properly, attending anything was a nightmare, and having a normal sex life with my partner was just out of the question.
In the year prior to this, I was having perimenopause symptoms and had started systemic Hormone Replacement Therapy (HRT) - an estrogen patch and progesterone pill - but nobody had realized that the constant cystitis was hormone related at this point. The HRT hadn’t helped, so there was no epiphany, only the sad acceptance that this endless debilitating situation would continue.
Finally, at 54, it was the constant UTIs that got me the treatment I so badly needed – I saw an A&E doctor with yet another really bad bout of cystitis, and at this point I was so mentally beaten down with the constant infections, the pain, the huge impact on my life, that I was on the floor sobbing for help. After listening to me, asking me the ‘right’ questions, he realized what was happening and prescribed me a course of Vagifem – local vaginal estrogen (body identical estradiol) pessaries.
Since that night I haven’t had cystitis. Not once. I know it sounds dramatic but local vaginal estrogen saved my life.
Genitourinary Symptom of Menopause (GSM) is the more formal name for vaginal atrophy – and it can affect the vulva and urinary tract system, as well as the vagina. It cannot be cured as such but can be very well managed with the right medication and regime. It will likely return or worsen if treatment stops, however, so once diagnosed it can be seen as a lifelong condition.
"The thing that gets me every time I think about it, is that nearly 1 in 3 vagina owners experience vaginal atrophy in their lifetime, and yet hardly anyone knows about it!"
Vaginal atrophy may occur when estrogen levels fall in the body – during peri/post menopause (cis women) or testosterone therapy (trans men). It can also happen after a hysterectomy/oophorectomy or following radiation/chemotherapy or estrogen suppressing medication. It can occur temporarily while breastfeeding (in hindsight, I had VA while I was breastfeeding which also went untreated).
The thing that gets me every time I think about it, is that nearly 1 in 3 vagina owners experience vaginal atrophy in their lifetime, and yet hardly anyone knows about it! I had never heard of it before I was diagnosed, and our GPs don’t really know much either - my doctor hadn’t picked up on the indicators at all, even with all the ‘pointers’ of age, frequency, perimenopause symptoms etc.
I now spend a considerable amount of my time educating people about this condition. I want others to know what I didn’t – I don’t want anyone to go through what I did – I have knowledge to share, and I want to share it with as many people as possible.
I talk about it to young women, older women, to men and partners of people who are going through the menopause. Very rarely do I talk to anyone who knows about this – in fact I think the only people I’ve spoken to who DO know about vaginal atrophy, are those who have been diagnosed with it!
So…let’s get you up to speed, so you can recognize the symptoms in case you need treatment!
In no particular order, here are some of the indicators of vaginal atrophy:
Abrasions and micro tears of the vulval tissues
Vaginal and vulval dryness
Thinning of the tissues of the vulva and vagina
Narrowing of the vaginal opening
These are the main symptoms. If you are suffering from any of these, please see your doctor. It absolutely helps to write down what you are experiencing, along with frequency, duration, and how much each symptom is affecting you and your day-to-day life.
If you are in the UK and 45+, your GP is guided to prescribe you with either systemic HRT, local vaginal estrogen, or both.* In the US, the accepted ‘no issue to prescribe’ window for receiving HRT is 40-55, if there are no medical complications but there are perimenopause symptoms. Likewise with vaginal estrogen.* If your doctor doesn’t offer it – ask for it. Tell them that you think you have vaginal atrophy. If you are under 45 you are going to be working against a system that doesn’t readily recognize that younger people can have this condition. You will need to ask and keep on asking. Be relentless. Be brave. Advocate for your body and fight for what you need.
Local vaginal estrogen is very safe. It uses a tiny dose of estrogen and is not linked* to a high risk of invasive breast cancer, colorectal cancer, endometrial cancer, stroke, or blood clots.
The types of local estrogen are:
Pessary – Vagifem, Vagirux, Imvaggis
Cream – Ovestin, Estradiol
Silicone Ring Insert – Estring
The pessaries and creams need a loading dose which is usually two weeks of being used every night, then twice weekly, and the silicone ring is put in place in the vagina and is replaced every three months.
In addition to receiving a prescription, you will likely need to change your personal hygiene routine from baths to showers, only using a very mild shower gel or soap on the outside of the labia majora, and only water on the labia minora, clitoris, and inner vulval areas. You should not ‘clean’ your vagina with anything but water. You might need a peri bottle to help with stinging during peeing, and you should look for underwear that doesn’t have a gusset seam to prevent abrasions to your vulval tissues.
Intimacy of any kind will likely be painful and can affect your relationship. I missed that side of things so much so I completely understand. But after medical treatment, a change of routine, a very understanding and gentle partner, and a fuck-tonne of lube, I do have a sex life again, albeit a little different from the one I had before. My tip on that – the positions recommended for sex during pregnancy are good to adapt to a VA vag.
The upshot? It may take time for your vulva and vagina to get to anywhere near ‘normal’ but with the right treatment and dosing, it can be done – that’s from someone who has been through it and is now out the other side.
artwork by georgia o'keeffe
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