Amaryllis © lynette sheppard

Amaryllis © lynette sheppard

I had a wonderful time interviewing Dr. Mary Jane Minkin, an activist for vaginal health. She claims that “everyone should have a happy vagina.”

Here’s what she shared with me:

MGB:  What is vaginal atrophy?

Dr. Minkin:  Vaginal atrophy is very common, but often we don’t talk about it. It affects so many menopausal women because the vaginal and vulva are the tissues most sensitive to decreased levels of estrogen.

MGB:   What are the signs and symptoms of VA?

Dr. Minkin:  Itching, burning, discharge, discomfort during sex or even riding a bike are common symptoms. And believe it or not, urinary tract infections can result. What happens is that in VA, there is a loss of the good vaginal flora (good bacteria) that keep the pH optimal. Bladder infections occur due to this change in flora – and also when the vagina is dry, the bladder and urethra may also be dry, making them more prone to infection.

MGB:  What can VA be confused with?

Dr. Minkin:  Drainage may be attributed to infection alone (which may or may not occur with VA). Treatment with antibiotics may help but won’t address the underlying problem. Women need to be educated and talk with their health care providers about this.

MGB:   What are some treatment options?

Dr. Minkin:  Basically, we need to introduce estrogen locally. Non systemic estrogen is less risky than systemic (pills, patch, etc.) Note: the FDA requires the same warnings for all estrogen preparations regardless of whether it is systemic or not.

Options include the vaginal ring, vaginal estrogen creams, and the vaginal tablet (Vagifem).  A recent study looked at compliance with various regimens. The cream was messy, according to some women, and involved cleaning applicators.

The vaginal ring stays in place for 3 months and some women worried about that, although it’s been shown to be safe (no toxic shock risk, etc.) Rarely, the sexual partner noticed it on intercourse.

Vagifem tablet is tiny and generally creates no mess, so might be better for sticking with treatment for those who worry about messiness and so on. You use it every day for 2 weeks, then maintenance dose is 2 times per week.

MGB:  What about products like Replens or Hyalo Gyn to help with vaginal atrophy?
Dr. Minkin:  These products are good in helping with moisture – and they are longer acting than lubricants. For some women, they will need more. Also, these often don’t help with the bladder problems.

MGB:  What if a woman does not want to take estrogen? What about soy based remedies or other phytoestrogens?

Dr. Minkin:  These are fine, keeping in mind that soy isoflavones are a weak plant estrogen and may not be enough.

MGB:  How do you propose that women take charge of their vaginal health?

Dr. Minkin:  One of the most important things is to find a health care provider with whom you feel comfortable. Some women feel better talking to a woman, be she an MD, nurse midwife, or nurse practitioner. Together, you can explore options and find what is right for you.

MGB:  What additional resources do you recommend?

Dr. Minkin: and NAMS (North American Menopause Society) at  Also, visit where I am one of their Menopause advisors.

MGB:  Anything else you’d like to share with our readers?

Dr. Minkin:  Women with VA should know that they are in very good company. And we shouldn’t be afraid to talk about it.

Many women are simply not aware there are options. Remember in the year 1900, the average age of Menopause was 48. And the average life expectancy was…48!

Now the average age of Menopause is 51 and our life expectancy is into our 80’s.

One of the perks of treating VA is a pain free, healthy sex life. I was once on a show with Dr. Ruth who stressed that we should have sex until we are 99. I suggested even longer if we live into our 100’s. “Why not?” she said.