Jane Lewis is the author of the superb, taboo-busting book Me and My Menopausal Vagina. In an exclusive interview, we talked to Jane about her menopause experiences, the condition of vaginal atrophy, and how she wrote her groundbreaking book...
Vulval-vaginal atrophy is an extremely distressing condition that causes dryness, discomfort, and pain in the vaginal and vulval areas and which affects millions of women. At least 50% of the UK’s post-menopausal women aged 45 and upwards have some degree of vulval-vaginal atrophy but some menopause specialists, such as Dr Louise Newson, believe that the true figure is much higher, with 70-80% of post-menopausal women affected.
Very few seek medical help but, even when they do, far too many are not being listened to and are not receiving treatment that could really help, according to Jane Lewis, author of Me and My Menopausal Vagina.
Can you tell us a little bit about your symptoms, Jane? When did you begin to notice vaginal and vulval changes?
I was 45; sex had already started to become slightly painful; then I noticed that my normal light vaginal discharge had stopped completely. The whole vulva area had become very dry. I also became very sore and had a burning sensation when I went horse riding – something I loved. When I examined myself, with a mirror, I could see that my vulva was very red, my outer labia were very thin, like tissue paper, and the clitoral hood was pulled right back. It’s a condition called vaginal atrophy. To be honest, I had thought about the ageing process, as far as the rest of my body was concerned but I’d never stopped to think that my vagina would age.
In your book, you mention that, while your own GP listened and was supportive, that is often not the case, for example the woman who was told to 'drink a bottle of wine to relax and see a counsellor', when she consulted her doctor about dealing with sex and vaginal atrophy. What advice would you give to women who aren't getting the support they need from their GP?
It’s not easy but you do have to be determined because it’s vital to get the correct diagnosis. For example, vaginal atrophy and a condition called Lichen Sclerosus can present with similar symptoms. Lichen Sclerosus is usually treated with a steroid cream – but that’s the worst thing for vaginal atrophy, which can be treated with a topical oestrogen cream. That said, I need everything to manage my VA – topical oestrogen, hormone replacement therapy, dilators, and the support and guidance of a women’s health physiotherapist!
You mention how helpful your women's health physiotherapist (WHP) was. Can you tell us a little more about what WHPs do and how to find one?
They’re wonderful – they can support a woman through pregnancy, the post-natal period and prolapse, and, of course, through menopause. They can help with urinary incontinence – such as stress incontinence. Urinary incontinence is not normal but so many women put up with it! Panty liners, for years on end, are not the answer – and can irritate already dry, sensitive skin. WHPs can show you exactly how to do your pelvic floor exercises, which is vital because most of us are doing them incorrectly. And if, like me, you are finding intercourse painful, they will teach you how to use vaginal dilators.
Unfortunately, there aren’t many of them. Some major hospitals have WHPs but most work privately. I used a credit card to pay for my treatment and, really, it was worth every penny.
(Check with your local medical centre or simply do an online search to see if there is WHP in your area.)
You had to do a lot of research and experimentation to find a combination of medication, treatment, and a vaginal care routine that worked for you, and that included private healthcare, such as laser treatment. That won't be an option for everyone, so what changes would you like to see in the NHS to enable more women to get the care they need. For example, would you like to see more Well Women Centres at GPs' practices?
Yes, that would be a great help; we need to start demanding better menopausal health care for women. After all, most of us are now living for 30 years or so beyond menopause; it’s unacceptable that, in the 21st century, we should live out those years with sore, painful vaginas and vulvas. If you have a copy of my book, you could give it to your GP – or just photocopy the relevant sections for them.
HRT has been an important element of your continuing treatment. Have you any suggestions that women who, for one reason or another are unable to take HRT, could consider?
Oestrogen cream, which you apply, appears to be perfectly safe to use so do ask your GP to prescribe it for you. The most important thing you can do is to keep your vulva and vagina area from becoming dry. If you’re uncertain as to whether you should or should not take HRT, I recommend seeing a doctor who specialises in menopause, as they are up to date with the latest research. I consulted a private specialist but I was in such agony that it was a necessity rather than a choice.
Throughout the book, you stress the importance of talking to loved ones, including partners and family members, about the effects of vaginal atrophy, not just in terms of pain but on physical, emotional and mental wellbeing. Any advice for women who are struggling to do that, for example, women with partners who simply don't want to know?
We really do have to get over this barrier of being too embarrassed or ashamed to talk about our vulvas and vaginas – for the sake of our health and wellbeing. But if you really are struggling, get a copy of my book and give it to your partner – or other family members - to read. We need to educate men – husbands, partners, sons – as well as the women in our lives.
What's the most important message we can give our daughters and granddaughters about vaginal and vulval care?
Your vaginas and vulvas are precious – please look after them. I’d like to see an end to this labioplasty nonsense that so many younger women seem to be opting for – because they think that their labia don’t look ‘normal.’ Stop wearing tight jeans and stop shaving your pubic hair – it’s there for a reason. Ask yourself why you are doing it and for whom. And stop using inappropriate scented products, which are full of chemicals, in the shower and bath.
Your life has changed dramatically in recent years, especially since the publication of My Menopausal Vagina. How has it changed and what do you do when you want to switch off?
Well, I don’t like social media but I’m having to get used to it! I do want to help and encourage other women to deal with this and similar conditions, so I’m speaking to women’s groups and at conferences – recently with menopause specialist, Diane Danzebrink*. I’m also talking to GPs and other medical professionals and– and encouraging them to read my book, so that they have a much better understanding and awareness of how women are suffering – and suffering quite unnecessarily.
I’m very fortunate to have a close and loving family, including my daughter, Penny, who co-wrote Me and My Menopausal Vagina with me, and they have all been so encouraging and supportive. And, until very recently, I had two dogs, Bertie and Bonnie, and I have always loved walking them. Bertie died recently, however, and I have just about come to terms with the fact he’s no longer trotting behind me. My walks with Bonnie are now even more special . . .
Me and My Menopausal Vagina is available in the Live Better With Menopause online shop. As one of our Facebook community group says: ‘I’ve read it, brilliant and so helpful. Everyone should read it so they have a better understanding of how it all works. Thank you for writing it!’
If you are suffering from vaginal atrophy, you are not alone! Visit the Live Better With Menopause Community Forum for information, advice, and tips, and to share your own questions and suggestions.