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Menopause and Breast Cancer Survivors

Recently a study was done to evaluate the changes in sexual function of breast cancer survivors who also were experiencing genitourinary syndrome of menopause (GSM) after they had received fractional CO2 laser therapy. The study results were published in Menopause.

Let’s break down the meanings of GSM and fractional CO2 laser therapy for a better understanding.

GSM (Genitourinary Syndrome of Menopause)

During menopause levels of estrogen decrease often resulting in the skin of the vagina and vulva becoming thinner. Once referred to as vaginal atrophy, it is now referred to with the broader term of GSM. GSM’s most common symptom is vaginal or vulvar dryness and loss of elasticity. This lack of lubrication causes pain during intercourse and can even result in the tearing of flesh. GSM can also result in risks of urinary infections.

Fractional CO2 Laser Therapy

Fractional carbon dioxide (CO2) lasers are on the cutting edge of non-surgical rejuvenation treatments. This treatment has been typically used to improve skin texture and decrease wrinkles and discoloration of the skin. The laser treats both the superficial and deeper skin layers at the same time and is effective in treating the collagen of the dermis.

The Study

The purpose of the study was to evaluate the efficacy of the fractional CO2 laser therapy on GSM in breast cancer survivors. 50 patients, mean aged 53.3 years, participated in the study with very promising results. The majority of the patients were satisfied and reported no adverse effects. The study concluded that the treatment was feasible and effective.

The Ins and Outs of Pelvic Pain

Many women suffer from chronic pelvic pain and aren’t sure what it is and why it’s happening to them. And most of them have heard that the solution is surgery which scares them. That isn’t necessarily true, and surgery is not recommended in most cases. Let’s start at the beginning and clear up some myths about chronic pelvic pain by first understanding what the causes of chronic pelvic pain are, what the symptoms are, and what treatment options are available.

What is chronic pelvic pain?

If your pain is below your bellybutton and between your hips and lasts for at least six months, you are most likely experiencing chronic pelvic pain. This pain can have a big impact on all aspects of your quality of life, including your sex life as intercourse may be very painful. The pain can go from dull aches to severe pain that disrupts your sleep.

What are the causes of pelvic pain?

There are a variety of causes, ranging from endometriosis, interstitial cystitis, vulvodynia, uterine fibroids, and vulvar/vaginal atrophy to name the most common.

  • Endometriosis: Endometriosis is the result of tissues that would normally grow inside the uterus, and that begin to grow outside of it. Menstruation and sex become very painful with this condition. Another result of endometriosis is difficulty in becoming pregnant.
  • Interstitial Cystitis: This condition is also known as painful bladder syndrome. The symptoms are pain in the bladder and a need to frequently urinate.
  • Vulvodynia: This is when the vulva experiences chronic discomfort. It could be in in the form of burning, stinging, rawness, throbbing, and swelling.
  • Uterine Fibroids: These are pelvic tumors that commonly cause heavier and longer than normal menstrual periods, pressure, and pain.
  • Vulvar/Vaginal Atrophy: This occurs due to the thinning of the vaginal walls as a result of a reduction in estrogen. The lining of the vagina becomes drier, thinner, and painful.

What treatments are available?

Surgery isn’t always the answer. Laparoscopy is the preferred option in most cases. Laparoscopy allows the doctor to see the entire interior of the abdomen and pelvis via a small, noninvasive incision. This option is less painful with a shorter recovery period and less scarring. Therapy, including the prescribing of antibiotics, is another option that in some cases can be used on its own and in other instances combined with laparoscopic surgery. These are some options to discuss with your doctor who will walk you through each of the procedures.

The important fact to take away is that you don’t have to live with pain! Dr. Vahora is experienced in all aspects of pelvic pain and will work with you to find the ideal solution for your chronic pelvic pain. Don’t spend another day in pain!

Vulvar Atrophy and Lichen Sclerosus – What You Need to Know

You may or may not have heard of vulvar atrophy or lichen sclerosus, but odds are that you know someone who has been diagnosed one of them. The names sound alarming but know that these two conditions are treatable. The common factor between them is painful intercourse.

Vaginal atrophy occurs most frequently after menopause. It’s a thinning of the vaginal walls. This thinning is accompanied by drying and inflammation and occurs when your body’s estrogen levels decrease. This can make intercourse painful and can lead to urinary tract distress.

Other symptoms of vaginal atrophy include:

  • Vaginal burning
  • Itching
  • Frequent urination that may also include a burning sensation
  • Vaginal discharge that is unusual
  • More frequent yeast infections
  • More frequent urinary tract infections (UTIs)

This condition often goes untreated for long lengths of time at which point the skin becomes quite damaged. Potent topical steroids have been used to relieve symptoms and curb further skin damage. Laser systems, such as the MonaLisa Touch™ have shown to be effective in improving the condition of the vaginal tissue and relieving itching.

Lichen sclerosus is not as common as vaginal atrophy and is most commonly experienced in postmenopausal women. Lichen sclerosus can be the result of an imbalance of hormones or an overactive immune system. It’s a thin area of skin that appears patchy and white, usually showing up in the genital and anal area and making intercourse painful.

Note that lichen sclerosus is not limited to those areas and in some cases may affect the skin in the breast and upper arm areas. Symptoms other than the white blotchy skin, include itching, discomfort even pain and bleeding. Know that it is not contagious and can’t be spread through intercourse.

The MonaLisa Touch™ system has been highly successful as a treatment for both vaginal atrophy and lichen sclerosus. Its laser pulses are aimed at the vagina tissues and affected areas to create micro-lesions, triggering natural repair by stimulating the production of collagen and blood flow. All of this promotes lubrication which then restores hydration and elasticity to the tissue.

The MonaLisa procedure is both safe and effective. It’s a great alternative for women who don’t want to take estrogen.

Your Sex Life Between Menopause and Retirement

When you were younger, you undoubtedly overheard your mother and her friends talking about how sex just wasn’t the same after menopause. How the urge just wasn’t there and how it just wasn’t “good” anymore. They may have been experiencing a hormonal issue called hypoactive sexual desire disorder which acts to decrease sexual desire. Well, that was then, and this is now. Hypoactive sexual desire disorder still exists, but the times have changed and there are more open conversations about sexual issues. Today, sex can be great at any age, even post menopause.

Let’s back up a bit and think about when the first signs of change in the sexual experience began. Most likely it was when perimenopause started to make changes in your hormones. This change in hormone levels affect the genital tissues and circulation, which in turn affect the levels of sexual pleasure. Don’t despair. There are solutions.

Chances are that when you went through (or are going through) menopause, your household changed a bit. Your children have grown up and moved out creating an opportunity for more sexual freedom in the house without interruption! It would be a shame to not take advantage of this newfound opportunity. Let’s help things along. The following are a few ways to improve your sex life after menopause.

Vaginal Dryness. It’s completely normal to begin experiencing vaginal dryness during menopause. This dryness makes sex uncomfortable and automatically reduces the desire to have sex. There are many good vaginal lubricants available over the counter and by prescription. Using these lubricants will not only make sex comfortable, they will help keep the vaginal tissues healthy. I keep a variety of samples in the office, and we can talk about how these can be used depending on your dryness.

Genital Arousal. The lack of estrogen directly affects genital arousal. The blood supply to the genital area decreases resulting in a delay in arousal; it can even be responsible for creating fewer satisfying orgasms. Uh oh. This absence of estrogen creates tissue shrinkage resulting in elasticity greatly decreasing, and your natural lubrication drying up. As your doctor, we can work on a plan that can adjust your estrogen level to remedy this.

Sexual Routine. If the act of sex has become very routine over the years, it’s time to change your habits and become intimate again. The key is to have a true connection with your partner. However, you may find it difficult to discuss this with your partner. This is where, as your doctor, I can be of help. Don’t hesitate to open up and discuss your feelings, especially your desires and disappointments.

Knowledge. Knowledge is key. Let’s talk about everything you are experiencing from hot flashes to vaginal dryness to difficulty being aroused or reaching orgasms. Menopause can have a big impact on you emotionally and physically. By talking it out together, we can put a plan in place that can have you feeling great.

Sexual health is an important part of your overall wellbeing. I’m here to help you regain your sexual health and to remind you that you’re not alone. The majority of women experience similar issues!

Teens Talk With Your Doctor About Sex

Sometimes it can be difficult to discuss sex and sexual issues with an adult, especially if it’s all new to you. Trying to have open conversations about sex can be frustrating as it’s not unusual for a teenager to be reluctant to openly discuss and question sexual issues with an adult. Here’s where your doctor can be a valuable resource.

Girls: Time to open up

Talk to your doctor about everything that’s on your mind regarding sex and sexual activity. This is a “no judgement” zone, so feel free to discuss anything. For example, you may want to discuss or know about:

  • They seem to be on a roller coaster ride ranging from depressed, to angry, to happy, etc.
  • Sexual feelings. Sensations are occurring more often or maybe they aren’t happening at all
  • Birth control options
  • Safe sex and STDs (sexually transmitted diseases)
  • Eating issues and body image
  • Body odor

It’s extremely important to talk openly and honestly. Ask lots of questions. Especially if you have found information or sought advice on the internet. Every girl is different, so you shouldn’t rely on advice or diagnoses found online. Tell your doctor everything – she can’t help you if she doesn’t have all the details. If you are embarrassed to start the conversation, write up a list of your questions, concerns, symptoms and problems and present it to your doctor. This way I can open up the conversation and before you know it, you’ll feel at ease and able to talk openly. Remember, as your doctor, I’ve seen and heard it all many times before. You’re not alone or the first to experience what your body is going through.

That old adage about “knowledge being power” is especially true here. The more you know about your body and sex, the more apt you are to make good decisions. Don’t spend sleepless nights wondering or worrying about your changing body and sex. Everybody goes through it. Talk to your doctor and let us help.

Parents: What you need to know

Ease your teen by letting her know that a gynecologist is educated in all aspects of sexual health and can answer any questions from emotional concerns to the physical changes girls go through. And, most importantly, assure her that the conversation is private – only between them – with no judgements. It’s an opportunity for your teen to be completely honest about her feelings and know she can ask any and every question on her mind. Set an appointment for your teen with a doctor – and if she’s uneasy going to your doctor – choose a doctor that’s all her own. Assure her that she should feel free to talk about anything, even if it’s a bit embarrassing or things she don’t want to discuss with a parent.

How to wean off of birth control

You’re a young married woman and want to stop taking birth control. You may want to get pregnant or you had some side effects that didn’t agree with you. Regardless of the reason, you’ll want to stop safely. Is there a right way? There really isn’t a “right way.” However, there are some things steps you can take both prior to quitting and for a few months after quitting that will be easy on your body.

Preparing to stop
If you desire to become pregnant, the things I recommend right away are prenatal vitamins, keeping ovulation kits handy and a cervical cap to put in after sex.

Regardless of your desire to become pregnant, the first thing I always recommend to every woman is to use a period tracker app on your phone. The app alerts you when you are ovulating and is a great tool to help your doctor guide you through various expectations.

Whether you are on the pill, using a ring or patch, planning ahead of stopping is always recommended. First, talk with your doctor and ask for advice on how to safely wean off birth control without affecting your overall health. Since contraceptives release hormones into your body, you’ll want to make sure your body will adapt to the changes it will encounter after you stop.

Diet is an important part in the preparation to stop. Begin fueling your body with nutrients a few months prior to stopping. Your doctor will provide a healthy diet and exercise regimen to ensure that your body has a smooth transition.

A positive side effect of taking oral birth control is good skin, or the decrease of hormonal acne. Stopping will cause your hormones to return to their previous level and if you are prone to skin break outs, you will find they come back. By knowing this in advance, you can take the extra care to minimize this by using products your gynecologist suggests.

Planning the date to stop is also important. You can safely stop any time, but it makes much more sense to stop the pill when you finish the pack. With the ring or patch, you’ll want to stop right after your period. Stopping any of these mid-cycle will alter your period and make it hard to know when to expect it.

After you stop
Stopping any form of birth control will affect your menstrual cycle. Your body will need some time to adjust. You might skip your period for a couple of months or experience some spotting or bleeding between. Your menstrual cycle may even become irregular for a while. This is common and your cycle will return to normal fairly quickly.

You may experience mood swings due to hormonal fluctuations. Exercise is a great way to alleviate this! Plan to begin a regular exercise routine – you’ll get an endorphin boost!

Pay attention to your diet by adding nutrient rich foods and vitamins to your daily menu. Now for the less than great news: it’s a good idea to skip alcohol for the first few months after quitting as your hormones are affected by alcohol. Talk to your doctor to see what is best for you.

Last, but certainly not least, try to reduce stress. Your hormones will start to balance out in the first couple of months after stopping the pill. Reducing stress will help keep them in balance.

Do consult with your gynecologist throughout and after the “weaning” stage. Dr. Vahora has worked with young women weaning off of birth control for many years and will share the tips and tricks to make weaning a nearly seamless and comfortable transition.

Sex and Aging. Is it Safe?

We don’t often hear conversations about seniors and their sexual activity. Why? There’s really no reason not to talk about it. It’s natural and many seniors enjoy sexual activity. There really is no age limit.

Is It Safe?

Sexual activity can actually be very good for your health! However, since it’s rarely a topic of conversation, you may be wondering if it’s safe. That depends completely on the state of your personal health. If you experience discomfort and have abstained because of that, good news. There may be a simple explanation that can be caused by hormonal issues or HSDD (low sexual desire disorder) to name a couple. These can be successfully treated!

The Myth

Let’s start at the beginning of the senior sexual myth. Because we don’t talk or hear about it, the assumption is that seniors just lose interest in sex. Not true! Not all seniors lose interest. In fact, the odds are that the majority still enjoy all types of intimacy, including intercourse. They just aren’t talking about it! Granted, the frequency may diminish a bit as we age, but the quality will most likely increase, and there are some great benefits in staying sexually active.

The Benefits

As we mentioned earlier, staying sexually active has no age limit. And, there are many benefits of remaining active into your silver years. Research has shown that sexual activity provides the brain with endorphins and oxytocin resulting in a noticeable improvement in a person’s mood and attitude. In short, it benefits your spiritual and emotional health. And there’s more.

According to the Society of Obstetricians and Gynecologist of Canada (https://sogc.org), sexual activity can be an antidote to aging!

  • Boosts your immune system
  • Burns fat
  • Relieves stress
  • Improves mental and physical health
  • Helps minimize the risk of incontinence

Seek Help and Advice

Aging does not mean that you will lose your desire for intimacy and sex. If you are experiencing a lack of desire, talk to your Doctor. Be open and honest. And don’t be embarrassed to talk about it as there may be an underlying medical or emotional reason. Hormone issues can play a big role in changing desires and can be easily treated with medications.

Our bodies change as we age. As women, our vagina goes through changes. It can become shorter and narrower, the walls can become thinner, and natural lubrication can lessen. All of this can cause pain resulting in sexual desire diminishing dramatically or completely disappearing.


First and foremost, let’s talk about it! Talk with your Doctor to determine if staying sexually active is right for you and what treatment options you have. Chances are that you’ll discover that staying sexually active is right for you and that there are solutions to make intimacy enjoyable and satisfying again!