Comedian, actor and writer Cathy Jones shares her experience of dealing with cystitis and vaginal atrophy.
I don't want to be the poster child for vaginal atrophy. I don't want people to look at my picture and say, "She's got vaginal atrophy!" I just want to be a person who promotes the idea that we should address it.
One of the big things I say on stage is women have to keep it going. Do what you got to do to keep it going. I have friends sitting around the mahjong table, going like, "Nope. I don't care if anybody ever touches me again." And I'm thinking, "Ahh! Don't give up! Don't let it go like that!"
I'm 61. In my middle to late 50s, I was experiencing symptoms of getting urinary tract infections a lot and having a little bit of cystitis (bladder inflammation). I would have aching. Like aching. And feeling like, "Oh, I'm not feeling 100 per cent." I would just lie there and have this pelvic pain.
At that point, I wanted to ask my doctor to put me in touch with a specialist. My doctor was kind of dismissive. She was like, "I don't think you really need to."
Well, when I got to see the urologist/gynecologist, she was awesome. I got that test where you put water inside your bladder, and you can see on a screen what the lining looks like. And lo and behold, the lining of my bladder looked like it was blistered. I think I had severe cystitis at that moment. And that's when the doctor said it would be really good to try this local product that would deliver estrogen to the tissues.
I think that's what happens to people. I have many friends who start getting UTIs when they have sex or just generally feeling like they can't get back on the horse in terms of getting their health together down there.
You hear you're going to have this situation: There's going to be thinning of the tissue. There's going to be dryness. I was thinking, "Well, I'm not really getting that." But my symptom was I was getting a lot of urinary tract infections.
No one ever said to me, "You have vaginal atrophy." They were just like, "You're getting dry tissue." And they explained the whole connection: The tissue of the vagina is not just about the vagina. It's also right next to the bladder and right next to the rectum, so keeping the tissues healthy there is going to benefit that whole area. There's a lot of stuff happening there.
Now, I feel healthier. I feel less discomfort. When you think about a lot of women experiencing this and thinking there's nothing they can do, or not even bringing it up, I think that's ridiculous. I think we need to talk about it.
In my show, I talk about women giving up and trying to disappear so they don't have to deal with it. They just want to get out of the whole situation of the possibility of being a sexual person because they think it's going to hurt. We also think older women who are having sex in their 80s and 90s and stuff are probably not comfortable and are just doing it for their partner. But the truth is they can have awesome sex, as long as they don't have discomfort. And they can be interested and turned on, and all of that.
I'm not with a partner. I've been single all these years. I've had relationships come and go. Even if I wasn't having sex all the time, if it comes along, I want to be ready.
It was looking like I was getting close to sex with this guy last year, and I was making all these preparations like, "Okay. I'm going to have some coconut oil right there. We're going to have to have lots of lube because I don't know what's going to happen. I'm pretty old." And then everything was so great. Everything was way better than I thought because I had been taking care of things.
– As told to Wency Leung
This interview has been edited and condensed.
What is vaginal atrophy?
It's estimated 50 per cent of women experience vaginal atrophy – also known by the broader term, genitourinary syndrome of menopause – within three years of menopause.
Dr. Vivien Brown, assistant professor in the department of family and community medicine at the University of Toronto and president of the Federation of Medical Women of Canada, sat down with us to explain the ins and outs of this common condition:
What physically happens with vaginal atrophy?
Basically, the lining of the vagina is getting thinner. So if you look at pictures, instead of it being 10 cells thick, it may be one or two cells thick. The lack of estrogen thins the lining and makes the lining more friable – it's easier to tear and cut and bleed. Think of an elderly woman with papery skin. They bruise easily and it tears easily. That's what's happening vaginally.
The back wall of the bladder is the top part of the vagina, so this area shares tissue. With the lack of estrogen, this area actually shrinks. It doesn't have that same stretch and give that it had in younger women. And it gets much more sensitive, which makes it prone to be irritated and that irritation is when people think they have a yeast infection or they're just uncomfortable.
Why does the lack of estrogen have this effect?
Estrogen normally maintains the vaginal tissue, the uterine tissue and the genital tissue in that area. With the decline of estrogen in menopause, some women still have lubrication and don't feel the change as much. But with time, this just gets worse.
A lot of symptoms in menopause, hot flashes for example, get better with time. Your body sort of equilibrates and you don't feel it as much. But in terms of this vaginal atrophy, it gets worse with time. But when you do look at older women, in their 80s and 90s, the ones who are doing well are the ones still in a relationship, who have social connectedness and who are using something vaginally if they need it – and most women need it at that point.
What are the treatments like?
There are hormonal and non-hormonal treatments. The non-hormonal treatments are things that you can buy in a pharmacy without a prescription, such as a lubricant. And those work well, or reasonably well, at the beginning, when you still have estrogen around. But the most effective products are some kind of estrogen. In Canada, we have cream, we have vaginal tablets and we have a ring that can go in the vagina and be left for three months.
They work vaginally, but because they are poorly absorbed into the blood system, they don't have the side effects and the risks of oral estrogen.
How long do women take estrogen treatment?
If you had diabetes and you were on insulin, it would work when you took it and when you stop taking it, it would stop working. This is about the same. We never say "forever" in medicine because medicine changes and advice changes, but when I put women on this, I say it's long-term.
How can you tell whether what you're experiencing is a problem that requires treatment or a natural part of aging?
I think it's different with each patient. This is a clinical diagnosis. There's no particular test that you do. It's not like you have to do a biopsy . It's both the art and the science of medicine when you're evaluating someone and asking about their situation. I have women in their 60s and 70s who aren't uncomfortable and still are in happy relationships and don't need to be on anything. But I still think their age warrants me asking how they're doing.
– Wency Leung
Cathy Jones is a comedian, writer and actor, known for her performances on This Hour has 22 Minutes. She was paid by the drug company, Novo Nordisk Canada, to speak publically as part of a media campaign. The Globe was not aware of the payment at the time of publication.
Dr. Vivien Brown was paid by Novo Nordisk Canada to speak about vaginal atrophy as part of a media campaign. The Globe was not aware of the payment at the time of publication.