Painful Sex Gets a New Treatment

Painful sex, dry vaginal tissues, chronic urinary tract infections, all are due to the lack of estrogen as a woman ages through menopause. There are both medical and non-medical therapies for this condition. Women who have painful sex in menopause usually have the condition of atrophic vulvovaginitis,or genital atrophy or what is more commonly known as the thinning of the vaginal walls due to menopausal changes. There are even pap tests to determine if this is the diagnosis, although your gyno can usually tell just by looking. The US Food and Drug Administration (FDA) in Feb of 2013 has approved ospemifene (Osphena, Shionogi, Inc) for treating this condition of painful sex due to vaginal dryness also known as  dyspareunia in postmenopausal women. Dyspareunia, in younger women, can be caused by a number of conditions  yeast infections, bacterial vaginosis, PID, STDs, or endometriosis. In menopausal women it is associated with declining levels of estrogen during menopause, which leads to the thinning and dryness of the walls of the vagina and the vulva. This then can result in too much dryness, actual cuts and thus pain during sexual intercourse.

Generally gynos have recommended estrogen therapy as the treatment of choice for this condition, but not all women want to take estrogen therapy, and very little else works. Now there is an alternative. The new painful sex treatment ospemifene is a  selective estrogen receptor modulator that makes vaginal tissue thicker and less fragile, resulting in a reduction in the amount of pain women experience with sexual intercourse. It is a given as a pill, and it works fairly rapidly to restore the natural moisture and the comfort of sex. We estimate that virtually all women remaining sexually active into their post menopausal years will have this complaint if not treated by hormone therapy, so a great number of women stand to benefit by considering this therapy. Women need to be treated for about 3 months for full effectiveness, and there is a warning that the medication can cause thickening of the lining of the uterus which would need to be evaluated. Women experiencing unusual vaginal discharge or bleeding need to see their gyno to see if they have this complication.

The boxed warning for ospemifene also states the incidence rates of thrombotic and hemorrhagic strokes (0.72 and 1.45 per 1000 women, respectively) and the incidence rate of deep vein thrombosis (1.45 per 1000 women)."These rates are considered to represent low risks in contrast to the increased risks of stroke and deep vein thrombosis seen with estrogen-alone therapy," the FDA said. Minor side effects can include hot flashes or vaginal discharge.

Making the decision as to whether to take a systemic therapy or to use estrogen therapy is a complex one. Most women will try simple therapies first and do have to consider risks and benefits of alternatives.  Recent web articles have focused on the negative aspects of this therapy, implying that this risk is greater than other therapies.. These articles not only focus on potential risks, but clearly doesn't list percentages of these risks, nor does it do a good job of addressing benefits and or does it do a good job of discussing alternatives and their risks and benefits. As first line in the discussion with your gyno figure out if you indeed need treatment at all. Most women who take therapy are sexually active, but if you aren't and you plan to be, you are still a candidate for treatment. Osphena as a SERM (selective Estrogen Receptor Modulator) has potential benefits on breast tissue and bones. Find out if you have a baseline risk for for blood clots.  All the clinical trials were done without a progesterone, and the risks were very low of lining changes to the uterus. Some physicians may decide to put you on progesterone therapy if you are on Osphena. Even off hormones entirely women have a baseline risk of endometrial cancer. Estrogen therapy used locally is thought to be safer than systemic therapy,for atrophic changes of the vagina and vulva, yet it does have the same package insert risks listed in terms of blood clots and lining changes of the uterus, and thus it's a decision as to which will be best for an individual woman.. For women who do not want to take hormonal medications, and for women who are not completely cured by hormonal medications, the new therapy MonaLisa Touch is a good alternative.