Category: Made For Life

It’s More Than “Just a Pinch”

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It’s More Than “Just a Pinch”

Lisa Samy

January 2024

Hysteria. It’s a word that has stigmatized women throughout the ebb and flow of history, bunching a plethora of illnesses—and all women—into one category.[1] While this term lost its place as an official diagnosis, its connotation still negatively affects modern medical care. A recent study shows that doctors tend to undermine women’s pain compared to men and that women should primarily seek psychotherapy to alleviate their pain.[3] This originates from the subconscious, stereotypical belief that women are more “openly expressive” and “more emotional” when tolerating pain.[3] Therefore, there’s no need to take extra precautions, even for an extremely invasive procedure that myriad women dread having to endure: gynecological
exams.

Pain Isn’t Static

Lauren Capps, 28, accounts her past pap smears—a procedure where a medical provider scraps cells from a patient’s cervix to test them for cervical cancer—with, “I just remember the most terrible pain,” and, “I remember feeling violated.”[2] Additionally, Cooper Owens, 43, underwent a cervix dilation without anesthesia—she recalls, “I have never gone through that kind of physical agony in my 43 years of life.”[2] In the end, these women are shrugged off by medical providers because, well, childbirth hurts. Periods hurt. Women go through them all the time.

Therefore, women’s pain is routine.

The bottom line is this: levels of pain tolerance aren’t universal from person to person. When the line between necessary discomfort and pain blurs, so too does a medical provider’s judgment. That’s when it feels easy for a medical provider to laugh off a woman’s pain, or continue with the exam even though the patient doesn’t feel comfortable doing so.

It is important to communicate your comfort zones and limitations with your doctor.

For women who have experienced sexual assault, the barriers are even higher. Huma Farid, a practicing gynecologist and instructor at Harvard Medical School, says her patients who “experienced sexual assault confess that they have avoided or delayed seeking medical care due to their anxiety surrounding pelvic exams.”[4] Furthermore, these women have higher rates of post-traumatic stress disorder (PTSD), which instills the fear that they may relive their trauma during the exam.[4] This, of course, puts fearful and traumatized women at a higher risk of suffering from undiagnosed illnesses like cervical cancer or endometriosis.[1]

What Can Medical Providers Do?

Most medical providers wouldn’t intentionally harm their patients; however, biases, inattentiveness to a patient’s comfort, and a lack of pain management may cause them to inflict physical and/or psychological pain on their patients. The key to mitigating these issues is to reevaluate their mindsets toward women’s care; in particular, they can focus on a particular goal: individualized patient care.[2] 

This entails caring for a patient’s unique needs, fears, and ultimately, adjusting standardized procedures to their comfort. Medical providers can offer pain medication such as topical numbing cream before the procedure starts. Furthermore, they should remind the patient that they have full control and bodily autonomy, and encourage the patient to control the pace of the procedure. If the patient feels overwhelmed or is in excruciating pain, the medical professional must stop and ascertain their condition. If they’ve exhausted all their other options to continue the procedure, then there is only one option: schedule the appointment another time and prepare accordingly. Rescheduling should preferably be cost free to ensure the patient does not incur additional stress over finances and affordability. This in turn, helps the patient feel genuinely cared for and supported by their medical provider.

What Does Good Care Look Like?

For Kendra Perry, 47, her experience with an ideal medical provider is a paragon of good patient care. After several unsuccessful, and painful, attempts of undergoing an endometrial biopsy, even with prescribed medication, her medical provider opts to reschedule her appointment to conduct the procedure under general anesthesia for a pain-free experience.[2] Perry, pleased and relieved, says her gynecologist, “respected what [her] body could and couldn’t tolerate, or could and couldn’t do.”[2] To many people, this sounds like a pipe dream. And it’s about time this shifts into a shared reality for all women.

References

[1] Brooks, Laken. (2021). Painful Gynecological Visits Can Be Traumatic Instead of Healing. Forbes.

https://www.forbes.com/sites/lakenbrooks/2021/11/06/painful-gynecologist-visits-can-be-trauma tic-instead-of-healing/?sh=ffe63e847dbb​

[2] Nudson, Rae. (2022). Gynecology Has a Pain Problem Our discomfort is routine. What if it didn’t have to be? The Cut. https://www.thecut.com/2022/06/pain-in-gynecology-practice-exams.html 

​[3] Zhang, Lanlan. (2021). Gender Biases in Estimation of Other’s Pain. The Journal of Pain. https://www.jpain.org/article/S1526-5900(21)00035-3/fulltext ​

[4] Farid, Huma. (2019). When a pelvic exam is traumatic. Harvard Health Publishing. https://www.health.harvard.edu/blog/when-a-pelvic-exam-is-traumatic-201901291586

Breaking the Silence: Navigating Vaginismus with Understanding and Empowerment

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Breaking the Silence: Navigating Vaginismus with Understanding and Empowerment

Paz Etcheverry

January 2024

Is penetrative sex with your partner impossible because attempting it feels like “hitting a wall”? Have you never been able to insert a tampon? Do you skip your annual gynecological exam because the idea of having a speculum inserted into your vagina makes you extremely fidgety? If any of these scenarios resonate with you, you may have a condition known as vaginismus. Fortunately, there are treatment options.

Vaginismus is a psychological condition where the muscles of the vagina tighten up in a manner that makes the scenarios above very challenging or seemingly impossible to perform. It’s a completely involuntary response of the body triggered by fear and anxiety of penetration that affects up to six percent of women.[1] In those with this condition, vaginismus can lead to feelings of shame, hopelessness, and body insecurity,[4] which can result in relationship issues and mental health struggles.

Kegel exercises have been shown to improve symptoms of vaginismus

The term vaginismus was first coined in 1862 by James Marion Sims, a physician and pioneer in gynecology from South Carolina. He identified several contributing factors to this condition including emotional factors (anxiety of performance, sexual abuse, sexual issues with the partner, religious beliefs, and past trauma) and physical factors (cancer, childbirth, inadequate lubrication, and insufficient foreplay).[1]

Despite vaginismus being described over a century and a half ago, it continues to be a taboo subject, leading to significant stigma and underdiagnosis. It is rarely discussed in medical conferences, residency, or medical school. However, unlike other sexual disorders affecting women, vaginismus treatment has a high success rate.[6]

Treatment for vaginismus often involves a combination of physical therapy and psychotherapy. It’s essential to consult with a healthcare professional to determine the most appropriate treatment plan.

Some of the Treatment Options

Kegel Exercises

Kegel exercises consist of rapidly contracting and releasing the pelvic muscles, as though attempting to stop the flow of urine. As first described by Dr. Arnold Kegel in 1948, Kegel exercises can help with more than just alleviating vaginismus. These exercises have been shown to prevent urinary incontinence and genital organ prolapse, a condition where the uterus, bladder, or rectum descend into the vaginal canal due to weakened supporting tissues.[3] 

Vaginal Dilators

These dilators are graduated silicone or plastic tube-shaped devices that range in both size and thickness. Women insert a dilator into their vaginas and allow it to stretch the vaginal muscles for approximately twenty minutes. When they no longer experience discomfort, women can move on to the next size. This process is known as systematic desensitization.[5] Materna Medical has come up with an ingenious vaginal dilator by the name of Milli[TM] that gently enlarges within the vaginal area at a pace under the user’s control. In other words, Milli[TM] does not consist of multiple dilators, rather a single dilator that women can control with the simple press of a button.

Support Online Groups/Programs

Maze Women’s Sexual Health has a comprehensive supportive forum where women can discuss their symptoms, treatment, and progress in overcoming this condition. HelloGina[TM] offers an evidence-based digital therapy program through an app where women receive guidance from a skilled coach who supports them throughout their journey. The program, while pricey ($288), has a satisfaction rate of more than ninety-seven percent among users.

Primary Care Physician or Ob/Gyn

During the upcoming annual exam, ask your ob/gyn healthcare provider to consider using a smaller speculum. It’s also advisable to request the speculum to be warmed for added comfort. If you’ve been using dilators, you may choose to self-insert the speculum. Make sure to talk to your doctor so that the gynecological exam can proceed at a pace that is most comfortable for you.

Cognitive Behavioral Therapy

Cognitive behavioral therapy, or CBT, is a form of psychotherapy that aims to identify and modify negative thought patterns and behaviors. It focuses on the interplay between thoughts, feelings, and behaviors, helping individuals develop healthier coping mechanisms. There is evidence that CBT may help women with vaginismus. For example, after receiving CBT for three months, eighteen percent of women were able to successfully have intercourse with their partners compared to none in the control group.[8] 

Hypnosis

In the course of hypnosis, the underlying issues contributing to vaginismus can be examined, and efforts may be made to address, and potentially reverse, the fears and anxiety associated with the condition. Hypnosis can delve into some of the psychological causes of vaginismus, suggesting that some women have the capability of overcoming vaginal muscle spasms.[5]

Botox

Botulinum toxin, when injected in the perineum or area between the anus and the genitals, may be an effective treatment for vaginismus based on a few studies.[2] 

While overcoming vaginismus may initially appear quite daunting, it’s important to remember that there are available treatment options to address and manage this condition. Experiencing vaginismus can lead to feelings of shame and body insecurity, but it’s crucial to remember that you are not alone. Embracing the journey to overcome vaginismus brings the promise of empowerment, healing, and the possibility of rediscovering a fulfilling relationship with one’s own body.

References

[1] Anğın, A. D., Gün, İ., Sakin, Ö., Çıkman, M. S., Eserdağ, S., & Anğın, P. (2020). Effects of predisposing factors on the success and treatment period in vaginismus. JBRA Assisted Reproduction, 24(2), 180–188. https://doi.org/10.5935/1518-0557.20200018 

[2] Helmi, Z. R. (2022). Comparative Study of 150 vs. 200 Units of Botulinum Toxin as Treatment for Vaginismus. Estudo comparativo de 150 vs. 200 unidades de toxina botulínica como tratamento para vaginismo. Revista Brasileira de Ginecologia e Obstetricia : Revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 44(9), 854–865. https://doi.org/10.1055/s-0042-1751287 

[3] Huang, Y.C. & Chang, K.V. Kegel Exercises. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555898/ 

[4] McEvoy, M., McElvaney, R., & Glover, R. (2021) Understanding vaginismus: a biopsychosocial perspective. Sexual and Relationship Therapy. 

[5] Melnik, T., Hawton, K., & McGuire, H. (2012). Interventions for vaginismus. The Cochrane Database of Systematic Reviews, 12(12), CD001760. 

[6] Pacik, P. T. (2014). Understanding and treating vaginismus: a multimodal approach. International Urogynecology Journal, 25(12), 1613–1620. 

[7] Pithavadian, R., Chalmers, J., & Dune, T. (2023). The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review. Women’s Health (London, England), 19, 17455057231199383. https://doi.org/10.1177/17455057231199383 

[8] ter Kuile, M. M., van Lankveld, J. J., de Groot, E., Melles, R., Neffs, J., & Zandbergen, M. (2007). Cognitive-behavioral therapy for women with lifelong vaginismus: process and prognostic factors. Behaviour Research and Therapy, 45(2), 359–373. https://doi.org/10.1016/j.brat.2006.03.013

Understanding Menopause and Osteoporosis: What’s The Link and What Can You Do?

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Understanding Menopause and Osteoporosis: What’s The Link and What Can You Do?

Emily Bergin

January 2024

What is Osteoporosis? 

Osteoporosis is a condition marked by decreased bone mass and strength, which inevitably leads to fragility and fractures.[1] It can negatively impact an individual’s physical and mental health by causing pain and reducing both mobility and independence, particularly in older adults. While this disease affects all people, it has the largest impact on women, with about 80 million women over the age of 50 in the U.S. afflicted with this disease compared to only 2 million men.[2]

Risk Factors 

One reason for the higher risk for older women is because of the accelerated bone loss that occurs when women enter menopause. Estrogen is the hormone that regulates bone growth and loss and when its levels plummet during menopause, many women are at an increased risk of having brittle bones. Other risk factors outside of age and gender include genetics, smoking, and other diseases and drugs that impact bone health.[3] 

Age can contribute to an increased risk of osteoporosis. If you suspect symptoms, talk to your doctor.

Treatment 

To mitigate the impact of estrogen on bone health during menopause, estrogen therapy was the first developed treatment established in the 1960s. Since then, various studies have raised concerns over the safety and efficacy of estrogen therapy, citing possible increases in heart attacks and breast cancer, making many women weary of this approach.[4] 

The first line of pharmacological treatment for osteoporosis is now bisphosphonate drugs, also known as antiresorptive drugs, which work to prevent the reabsorption of bone mass during turnover, reducing overall bone loss. A second, newer line of drugs known as anabolic medications works to build new bone to increase bone density as opposed to merely preventing future loss. Many individuals tend to see benefits in bone strength and reduced fractures through using a combination of the two.[5] 

Despite the increase in therapeutic options, concerns have arisen about the actual prevalence in use of these drugs. Among postmenopausal women, the use of these pharmacological solutions has been decreasing since 2007 with postmenopausal women in 2017, 61% less likely to use any osteoporosis medication compared to 2007.[6] 

Other Solutions 

Outside of pharmacology, there are a lot of things individuals can do to decrease their risk of osteoporosis and bone loss. Good nutrition is key, particularly maintaining a sufficient intake of vitamin D, calcium, and protein to keep up bone strength. Physical activity, especially strength training, can serve as another way to improve and maintain strong bones, reducing risks for osteoporosis and fractures.[1] 

Addressing the Gap 

There appears to be a large prevention and treatment gap for this group of patients, despite the high impact on both a personal and societal level. Osteoporosis has a significant impact on function and pain, affecting the individual’s ability to carry out their daily tasks, and eventually leading to a higher mortality rate. The costs to society are high as well, by increasing direct medical costs and indirect healthcare expenses through loss in productivity.[7] 

Little research has been done about the true impact on the quality of life this condition can have for women. More attention and focus are essential to address the risk and gap in care for older women to ensure that they are aware of and able to reduce their risk for osteoporosis. There is a significant need to adequately inform patients, particularly women, about the benefits of these interventions, as well as the benefits of pharmaceuticals. Additional research is needed to better understand how menopause affects risks for osteoporosis and other conditions. Despite the correlation between menopause and osteoporosis, with the correct education and treatment, individuals can mitigate their concerns and keep their risk of fragility and fractures at bay. 

References

[1] Lane, J. M., Russell, L., & Khan, S. N. (2000). Osteoporosis. Clinical orthopaedics and related research, (372), 139–150. https://doi.org/10.1097/00003086-200003000-00016 

[2] Wright, N. C., Looker, A. C., Saag, K. G., Curtis, J. R., Delzell, E. S., Randall, S., & Dawson-Hughes, B. (2014). The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 29(11), 2520–2526. https://doi.org/10.1002/jbmr.2269 

[3] Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. (2021). Menopause (New York, N.Y.), 28(9), 973–997. https://doi.org/10.1097/GME.0000000000001831

[4] Tella, S. H., & Gallagher, J. C. (2014). Prevention and treatment of postmenopausal osteoporosis. The Journal of steroid biochemistry and molecular biology, 142, 155–170. https://doi.org/10.1016/j.jsbmb.2013.09.008 

[5] New York State Department of Health . (2020, June). FDA-Approved Medications for Osteoporosis Treatment. Department of Health. https://www.health.ny.gov/publications/1984/index.htm ​

[6] Orces C. H. (2022). Trends in osteoporosis medication use in US postmenopausal women: analysis of the National Health and Nutrition Examination Survey 1999-2000 through 2017-2018. Menopause (New York, N.Y.), 29(11), 1279–1284. 

[7] Amin, U., McPartland, A., O’Sullivan, M., & Silke, C. (2023). An overview of the management of osteoporosis in the aging female population. Women’s health (London, England), 19, 17455057231176655. https://doi.org/10.1177/17455057231176655