Episode 36: Peri/menopause: vaginal and sex symptoms

Dr. Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an ObGyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone, and welcome to the Doctor Sophia ObGyn podcast. I am excited because we get to talk to you today about sex.

Touseef Mirza:
Sex and-

Dr. Sophia:
Menopause. So of course I am joined by my friend and co-host, Touseef Mirza.

Touseef Mirza:
Hello everybody. So Sophia and I being such good friends, we talk about everything. And so one of the things that came up was, I'm sure a lot of, you know, Halle Berry has become the, the actress, the amazing actress, has become sort of a spokesperson, definitely right, for menopause, and has been sharing her story about what she went through in the past couple of years. And I believe she also started a company to help women deal with symptoms around perimenopause, menopause. And she did an interview recently about two months ago.

So that would be, we are in May, so in March of 2025 on the Trevor Noah Show. And it's a very good interview in the sense that she really opens up and talks about all the intimate details in terms of what she's going through. And then me and Sophia, by listening to that, we had some observations that we wanted to talk about. So as an overarching sort of story that she was telling, she was explaining how she found out that she was having perimenopausal issues. So she was saying she was around 54, she's 58, which is unbelievable, but that's another story. She was 54 and she was with her new man and enjoying having a sexual relationship with him. And then all of a sudden, I think the next day after having sex, she went to the bathroom and couldn't, when she was peeing, it was just excruciatingly painful.

Dr. Sophia:
Yeah. She had so much pain, so much pain, and just discomfort burning. She's like, what's going on? Like, I've gotta get to my doctor asap. Something terribly wrong has happened. And so she goes to the doctor, and then at the doctor's office, the doctor examines her and then says, I think I know exactly what this is. And she's like, okay, well tell me like, what's going on, like, what's happening to me? And he says to her, well, I think you have herpes. And she hears him, but she's like, how can that be? I have never had that before. And, you know, and of course he asks her, well, are you seeing someone new? And she's like, yes, but this is my person. And you know, he doesn't have it because he would've told me. So no, I'm not following, how do you, how do I have herpes?

And he says, no, I definitely think this is what you have, but you know, I'm gonna test you for it. I'll get the results in a couple of days, but you know, here, I'm sorry, this is what your situation is. And so of course this leads her into a whole series of events of having to confront her partner and say, Hey, how could you have done this? How could I, how could you have given me herpes? And of course, now this leads into them having this situation of exchanging who gave who what. And so her partner goes to get tested as well, and it comes back negative. And so he says, I'm sorry, I, I, I know you're going through something, but I don't have herpes. And so she says, huh, she doesn't understand because for sure she has it. And as she's waiting for her test results, then her doctor now says, but

Touseef Mirza:
Before she says that, she says to herself, okay, then I must have herpes.

Dr. Sophia:
That's true. And she says, yeah, well then fine. I'm the one with it. I have herpes. And she's trying to understand how she had herpes? And she never knew she was going through all of these rollercoasters of emotions. And so now her doctor comes back and says, your tests are negative for herpes. For herpes, but I'm not exactly sure what's wrong with you. Eventually we found out that it was a symptom of perimenopause.

Dr. Sophia:
So yes, we do find out that this was a symptom. What she was going through is called the genitourinary syndrome of menopause. But before we get there with her, she is explaining how having herpes and how just devastating basically that was, and in this particular episode between her and, and Trevor Noah. And while she's describing this and the banter between them in terms of, oh my gosh, it must be what, you know, how could it be herpes? I like to just point out that the genitourinary syndrome of menopause is a great masquerader and so is herpes. The interesting thing in terms of herpes, and I just want us to take away the shame and stigma from herpes. And the same way that we are currently trying to take away the stigma of menopause. Why is it so important? It's so important because we need more people to be able to have an open and honest conversation regarding these issues. This particular episode is gonna be focused on all of the symptoms that surround sex and the vagina as far as menopause is concerned. But when watching that episode with Halle Berry and Trevor Noah, I just brought, it just made us feel like we needed to bring up the herpes thing again.

Touseef Mirza:
Yeah. Because in the story when Halle Berry says, the doctor says You have herpes, they all sort of were lighthearted about it. And even were joking around about it because herpes has been the pun of jokes like menopause and perimenopause in movies throughout, like Yeah, a couple of decades has been the pun of jokes. And we need to reclaim that. And we need to say there's nothing funny about herpes. Right.

Dr. Sophia:
There's definitely nothing funny about it. Or, and nor should it be something that is so stigmatized. Correct. Either.

Touseef Mirza:
In that interview she's basically saying, oh, I didn't have it before and now I'm with this man and I got it. So obviously he gave it to me. Right? But that's not how herpes works.

Dr. Sophia:
If you actually have herpes, you can totally have what we call a recurrence. Herpes can present itself months later, years later from the time you were exposed and so, and not

Touseef Mirza:
Have any

Dr. Sophia:
Symptoms and not having any symptoms, you may not have any symptoms at all. And then all of a sudden you get symptoms.

Touseef Mirza:
If somebody has herpes and you have a partner that you just started to be with, it does not mean that that came from the other person. It's possible that it was actually just latent in you that has now surfaced and or it doesn't mean that it is the partner that you were with the night before or two nights before. It could have been somebody that you were with like two

Dr. Sophia:
Years ago.

Touseef Mirza:
Two years ago. And that it stayed in your body and stayed dormant. And now it's surfacing. That is correct. So it is not a direct association that we can make.

Dr. Sophia:
Yeah. And I know that maybe it's not gonna be from this particular episode, but we hope that at least one person gets that information from it. And of course, like we said, the person who highlighted this for us was the Halle Berry interview, which is really what brought us to the point of wanting to discuss the vaginal symptoms of menopause. And there's so much urinary frequency, vaginal dryness, vaginal itching, burning discomfort just with walking from the dryness, urinary pain or frequency discomfort when you go to the bathroom, leaking a bit of incontinence. And of course we go into vaginal pain or painful sex.

Touseef Mirza:
So those are a lot of things. Yes. So let's, let's just reel it back a little bit and, and talk about why is this happening in the first place? Why are we having symptoms all of a sudden during sex or right after sex or the next day after sex that we didn't have before when we were not in perimenopause? And number one, let's just describe real quick perimenopause, menopause as well.

Dr. Sophia:
Perimenopause is the transition time that can happen 10 up to even 15 years before you actually have your last period, your last period being if you've gone through 12 months, 12 full months of no period, you've entered menopause all that time before considered perimenopause. And the thing about them is that they share a lot of similar symptoms. Those include hot flashes, night sweats, headaches and joint pain. Oh, a whole plethora. And of course what we're talking about today, vaginal symptoms, vaginal symptoms that can happen in perimenopause and menopause. And

Touseef Mirza:
Usually what would, what is the age range of perimenopause?

Dr. Sophia:
Well, let's start actually with the average age of menopause. Mm-Hmm . Okay. So the average age of menopause is 51 in this country. So a woman who is 40, who goes through menopause, is considered normal because you can go through menopause as early as age 40.

Touseef Mirza:
Meaning you stop your periods at age 40,

Dr. Sophia:
You have your last period at the age of 40. And no doctor will be like, oh my God, I can't believe you went through menopause. No. 'cause you're 40. So that's considered, okay, the average age is 51, but you can go through it as early as 40. You can go through it as late as 58. And people will look at you and be like, okay, this is what's happening. Mm-Hmm . The problem is imagine the woman who is 40, who is going through perimenopause, meaning the transition to get her to menopause. And that starts on average 10 years earlier. For some it could be as early as 15 years earlier. So a woman who's in her late twenties starts to develop certain symptoms, could actually be perimenopausal. And it's not just, oh my gosh, I have a lot of hormone issues. I have a lot of hormone imbalance issues. But it could actually be that her ovaries are starting to go through the period of the transition of losing the function of producing estrogen. Because ultimately what's happening is that we lose our estrogen.

Touseef Mirza:
So in certain cases, a woman can start menopause at 40. It means she can, she begins perimenopause

Dr. Sophia:
30, 30, 30.

Touseef Mirza:
Which, you know, we never, we never talk about because we always think that menopause is really the issue. Meanwhile, at 30 you can have symptoms of perimenopause that can be similar to menopause.

Dr. Sophia:
That is correct. Crazy, crazy.

Touseef Mirza:
So you were talking about the fact that we start to lose estrogen.

Dr. Sophia:
We lose estrogen. It's the main hormone that, you know, that helps us women to be women. Right. Estrogen has almost over 400 functions in the body. Those functions are in the brain, they're in the skin, they're in the heart. They're in the bones,

Touseef Mirza:
Not just around the the vagina and the, not, not just

Dr. Sophia:
Around the vagina, but they are definitely a major part of the vagina and the vulva area. Mm-Hmm . And so loss of estrogen and its effects on our skin and on our vulva and on our vagina is tremendous. Just imagine that same dry, flaky skin that women as we age, are starting to develop because of the loss of estrogen. Mm-Hmm . That thinning skin, that that concept is happening at the level of the vulva and the vagina.

Touseef Mirza:
Because we’re losing

Dr. Sophia:
Estrogen, because we're losing estrogen.

Touseef Mirza:
So then you have the estrogen level going lower, which affects the walls of the vagina. Yes. And, and dries them up and make them thinner. So what happens during sex in those conditions?

Dr. Sophia:
So what can happen is you can have small tears, abrasions, cuts that can happen. That's just one thing.

Touseef Mirza:
So hold on. When you say abrasions, tears, cuts, that's when you are having penetration. And it is because of the friction that's happening. That's how these different conditions occur in terms of tears, cuts.

Dr. Sophia:
So honestly, you don't necessarily need to be having penetrative sex. It could be with, or well, I guess hands, fingers, toys, all of those things count. Mm-Hmm . And it doesn't have to be all the way in. It doesn't need to be inside of the vagina. We're talking about the vulva as well. That tissue has become a lot more fragile tissue in the sense of why you can have small abrasions or cuts. And yes, it can, can it be from friction? Absolutely. But the reality is, there are changes that are happening all around that area due to the lack of estrogen. Some of those changes are because of the thinning of the walls of the vagina. The vagina is kind of like the floor of our urethra and our, you know, urinary system in the sense of the bladder sits on top of the vagina. And when the vagina now gets weak, bladder muscle and tissue of the bladder also gets weak. And so 'cause of the estrogen, all of this is related to estrogen.

Touseef Mirza:
Oh, estrogen.

Dr. Sophia:
And in that you may have women who have some leakage at the level of the urethra. They will have meaning

Touseef Mirza:
That you pee,

Dr. Sophia:
You leak a little bit of urine. Yes. Would that one,

Touseef Mirza:
No. Yeah.

Dr. Sophia:
Or that you feel like you don't completely empty, or that you feel like you're almost like dribbling a little bit, or you have frequency and urge to go to the bathroom all the time, or you have burning when you pee

Touseef Mirza:
Like a UTI

Dr. Sophia:
Kind of like A-A-U-T-I would be, I guess, yeah, I guess because we always ask about the concept of do you have burning? But it's different because the burning could also be just at the level of the vagina, like in the vulva. So just when the urine hits certain aspects of the vagina, that burns. It's not even just the stream. Like we think about when you may have a urinary tract infection or a UTI mm-hmm . But it's totally a part of it. You can have that as well. So there's just so many, many symptoms that can go with the lack of estrogen and the concept of the tears, the thinning, the, and the walls. Right. So now imagine the walls are thinner. You're trying to have sex. Your moisture is lower

Touseef Mirza:
Than what it used

Dr. Sophia:
Than what it used to be. And you may actually have sexual thoughts and really want to, but your body doesn't respond.

Touseef Mirza:
It doesn't produce

Dr. Sophia:
Because it's not producing the moisture and the lubrication that it wants. Or you could be someone whose body, okay. When, when you are having sexy thoughts and you're able to have sex with your partner, and in Halle Berry's case during the sexual encounter, she didn't feel anything. She didn't know anything was going on. It's not until afterwards that there is this extreme pain or discomfort or burning or itching that happens that then triggers your mind to say, what the heck is going on here? And it must be the sex. What's really happening is your body has had changes in response to the decrease or lack of estrogen.

Touseef Mirza:
I mean, is it something that we feel like, is, is it just what I'm trying to say is let's say that you're not having penetrative sex. Can you tell, like, is there a sensation that feels that your vaginal walls, the canal of the vaginal walls are thinner or are more brittle? Or is there a sensation or you, for

Dr. Sophia:
A lot of women, they feel dry, they feel itchy, they feel discomfort. Even just walking at the level of walking at the level of the vagina. They just feel like when they walk, they feel discomfort. So,

Touseef Mirza:
So we're not talking vulva, we're really talking vagina

Dr. Sophia:
Not just talking vulva. I'm talking about how they feel something deeper inside of them. They feel discomfort. Okay. Okay. And when you go in and you examine them, there's no secretions, there's no discharge, there's no, you know, you know, I could liken it to perhaps a woman who comes in with maybe a bacterial vaginosis or, you know, bacterial vaginitis, I should say. Who sometimes comes in and says, I just feel discomfort. And in the case of perimenopause and menopause, that discomfort can be from the dryness. Not everybody feels it, but for those that do, yes, they feel the atrophy that is happening at the level of their vagina.

Touseef Mirza:
Okay. And when we say atrophy, what does that mean? Atrophy. The

Dr. Sophia:
Thinning,

Touseef Mirza:
The thinning, the

Dr. Sophia:
Thinning, the loss of the thicker tissue, the, you know, mucus tissue. The,

Touseef Mirza:
So because it's thinning, the blood capillaries are closer to the surface, and therefore with the friction, you can have tears.

Dr. Sophia:
You literally have tears. Right. It's not even because, just because you have capillaries, the vagina's a very vascular place. Mm-Hmm . But more so, you have the thinning of the walls, and just like if you had dry skin and you stretch it a little bit, you can get little cracks.

Touseef Mirza:
Mm-Hmm . Okay.

Dr. Sophia:
That's what's happening.

Touseef Mirza:
And then, and therefore it becomes exposed.

Dr. Sophia:
It's exposed, exposed skin. And, and, or like, think of it as an abrasion. Mm-Hmm . Think of it, if you fell and you scraped your knee mm-hmm . You know, it feels like a scrape. And for some women they can even bleed. As a matter of fact, it literally happened to me this week that I had two friends call me to say that they had bleeding after sex. Hmm. Two, not one, two, it was, I was like, huh, well when, when's the third one gonna call ? Since, you know, we always say things happen in threes, but it was very interesting that I would have two friends who were like, I don't know who to talk to. I'm so glad I can call you. And

Touseef Mirza:
Can you, can you explain one of them?

Dr. Sophia:
And so one of the situations she said that she just, when she woke up the next day, she saw like blood on her sheets and, you know, and she was like, what the heck is going on? She wasn't on her period. It wasn't time for her to have her period or anything like that. And she realized that she must have torn or, or something like that. Something must have happened during her sexual encounter,

Touseef Mirza:
Which happened that night. Which

Dr. Sophia:
It happened that night. Okay. Exactly. And so that's one. And then the other one, also after sex, she said to me, I think I tore, and I said, really? Okay.

Touseef Mirza:
Tore something inside,

Dr. Sophia:
Something inside of her. Mm-Hmm . She says, you know, I started to have just a trickle of blood, but now it's more of like, more, much more bleeding. Okay. And what do I do about it? In that case, for her, it's not to say that she could not have had a tear. In her particular case, again, perimenopause rollercoaster here, this particular friend was actually having a bleeding cycle due to changes in her menses because she was not expecting her menses. So therefore, when she had the bleeding immediately after sex, it felt as if it must have been something that happened during sex. In her particular case, it wasn't, she didn't have a vaginal tear, but she did have unscheduled bleeding due to perimenopause.

Touseef Mirza:
Okay. So we're just talking about your second friend. Your second friend has sex. The next morning she had some blood trickling. Yes. And then she says, oh, there's something that might have happened during sex, maybe during penetration or something. Yes. That could have happened. Something at the level of my vagina. And so she calls you and says, this is what's happening. Yes. And then after you investigate, yes, you realize that finally she's actually having a different effect of perimenopause. That is correct. Which is not the thinning of the walls where the blood is coming from, but because perimenopause can also cause irregular periods.

Dr. Sophia:
Yes. But both of them happened right after sex. And that's the only reason why it's like, wow, this is really happening. One, definitely due to vaginal issues because of perimenopause, directly the thinning of the vaginal walls that caused an abrasion, that caused a laceration, that caused her to have some bleeding. The second friend also thought that she was having some tear or some issue with the vagina also in perimenopause or of the age to be in perimenopause, for sure. Had what started off as just a trickle. And actually the other interesting part is, is that she herself tried to look to see where she may have been bleeding from

And so when she looks at the vagina, she then sees what looks like a cut later when I'm able to examine her and I'm able to see what's happening. And we realize that no, actually what happened is that she was getting her menses. But when we looked at the vagina together, and I said, are they, is this the area that you thought may have been cut? And she said, yeah, I think so. And this is why I'm so happy that we do this podcast because we need to just look more, know ourselves more, know our bodies more. So what she was really seeing was just the way that the folds were of her hymenal ring, which was very interesting. This is, this is,

Touseef Mirza:
Okay, well now I'm gonna

Dr. Sophia:
Ask you in a whole

Touseef Mirza:
Nother Yeah. What, okay, so where is the

Dr. Sophia:
Hymenal ring?

Touseef Mirza:
Hymenal ring? Or is that the hymen? You know, we think of hymen. Yeah. Okay. The hymenal ring. The hymen. Okay. So she was, she was seeing little folds in that, which is totally natural. Yes. And she thought that that's where the tear was. But

Dr. Sophia:
You know, what's interesting is that she may have never noticed them before. No. Never noticed her hymen in that way. Because now her vagina is changing. Mm-Hmm . Her vagina is changing due to the symptoms of peri, of perimenopause, the changes happening because of the loss of estrogen. So now the hymenal ring in the way that it was once before looks different to her now.

Touseef Mirza:
So both of your friends had some bleeding after sex and both of them are in perimenopause and, and one of them was because of one cause, which is irregular periods friend number two, and friend number one. It was actually because of the thinning of the walls.

If a woman is in pain, should she go see a doctor right away?

Dr. Sophia:
So that's a very good question. That's a great point to think about, is that not only are we talking about the loss of elasticity and things like that, but the concept of the pain, the pain that can happen either with sex itself or after sex, and how that can be so disruptive to a woman who wants to have a sexual life and immediately, I guess after sex, that is painful. The pain can be due to swelling, it could be due to abrasions, it could be due to the friction causing just a burning sensation. I would say that perhaps an ice pack, literally. Hmm. May be soothing enough at the moment.

Touseef Mirza:
So we've talked about all different types of symptoms and what they are caused from, what are certain ways that we can help alleviate?

Dr. Sophia:
The fact is, it's best to stay sexually healthy. And that includes having a regular sex life, having regular sex and, and intimacy and really being in tune with your body, so that you even are aware that there are changes happening. B, so that you don't lose function of the vagina because that can happen. Your vagina can atrophy to the point or become so thin and, and become small. And the opening, the vaginal opening itself can become so small that you can no longer have penetrative sex or it will take a different

Touseef Mirza:
Type of treatment. So, so are you saying for certain women, if they don't have sex for a long time, then the penetration is gonna be either really difficult because the vaginal walls just kind of close up. It,

Dr. Sophia:
It closes up and it shrinks, it literally can shrink.

Touseef Mirza:
So it's almost like a muscle in that, in that situation where if you don't use, if you don't use

Dr. Sophia:
The vagina is a muscle.

Touseef Mirza:
Right. But you know, like, but you know, like common knowledge is like

Dr. Sophia:
Every other muscle in your body. We,

Touseef Mirza:
If you don't use your muscle, you're gonna lose it. So it's very similar, but we don't think about it that way. It

Dr. Sophia:
The only thing is, in terms of this muscle, is that it also has to produce lubricant. It needs both. And so you can continue to use your muscle if you lube it. You know, and for some women just having that conversation of needing lubricant, they start to feel inadequate.

Touseef Mirza:
Okay. So you're saying that the first thing that we can do is to consider lubrication?

Dr. Sophia:
Definitely like

Touseef Mirza:
Using a lubricant. Yes. But for some women, that is uncomfortable to even bring up because then you're thinking, well, something's wrong with me,

Dr. Sophia:
Something's wrong with me. Oh my god, does this make me old? Mm-Hmm . Does this mean that my sex life is over? Mm-Hmm . It just brings up so many different questions and, and really just like, kind of like shameful things in the sense that, oh, obviously it's my fault. You know, it's my problem.

You know, as opposed to just kind of understanding the shifts and the changes that are happening in the body and then working with it.

Touseef Mirza:
You know, that that's just how your body's

Dr. Sophia:
Evolving. Your body is evolving. We grew, we, we, we didn't stay small. We grew mm-hmm . And now we're growing in a different direction. I think a major part of understanding those, the vaginal symptoms of menopause, is really taking ownership of, well, how am I feeling? And understanding the concept of being deserving, of having a sexual life and associating a healthy sexual life actually with youth and longevity. Because a healthy sex life will help you to live longer. And women are equally entitled to it as men

Touseef Mirza:
Number one, I think it's just so important to have the proper information so that you can like, push away the stigma that this is not actually about me in the sense that it's, there's nothing wrong with me. This is actually a hundred percent natural. This is just the way it's supposed to be. And so in order to live in this moment, we just have to figure out different ways

Dr. Sophia:
To work with it.

Touseef Mirza:
To work with it in order to enjoy it and in order to help us live a longer, more full, fuller life full of vitality and longevity. Like, like you were saying. So lubrication is one way. So aside from lubrication, like are there treatments or modalities that we can use that can help in terms of the moisture and the elasticity from a vaginal level? Yes.

Dr. Sophia:
So this is where we should talk more about things like hormone replacement therapy. That's definitely a big one and a very easy way in order to target the vagina and be very focused and have a very focused treatment at the level of the vagina. Mm-Hmm . By giving back to the vagina, the estrogen that it's lost. And in doing that it will help to rebuild the tissue. It will help to bring back the moisture and help the glands to be more effective at lubricating the vagina. Vaginal estrogen comes in so many different ways. It could be as a cream, it could be as a tablet, it could be as a ring. And then a woman would use it for an initial period just to try to get the vagina tissue back to responding to the estrogen. And then she can go on to some type of maintenance treatment or therapy in order to help. And, and especially with things such as just bringing back the collagen, the tissue of the vagina will help with not just for things like lubrication at, in terms of sex, but also with the support of the urethra, for example. So perhaps that woman will no longer be experiencing things like urinary frequency or having lots of urinary tract infections, which can happen due to vaginal dryness, due to vaginal atrophy.

Touseef Mirza:
So you're saying that if we use that type of treatment, it not only helps on a vaginal level, but can also help other aspects as well?

Dr. Sophia:
Yes, because it can help the bladder, it can help with the urinary symptoms as well. That can happen. But there are other modalities. We are using red light therapy and that red light therapy is able to help with bringing back, again, elasticity and bringing back collagen, rebuilding the tissue as a non-hormonal perhaps way. We also have,

Touseef Mirza:
How, how does that work? The red light therapy,

Dr. Sophia:
Red light therapy stimulates collagen.

Touseef Mirza:
So, but are you putting red light inside the vagina? Oh, yes. Yes.

Dr. Sophia:
Okay. Yes. Yes. It, it comes

Touseef Mirza:
In a beam of light in the vagina,

Dr. Sophia:
A beam of light in the vagina. It actually comes in an instrument that relatively basically looks like a. Hmm. But that then has the red light emitted from it, and that you sit with it, you use it, you know, like daily for a couple of weeks and then afterwards you go into maintenance therapy with it. But yeah.

Touseef Mirza:
So just put it in you and you let it do its

Dr. Sophia:
Things. Yes. Let it do its thing.

Touseef Mirza:
Okay. And then it, it replenishes,

Dr. Sophia:
It helps to replenish the vagina. Yes. Yes.

Touseef Mirza:
Wow. Okay.

Dr. Sophia:
Yes.

Touseef Mirza:
I have Star Wars in my head right now. the beam of light, nobody would've thought that eventually could help for the vagina. Okay.

Dr. Sophia:
But there, I mean, you're right. Mm-Hmm . You're right. But there's so many ways in which we can help the vagina during this time. And I think the most important part is knowing that we should

Touseef Mirza:
Mm-Hmm.

Dr. Sophia:
That one of the other aspects of the symptoms of menopause is the loss of sensation. And by having the loss of sensation, you then have the loss of orgasm. Some women have a very hard time having orgasm in perimenopause and menopause, or it just takes them so much longer to achieve orgasm. And that's even at the level of the clitoris because all of the vulva, all of the genitourinary system is actually affected by the loss of estrogen.

Touseef Mirza:
Is there anything you can do from, just in terms of diets and diet and supplements? Is there anything that they can do from that perspective?

Dr. Sophia:
Well, for one, I would say that of course always having a very healthy lifestyle. So staying away from smoking, for example, just because smoking actually rushes you into perimenopause and menopause. Women who smoke on average will go through menopause two to three years earlier. Wow. So yes,

Touseef Mirza:
That's a huge impact.

Dr. Sophia:
Exactly. . So if we needed any reason not to smoke, yeah, that's one. Mm-Hmm . But when I say healthy lifestyle, just having a lot of good lean meats, protein, having good fat, having lots of fruit and vegetables.

Touseef Mirza:
It's just normal eating well. And that's just one of the organs, basically. It's

Dr. Sophia:
Another that will benefit, it's another organ that will benefit from having a healthy lifestyle. Yes. Mm-hmm . Your vagina will love you for being healthy. Mm-Hmm . That is very true because having those good prebiotics and then encouraging good probiotics in your gut is also going to help the vagina.

Touseef Mirza:
Okay. So just like an overall diet, an overall healthy diet.

Dr. Sophia:
Healthy diet,

Touseef Mirza:
Diet. So we talked more locally on how to help the vagina, but HRT is also taken orally and there's also skin administration of the estrogen? Is that better or is that worse? Does it still give the same type of benefit versus locally local modalities?

Dr. Sophia:
So for some women, just to, to take systemic estrogen is enough for them to feel that their symptoms at the level of the vagina have improved.

Touseef Mirza:
When you say systemic,

Dr. Sophia:
Oh, systemic meaning that they've taken it either as a pill or they're taking it perhaps as a patch, or they're taking it as a gel that they rub onto the skin. All of those are ways in which you can have estrogen that is considered systemic. And you know, for a lot of women that's like killing two birds with one stone. They're able to decrease and take away their hot flashes, their brain fog, some of their other symptoms of menopause, including their vaginal symptoms. But for some women, that's not enough. And they may need additional vaginal estrogen

Touseef Mirza:
On top of that, the pill.

Dr. Sophia:
Right. Because what's happening at the level of the vagina, very small amounts, like minuscule amounts of the estrogen at the level of the vagina actually gets absorbed to be in the system in your whole system. Okay. What we call systemic absorption. So minimal.

Touseef Mirza:
So there's so much variety, right. Because some women when they're in perimenopause, menopause might not have any of these symptoms in terms of the effects on the vaginal level. Some of them might be fine. Yeah.

Dr. Sophia:
Up to 50% of women don't experience them at all, but the other 50% are having a horrible time.

Touseef Mirza:
Right. So for the other 50%, then you have different ways of figuring out how to solve this issue. It could be maybe just with the lubricant, or it could be by taking a pill or a patch of estrogen and or locally.

Dr. Sophia:
We do know that from a, just a lubrication standpoint, and in helping the vaginal tissue perhaps not feel as dry, we know that hyaluronic acid, for example, has some benefit. We know that taking vitamin E has some benefits. We know that. Hmm. Okay. I'm having a perimenopause moment. I forgot what I was trying to say. ,

Touseef Mirza:
That happens, by the way, Sophia is in perimenopause and I'm in menopause, so we're like literally swimming in this stuff like all the time. ,

Dr. Sophia:
We are always in the perimenopause. Menopause, perimenopause, menopause. Yes. Phase in our brains. Yes. So you're experiencing it all live right here? Live and direct. Yes.

Dr. Sophia:
But the point I was trying to make is that there's so much out there, it's hard to sift through even as your, even your physicians can't sift through all the things. And what's even worse, I would say, is that most of your providers probably don't know anything about menopause anyway. So they don't even know how to start you on an estrogen patch. They don't even know how to start you on vaginal estrogen, for example. Just because, I don't know, as a community, we've basically gone through years of not treating women for perimenopause and menopause. And certainly when it comes to just the vaginal symptoms of menopause and perimenopause make that even worse because nobody wants to have that conversation.

Touseef Mirza:
So since when in your practice have these conversations about painful sex in perimenopausal and menopausal women and bringing solutions to the table, like have you always talked about this or this has come more to the forefront lately?

Dr. Sophia:
I have been doing menopause, perimenopause, menopause work probably for the last 10 years of my career. And that's just because I just really had a special interest and, and desire to treat women in this particular phase. And really how it came to be was because I wanted to help women who were having problems during sex is it's really the thing that catapulted me kind of into the world of perimenopause and menopause. Because I was just like, well, how come women are not having all the fun? You know, I have too many, too many patients who come. And when I asked them, okay, on the, you know, as I'm going down the list of do you have heart, any medical conditions, any problems going on, anything bothering you right now? How's your sex life? And I get to that part and they'd be like, it's just okay. Or it's, I'm not having sex right now. And they're like 35. And I'm like, what do you mean you're not having sex right now? What are you talking about ? And they're married, or they have a partner and they have, you know, it's not like they, they can't, they're just not. And I'm like, what, what, why, mm-hmm

Dr. Sophia:
And for the, the 52-year-old woman who was just, you know, having all kinds of issues when it came to their sexual selves. And so that's really what catapulted me and then drove me down the rabbit hole of how do I get these women feeling better? How do I get women in, well with any, the sexual problems that they may be having? How do we deal with that? And then on top of that led to, wait a minute, we've gotta deal with what is perimenopause menopause and what women are going through.

Touseef Mirza:
So in terms of the red light and then the HRT and then also the different estrogen inserts that you're using, this has been going on for a long time. I'm just trying to understand how long has this been in the medical field, that women have been using these different modalities? Or is it really something that's started to surface ever since, you know, Oprah started talking about menopause two years ago. No. And now it's much more mainstream.

Dr. Sophia:
No, there are definite providers. There's definitely doctors who have been treating menopause and perimenopause. Okay. It's just that the education around perimenopause and menopause is so small.

Touseef Mirza:
That's what it is.

Dr. Sophia:
Okay. And it's only now really getting the highlight or the recognition that it deserves as a thing that should be addressed. Right. And even the women themselves coming to their physicians, their providers and saying, Hey, these are the symptoms that I'm having. What is all of this about that part? I think because now women have people with whom they can identify with the Halle Berrys of the world that they can identify with and say, yeah, you know what? I feel like I'm at the top of the world and at the top of my game as a woman, but my body is not on top of the world. And then on top of the game with me, you know, that I wanna live a life that is full of vitality. How do I bring my body on board

Touseef Mirza:
And that it's possible to do

Dr. Sophia:
So? And that you can, I think before, basically what happened is, a woman went through menopause. She didn't talk about it, she didn't tell anybody about it. People had to kind of bear whatever mood changes she may have been going through. She herself had to go through it. It's as if she had like sexual suicide because she just didn't have sex anymore due to the fact of pain or due to the fact of low libido and changes in her mood that cause her not to wanna have sex anymore. But that is not the woman of today. And I think that is what has changed that the woman of today are like, I wanna live till I'm 99 and when I get to 99, I still wanna live some more because I'm healthy, I am happy, I am flexible, I can move my body, I can use my body, I can still have sex in my body.

Touseef Mirza:
That's, that's a part of being alive. That's a part of,

Dr. Sophia:
And that's definitely a part of being alive.

Touseef Mirza:
It's almost like, you know, like we had the sexual revolution now it's like the vaginal estrogen revolution. Like we're talking about it finally.

Dr. Sophia:
Yes. Openly, openly, openly. The other thing you do bring up a point when it comes to vaginal, other vaginal treatments. And to be honest, I think a lot of these vaginal treatments came to be because the providers were not doing enough actually offering treatment for vaginal symptoms is why we came out with things like CO2 lasers for the vagina. And why we're, we were able to develop things like red light therapy for the vagina in order to try to rebuild the collagen and help the vagina become more elastic again and help with lubrication. This is where these different things came about. Mm-Hmm . You know, in terms of the quote unquote vaginal rejuvenation craze that has happened over the last 10 or 15 years.

Touseef Mirza:
You know, as you were talking, I was thinking when I was, I'm, I'm 53 now in my twenties and my thirties, I didn't really take good, not that I didn't take good care of my skin, but I didn't, I moisturized a little bit, but whatevs, you know, just a little bit would wash my face and moisturized a little bit. And then when I got into my forties, I just started to be more careful about what I put on my face because I saw that it was dry a little bit. And so I made sure it was natural ingredients. And I would say since the past, like three years now, I have had a regimen . Like I have a three step process. I have a different soap for the morning and the evening, all natural. And then after that I have like, I put a serum and then I put hyaluronic acid, and then I put this oil that I love. And so, and you know, my skin, my skin looks great. Your skin looks great. My skin looks great.

Dr. Sophia:
Your skin looks absolutely great.

Touseef Mirza:
And so, you know, as you were talking about the vagina, it's kind of similar, you know, before we could just have sex and we didn't need that much help along the way, but, and then you realize, okay, it needs a little bit of help, but it's still fantastic.

Dr. Sophia:
Absolutely.

Touseef Mirza:
So, so it, it's to, I think sometimes because when we talk about sex and vagina, it's already such a stigmatized space that we tend to forget that we can also simplify things, you know, to bring it back to this is just what the body's doing, and this is just what we are doing along the way to keep feeling the way that we wanna feel. Because I think the moment that we start to talk about vagina, vulva, tears, penis penetration, we just have this whole heaviness and connotation that, you know, okay, I have to deal with this. Yeah,

Dr. Sophia:
It feels cringey. It's

Touseef Mirza:
Just, it's just, it's just a lot of load. But if you can't just break it down and actually say, no, we need moisture. I'm gonna give it moisture, and then we can continue. You know, like I think sometimes we just need to like to bring it back down to the basics.

Dr. Sophia:
Well, the basics is that the vagina is an organ in your body that we want working until we die. And whatever we need to do in order to keep it functioning

Touseef Mirza:
Like your heart, like your

Dr. Sophia:
Gut, we like all of those things we should do. And that woman, you deserve it. And that going through perimenopause and menopause, yes, these are things that can happen, but we have ways to make it better. You do not have to suffer through it. You do not have to just accept it. It should not be that women are losing their relationships over dry vaginas. Like that's not it. We can fix that. You should be able to have enjoyable sex and an enjoyable sexual life, both for you and for your partner. We are sexual beings. We should embrace the fact that we are sexual beings and perimenopause and menopause should not stop us from having a healthy sexual life. Amen. We need to embrace every bit of our vaginas and our vulvas and our vulvas. And as always, in closing, we simply encourage you to embrace your body and embrace yourself.

Dr. Sophia:
Until next time, bye bye.

Dr. Sophia:
This is general medical information, based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.