VAGINAL FATIGUE: WHAT IS IT
t a recent talk to clients on Vaginal Rejuvenation, I coined the term “Vaginal Fatigue”. It came about by accident and was a result of being inspired in the moment by the energy of the crowd. I had not heard the term before or since that talk. The term is relevant and descriptive in a manner that is easily understood by most. It can certainly mean different things to different people. These differences reflect the complexity of female vaginal anatomy where bladder outflow, childbirth and sexual function all try to peacefully coexist. Further complicating factors are genetics, age related collagen loss, childbirth injury and hormonal changes. As a Gynecologist with over 26 years of experience, I feel well qualified to speak on this subject. Since that night, I have reflected often how to discuss this topic with accuracy, clarity and sensitivity. The approach to this area by traditional gynecology has been clumsy and often not in the patient’s best interests. There have also been several advances in medical technology over the last 5 years that’s adds relevance to this discussion. These technologies are not part of mainstream healthcare in Canada. Despite this, several represent true advances in technology that can assist women with Vaginal Fatigue to find solutions without the disadvantages of surgery.
What is vaginal fatigue
My definition of Vaginal Fatigue is any disorder of function of the bladder and vagina. These include but are not limited to
1. Bladder leakage with laugh, cough, sneeze and exercise. We call this ‘stress incontinence’ in medicine.
2. Bladder urgency, frequency and urge associated leakage
3. Mixed stress and urgency bladder leakage
4. Prolapse, or falling, of the bladder, uterus or rectum
5. Vaginal dryness causing painful sex
6. Genitourinary Syndrome of Menopause
7. Vaginal relaxation or looseness
Now that we have outlined what conditions are included, let’s look at why these occur. There are a number of predisposing factors that lead to Vaginal Fatigue.
Collagen type and loss
There are a number of specific collagen ‘types’ that have been well characterized in the medical literature. The description of these is beyond our conversation today. All of us inherit a certain ‘type’ of collagen from our parents and may be one reason we can blame some of our difficulties on them. Different collagen types resist the stress of gravity and damage in childbirth better than others. Almost all the support to the bladder, vagina and pelvic floor is provided by sheets of collagen that is organized into ligaments and fascial sheets. There are often strong family histories of prolapse or bladder leakage with the stress of coughing or exercise. These families have a less desirable form of collagen that is passed from generation to generation and can not be modified as we speak. As well, there is a natural inherent rate of collagen loss for everyone that can not be reduced as we age. We can see the result of collagen loss in facial ageing that is observed over the years, It is usually easy to tell who is 25 and who is 65 based on their facial and body collagen loss or lack thereof. While we can’t reduce collagen loss associated with ageing, we can accelerate it. Factors that increase collagen loss are poor nutrition, obesity and a variety of lifestyle choices such as smoking and illicit drug use. As women lose collagen from the vaginal area they suffer a loss of pelvic support that shows up in urinary leakage and prolapse.
Pregnancy and delivery can be very damaging to the support structures (collagen ) of the vaginal area, The pregnant uterus with child can weigh more than 25 pounds and in that situation gravity is not your friend! In fact, even pregnancy followed by C-section can still result in damage to the collagen of the pelvic supports. To add insult to injury, vaginal delivery can result in tearing and disruption of the collagen supports to the bladder, uterus and rectum. These injuries can lead to prolapse of the bladder, uterus and rectum into the vagina. Collagen damage can’t be corrected with Kegel contractions which are prescribed
to correct muscle weakness that results from pregnancy and delivery. We know that pregnancy itself damages the nerves in the pelvis responsible for sensation and muscular contraction. Kegels can repair some muscular strength but can’t correct collagen damage.
menopausal loss of estrogen
In women, the menopause is associated with loss of periods and a drastic fall in Estrogen and Progesterone production. All of the muscles, nerves, collagen and mucosal surfaces of the vagina, urethra and vulva have large amounts of estrogen receptors. Estrogen is responsible for the health and proper function of all of these tissues. Women can now spend at least 1/3 of their life in the menopause where Estrogen levels are very low. This aggravates the loss of collagen due to ageing and childbirth. The mucosa or lining of the urethra, vagina and vulva have large amounts of Estrogen receptors that stimulate growth or thickness of the lining. As well, these mucosal surfaces have huge amounts of glands within them that produce lubricating fluids and mucous. This is so important to the urethra that all women with urine leakage after the menopause should have a course of vaginal Estrogen before any other treatments are considered. Fifty percent of these women will have complete resolution of their urinary leakage with vaginal Estrogen treatment alone!
Dr. Ron Brown
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