Let's have another conversation about vaginas

Following on from my last post, today was my first appointment with the gynaecologist to discuss vaginal atrophy. By a happy coincidence, it turns out that Dr Metawa is one of the two doctors that introduced the Mona Lisa touch therapy to Australia. He tells me that when he first started offering it, he contacted many of the cancer groups. It is his view that this treatment should be offered a a routine part of cancer treatment where menopausal symptoms are often induced. He shakes his head and tells me that they were skeptical and didn’t believe the therapy would work.

Since then it has become more broadly available and the cost has come down, but it is still too expensive for many people. I tell him my story, about my GP telling me I had vaginal atrophy and not bothering to let me know about laser therapy. “It’s cultural,” he replies in his clearly not-Australian-born accent. “In Australia there is a great reluctance to talk about vaginal health.”

Why is this? The doctor explains that vaginal atrophy results in the slow collapse of the vagina, often leaving women with symptoms of urinary incontinence, higher risk of urinary tract infections, higher incidence of prolapse (where inside bits become outside bits), and in some cases, irritation or pain so sever that patients have trouble walking. But we’re Australian, so let’s not talk about vaginas.

Then, of course, there’s intercourse, which we also don’t like talking about unless we’re using it as an analogy for something being broken. We have not trouble at all saying something is ‘fucked’ but we cringe at any conversation about actual intercourse and whether or not it’s still comfortable. I know, I’m generalising here and those of us from backgrounds like nursing or policing sex crimes are much less squeamish. Even so, I cannot recall ever having a single conversation with a girlfriend about our vaginas.

Dr Metawa thinks that discomfort during intercourse is the least significant issue when it comes to vaginal atrophy. He’s not diminishing the importance of my sex life. He says this in a way that means “There are so many other terrible things that come with vaginal atrophy that this is way down the list.”

The doctor ushers me into his examination suite and gives me some privacy while I take off everything below the waist. He returns after knocking, and asks me to put my legs up into the stirrups. He tells me that I’ll be able to follow the examination on the television screen attached to the chair, if I wish. Sure. Why not? Let’s have a good look at vaginal atrophy.

He turns on the camera and tells me that, of course, the image of my vagina is magnified. “Oh that’s good news,” I respond, “Or I’m in real trouble!” He chuckles like he’s never heard this one before and I decide I like him. Next up, vivid colour images of my vagina. (I can’t help noticing I’ve got a grey hair) and  the good doctor confirms that I have advanced vaginal atrophy. He explains that the vaginal birth of my daughter, twenty four years ago, stretched the skin and that’s why it has taken so long after chemotherapy for the atrophy to become apparent. If I’d had a caesarean birth, or never had children, it would have turned up sooner.

Dr Metawa advised me that I am a good candidate for the Mona Lisa Touch Therapy. He’s pleased that I’m not on any anti-oestrogen medication as this can make atrophy much worse, and treatment not as straight forward. He still treats women on anti-oestrogen medication so if you are in that category it is still worth seeing someone about this treatment.

I’m booked in for my first session on Friday. I’ve been warned that this one can be uncomfortable, and even painful, because the vagina is dry and the walls are thin. The good news is it will be all uphill from here, with little or no discomfort for my second and third treatments over the next couple of months. Once the three treatment are completed, the doctor will assess the condition of my vagina to determine if tone has been restored. I may need one more treatment. I am told I can expect a full recovery from the atrophy. I will not need to use any lubricant, inside or outside my vagina and I can also expect the associated incontinence issues to resolve.

Once we achieve OV (my abbreviation for ‘optimal vagina) I’ll have a followup at three months and then another at six months. After that, I’m told it’s best to just monitor vaginal tone and to book in for a top up as needed. “Better to have one treatment sooner than several later.” This seems like good advice. Some people only need one top up a year and others need two or three. Vaginas are all different.

There’s no doubt that this is a significant investment. I think it’s entirely worth it, particularly as I now know that without it I can expect “full collapse” of my vagina. I’ll post again after my first session on Friday.

Thanks to everyone that left feedback on this. It's clearly an issue of significance for a lot of women. It's my thinking that if breast reconstruction is covered by Medicare then treating vaginal atrophy should be too. Both of these things are important options for women recovering from breast cancer.

Meg X