Hot flashes, night sweats, moodiness, forgetfulness — these are menopausal symptoms that women have no problem discussing with their doctors.
But when it comes to the dry, tender vaginal tissues and painful intercourse caused by menopause, women suddenly become much less talkative, studies show.
That may be changing. The Food and Drug Administration recently approved Osphena, an estrogen-like drug some are calling the "pink Viagra" because it strengthens vaginal tissues, making intercourse less painful.
With the drug heading to market this month and drugmaker Shionogi planning a big marketing campaign, the problem of painful sex is suddenly getting a lot more attention.
And it's about time, says Sheryl Kingsberg, chief of the division of behavioral medicine at University Hospitals Case Medical Center in Cleveland.
In a study of more than 3,000 women ages 45 to 75, Kingsberg and her colleagues found that many women suffer silently with vaginal pain, mostly because of embarrassment about bringing it up. (In the interest of full disclosure, Kingsberg reports that she and her colleagues received financial support from Osphena's drugmaker, Shionogi, even though the drug wasn't part of the study.)
The condition the women have is officially known as vulvovaginal atrophy (VVA), which refers to the thinning and weakening of vaginal tissues due to the drop in estrogen after menopause.
A number of studies estimate that close to 50 percent of postmenopausal women will experience VVA-related symptoms, including vaginal dryness, irritation, pain during intercourse and trouble with urination. In some cases, inflamed tissues can become infected.
With all this discomfort and pain, you'd think women would be avidly seeking relief. But research in both the United States and Europe notes that women frequently don't report their symptoms and, as a consequence, go untreated.
"There is a tremendous lack of communication around vaginal discomfort," Kingsberg says. She says the condition is both "underdiagnosed and undertreated" in older women, thanks to a lack of communication between health care providers and their postmenopausal patients.