Pelvic floor & Menopause: Symptoms & Solutions

The Pelvic Floor

• The Pelvic floor à A muscular hammock consisting of fascia, ligaments, and other vascular structures. It provides structural support to the abdominopelvic pelvic organs and and helps regulate intra-abdominal pressure to provide bladder and bowel continence.
• The Pelvic floor muscles get affected by the aging process. The decline in Estrogen results in the loss of muscle mass and connective tissue, which are estrogen sensitive tissues.
• Changes in collagen concentrations due to estrogen deficiency can have a profound effect on the support mechanisms of the pelvic floor, thus making pelvic organ support and continence increasingly reliant on the muscles of the pelvic floor.

Menopause Effects

• 50% of women will have vulvovaginal symptoms that have an impact on their lifestyle, emotional wellbeing, and sexual health.
• Urogenital symptoms can involve the vulva, the vagina, and the bladder. Many women experience urogenital symptoms such as vaginal dryness, itching, discomfort, especially in relation to sexual activity and urinary incontinence or recurrent urinary infections.
• Vaginal atrophy can lead to vaginal dryness, soreness or pain during sex (dyspareunia). The skin and supporting tissues of the vulva and the vagina become less elastic and thin due to the reduction in circulating estrogen.
• Vaginal dryness is almost always the first symptomto be reported, whereas thinning of the skin and dryness are the most common causes of dyspareunia in women over the age of 50.

Dyspareunia

• Causes of dyspareunia :
• Irritation resulting from use of perfumed soaps. The first step—for these women and, in fact, for nearly all women—is to implement a protective skin-care routine. Women should use fragrance-free, hypoallergenic products and avoid the use of potential irritants, including feminine washes, perineal wipes, and even certain types of toilet paper.
• Irritation due to the lack of vaginal moisture and inadequate lubrication. The lack of circulation estrogen causes vaginal atrophy and dryness which in turn leads to painful sexual intercourse. For women who can receive HRT, the use of vaginal Estrogen creams can treat the underlying atrophy and allow them to have pain free intercourse. For women who cannot receive HRT due to risk factors, there are other solutions such as lubricants or the FEMI Lift laser.

FEMI LIFT

• A painless 15-minute office procedure utilizing third-generation CO2 fractional Laser Pixel technology delivered into the vagina via a vaginal-shaped probe. The laser waves exiting the tube 360° at closely spaced intervals “drill” microscopic, closely spaced micro-punctures 0.6 mm (600 microns) into the dermis, producing a mini-defect in the collagen that contracts, producing shrinkage (in proper power settings) and stimulating the collagen and elastin to grow, thus bulking and “rejuvenating” this layer. The procedure consists of 3 treatments over 12 weeks, with a “touchup” one year later.
• The results are a noticeable tightening of the entire vaginal barrel for increased friction and pleasure during sexual intimacy. If utilized in a different power mode, FemiLift is also quite effective in reversing the atrophic effects of aging in the vagina.

Who is a good candidate for FEMI LIFT?

Women with minimal to moderate vaginal looseness or laxity not severe enough to need a complete surgical repair (“Vaginoplasty”), but bothersome enough (less “grip,” too much “droop”) to diminish sexual pleasure and sometimes lead to modest urinary incontinence. Perfect candidates are:

1. Women who have not yet had a child but either feel themselves “wide” inside or have a partner with a smaller-sized penis.
2. Women with laxity after childbirth who plan on another child/children and need “temporary” tightening until their final childbirth, after which they may undergo a permanent surgical tightening procedure if the problem persists.
3. Women who will undergo a Vaginoplasty (surgical tightening procedure) of the outer (lower) half of the vagina/vaginal floor, but also have noticeable widening in the far inner (upper) vagina (where a surgical pelvic floor tightening procedure traditionally cannot reach), which frequently occurs with a coexisting problem of occasional involuntary loss of urine, and who wish to avoid an in-hospital general anesthesia, which is sometimes risky for upper-vaginal repair.
4. Women with mild urinary incontinence.
5. Women with only modest vaginal laxity and decent musculature, who wish to avoid a surgical procedure.
6. Post-menopausal women with dry, atrophic vaginal tissues.

Additional / Alternate Treatments

• Therapies that can be used in addition to or instead of hormone treatment include apart from the FEMI Lift Laser, vaginal dilators, pelvic floor physical therapy (PT).
• Gentle stretching of the vagina with the use of lubricated vaginal dilators of graduated sizes can help restore and maintain vaginal function. Re-initiating regular sexual activity once vaginal penetration is comfortable will help maintain vaginal health. Similarly, a vibrator can be used therapeutically to stimulate blood flow and maintain vaginal function in women with or without a partner.

Conclusion

• The lack of circulating Estrogen during the Peri – Menopause and the Menopause leads to vaginal and vulval atrophy.
• Atrophic changes and the loss of muscular strength of the pelvic floor cause what is known as the Urogenital Syndrome of Menopause which leads women to recurrent UTIs ,Stress Urinary Incontinence, Dyspareunia, Itching and Soreness.
• Most women will be given at some point lubricants or antibiotics but these treatments only mask the real cause which is Estrogen Deficiency.
• Solutions do exist so that women can improve their quality of life and instead of resorting to the aforementioned, we should listen to their needs and try to cure the source of the problem not just the presenting symptom.

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