By Monazza Ahmad, B.Pharm, MSc

To ensure best health outcomes in a healthcare setting, it is important to establish open, effective, and respectful communication between a patient and a healthcare practitioner.

As a patient, it is not only your right but in your best interest to ask your doctor for clarification or further explanation on your health condition and treatment plan. As a healthcare provider, it is your responsibility to provide a safe and comfortable environment for your patients to openly discuss their health concerns and make sure your diagnosis and treatment plan is well understood.

That said, menopause can trigger many complex and confusing symptoms that can be uncomfortable to talk about, which can make managing the symptoms difficult. Here are some tips for both patients and practitioners to start the conversation around menopause and its symptoms that we discussed in our previous post, Menopausal Symptoms.

When should I talk to my doctor about menopause?¹

First of all, don’t feel awkward. Menopause is a natural phase of life, and your doctor is likely familiar with all possible symptoms. Describe your condition and symptoms in detail and explain how they are affecting your lifestyle and relationships. The provider needs to rule out any other underlying conditions before determining it is menopause.

Reach out to your doctor if:

• You haven’t had your period for two consecutive months
• You have more than one period in a month or your cycle is unusually irregular
• You have uncomfortable vaginal dryness
• The symptoms are interfering with your daily activities
• The symptoms are affecting your sexual life and intimate relationship
• You consistently get brain fog and feel sad
• You often start sweating suddenly, and it doesn’t feel normal
• You are gaining weight unusually
• Other therapies are not helping with the symptoms

Don’t forget to tell your doctor if you have any allergies or other health conditions. Also mention any medications or supplements you’re already taking for menopause symptoms or other conditions.

What shall I ask my doctor?

Medical appointments can be stressful, and we often feel rushed. When you have a delicate issue to bring up, being prepared can help. Here are some of the questions you can ask your practitioner:

1. How do I know when I start menopause?
2. What is the difference between perimenopause, menopause, and postmenopause? And how do I know which phase I am going through?
3. What are the different challenges of each phase?
4. How can I tell hot flashes apart from normal sweating?
5. What can I do to relieve my symptoms such as hot flashes and vaginal dryness?
6. Why do I feel so much menopausal anxiety, and how can I overcome this?
7. What are my treatment options, and how long does each option takes to work?
8. Are there any side effects with these options?
9. What are the safe, nonhormonal solutions to manage menopausal symptoms that I can try first?
10. When should I seek further medical assistance?

How can healthcare providers ensure the right care during menopause?

Often, the reluctance from healthcare professionals to address these female issues can also cause lack of awareness. It is the healthcare provider’s obligation to make sure patients feel comfortable in discussing their menopausal concerns and understand the treatment plan.²

According to a survey by NIH, patients are likely to discuss menopause transition with providers who don’t make them feel rushed, are good listeners, and have expertise in this area of women’s health.

Here are some ways to help your patients receive the best care:

1. Keep your tone friendly.
2. Be empathetic and sensitive about their health challenges.
3. Use plain language and avoid medical jargon (do not assume that your patients are familiar with the complex medical terms).
4. Create communication material beforehand at 5^th– to 8^th-grade level of understanding.
5. Give women time to reflect and find words to articulate concerns.
6. Ask both closed-ended and open-ended questions to discover more.
7. Make sure to ask if they understand the treatment plan and what concerns they have about the treatment options or compliance. Offer to repeat the plan.

What to ask your patients:³

• Do you get sudden outbursts of sweat to the level that it makes you feel embarrassed?
• Do you have vaginal dryness accompanied with discomfort, and is it affecting your sexual life?
• Do you get brain fog and feelings of sadness? What do you feel like when this happens? How do you cope with it?
• Do you feel a lack of interest in daily activities? What does your day look like?
• Do you have any concerns about the treatment plan we discussed?
• Do you want me to go over the treatment plan again?

The menopausal rating scale and symptoms evaluation form can be used to track symptom improvement to see what treatment options are working:^4,5

Menopause is a natural phase in a woman’s life, and its challenges need to be accepted and understood at work, at home, and on a social as well as a societal level. Unless these concerns are progressively communicated in a healthcare setting, it will be tough for us to understand the impact of this condition on a woman’s life.

For more information on women’s health and general wellness topics, please visit the Metagenics blog.

References:

1. Sachdev P. Talking to your doctor about menopause. https://www.webmd.com/menopause/guide/menopause-talking-to-doctor. Accessed May 16, 2023.
2. Angelou K et al. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020;12(4):e7586.
3. Newson L et al. Guidance on diagnosis and management of urogenital atrophy or genitourinary syndrome of the menopause (GSM). https://pcwhf.co.uk/wp-content/uploads/2018/11/GSM-Guideline.pdf. Accessed May 16, 2023.
4. Heinemann K et al. The Menopause Rating Scale (MRS) scale: A methodological review. Health Qual Life Outcomes. 2004;2:45.
5. Hauser GA et al. About MRS. https://zeg-berlin.de/expertise/diagnostics-tools/menopause-rating-scale/about-mrs/. Accessed May 16, 2023.

Beginning stages of treatment of vaginismus must be supervised in a multidisciplinary way by specialists and/or pelvic floor therapist usually. Involuntary contractions are the main problem with vaginismus. A pelvic floor physical therapist plays a very important role in the treatment of Vaginismus. A treatment plan may involve a set of objectives to be achieved through manual techniques in order to improve the pelvic floor. These may include physiotherapy equipment, such as VuVa vaginal dilators. With their correct use it can help decrease Vaginismus symptoms.

What Is Pelvic Floor Physical Therapy?

Use Of Physical Therapy For The Treatment Of Vaginismus

In the event that the origin of vaginismus is triggered by a poorly healed scar tissue, physical therapy can try to improve that area and make it more pliable. In addition, any case of vaginismus can benefit from physical therapy techniques, since they can relax and re-educate the muscles.

For this reason, it is increasingly common for vaginismus treatment to be multidisciplinary: the psychological part is treated with the therapist, supported by treatment with a physiotherapist specialized in sexology. Within the treatments of vaginismus, at a physical level, biofeedback treatments and VuVa vaginal dilators can be used.

When we have a vaginismus problem we have a global floor contracture, there is an elevation of tone (hypertonia).

The chronicity of a pathology is something serious to take into account, when more than 3 months of pain go by it becomes chronic pain. Not only does the structure hurt physically, but also at a cerebral level. The pain needs to be treated at a physical and mental level at this point. 

Why Vaginal Dilators Are So Important During The Treatment?

Treatment with vaginal dilators allows progressively adapting sensitivity to penetration. With the vaginal dilators it is possible to learn to control muscle contraction/relaxation. With VuVa dilators our main function is to inhibit the involuntary contraction reflex to learn to control the muscles, gradually introducing smaller and larger sizes. They also help us as a proprioceptive technique and to stretch the pelvic floor muscles once we have achieved relaxation.

Are Vaginal Dilators Used Only For Vaginismus?

Vaginal dilators can contribute to treatment in other conditions such as the following:

Dyspareunia

Vulvodynia

Vaginal Atrophy

Pelvic Radiation Therapy

Menopause

Vulvar Vestibulitis

Vaginal Stenosis

Vaginal Agenesis

Pudendal Neuralgia

It is always important to consult your gynecologist or physical therapist to give a correct use of the vaginal dilator depending on the condition you have. Please for more information about condition treatments go to https://www.vuvatech.com/pages/conditions

How Long Does Vaginismus Physical Therapy Take?

The effectiveness of the results would depend on the way the physiotherapist teaches the patient and the perseverance and discipline of the patient to perform the exercises, therapeutic equipment, massage and the proper use of the vaginal dilators. However, each patient is truly different, but a typical treatment lasts between 4 and 12 months.

How Many Times A Week Can I Go To Treatment?

The usual is to attend the treatment 1-2 times a week to obtain results. The pelvic floor therapists always respect the privacy of the patient . The physical therapist will give their patients individual home therapy exercises that a very important to success in treatments. 

What Exercises To Complement My Treatment With VuVa Vaginal Dilators Can I Do With My Physiotherapist?

The physiotherapeutic approach consists of the following therapeutic techniques and tools, the choice of which will vary depending on the individual characteristics of each woman:

Pelvic Floor Muscle Relaxation Education

Helps create a body awareness of the pelvic area, thus avoiding myths or fears that cause muscle spasms that close the vaginal canal. The physiotherapist needs to educate in a understanding way the steps that the patient needs to follow to execute at the right way the treatment and improve the musculature in the pelvic floor:

1. Diaphragmatic Breathing: This is a type of deep breathing that engages the diaphragm muscle and pelvic floor muscles to work together and relax in a coordinated way. Here we have some steps to follow:

• Start by placing one hand on your chest and the other on your stomach.

• Take a breath for 3 seconds and expel it for a long time for 4 seconds, you should feel that your stomach grows when you breathe in and falls when you breathe out.

• You should repeat it about 5 to 10 minutes a day.

• Your pelvic floor muscles relax as you breathe in and out.

2. Stretching: This is also a good way to open up your pelvic floor muscles, the most common forms of stretching include:

• Happy Baby Position: Lie on your back, open your knees and hold them towards your head with your hands, hold this position for around 5-10 seconds and gently guide from side to side.

• Child Position: You should be on your hands and knees and spread your knees as wide as possible. Always keep your toes flat on the floor, bend down bringing your chest towards your legs and extend your arms out to the sides.

• Butterfly position or adductor stretch: Relax on your back and bring your feet together, letting your knees relax out to the sides. You can put pillows to support your knees at your sides.

• Needle position: While lying on your back and with your knees bent, position your left ankle over your right knee, bring your right leg toward your chest. You should feel a stretch on the outside of your left hip. You should repeat it with the contralateral side.

Pelvic floor training

With the specific training of the muscles that make up the pelvic floor, women learn to know their vaginal muscles and practice tensing and relaxing them consciously, to train the pelvic floor muscles we use Kegel exercises.

Kegel Exercises

1. Inhale deeply through your nose, allowing your abdomen to rise as you fill with air. Keep your pelvic floor muscles relaxed as you inhale.

      2. Breathe out slowly through your mouth while gently contracting your       pelvic floor muscles.

      3. Contract your pelvic floor muscles for 3 to 6 seconds (until the muscles  are tired) as you exhale.

      4. Inhale again and release the contraction to relax the muscles.

      5. Relax your muscles completely for 6 to 10 seconds.

      6. Repeat this exercise 10 times per session.

If you feel pain when you do Kegel exercises, stop doing them right away. Kegel exercises are not harmful but they are not suitable for everyone, when done correctly most people find them relaxing. If you feel pain during or after the exercises, you may not be doing them correctly or they may not be right for you.

Dilation Exercises Using Vaginal Dilators Of Different Sizes

1. Start with the smallest size.

2. Prop yourself semi-reclined on a bed/chair/sofa. Bending your hips and  knees a little may help.

3. To prepare, you could try actively relaxing  your pelvic floor muscles using your breathing.

4. A helpful step can be to practice resting the tip of the smallest dilator at your vaginal entrance and using your breathing to keep your pelvic floor relaxed.

5. When you think your pelvic floor is relaxed, take your time to gently slip the smallest dilator (covered in lubricant) into your vagina.

6. Leave the dilator in place for 1 to 10 minutes, keeping our pelvic floor relaxed. You will be able to increase the length of time gradually with practice.

7. Bring your attention to your physical sensations as you use the dilators, or to the sensations of our breath in your body.

 8. When read, try the next size up from the one you are using. You may find it helpful to try 1 minute of the size that you are comfortable with before using the larger size immediately after.

 9. Gradually increase the size of the vaginal dilator you are using, remembering you should be comfortable with a given size for up to 10 minutes, feeling the muscles are fully relaxed around it , before you move on to the next size.

If these exercises cause bleeding, or if you have difficult thoughts or feelings about using the dilators, which you feel are getting in the way, please discuss this with our doctor, physiotherapist , nurse or psycosexual counselor.

Superficial Thermotherapy And Ultrasound

Using superficial thermotherapy helps to intensify the temperature around the perineal muscles with a slightly higher body temperature, in order to achieve a vasodilating, therapeutic and relaxing effect.

With ultrasound we obtain a similar effect but the difference is that it acts deeply in the form of vibrations, when these vibrations penetrate the perineal tissue, producing heat in the area and relieving pain at the nervous level.

Global Postural Reeducation (RPG)

The health professional tries to correct the initial situation of conflict that will leave the discomfort. RPG aims to resolve the root cause, including discovering new postural habits that favor the patient’s well-being.

Therapeutic Perineal Massage

This technique helps us alleviate a little the pain and tension that can be generated in the perineal muscles, the therapist gives instructions to the patient and her partner in the event that her partner performs the massage.

1. With a little lubricant, the index and middle fingers are inserted into the vagina, gently on the vaginal walls in a U-shape throughout the vaginal cavity.

      2. Work muscles at a superficial level.

      3. Do not massage for more than 10 minutes.

In conclusion, with experience and knowledge in this field in the treatment of vaginismus, specialists in conjunction with helping you overcome this type of injury that has a cure, allowing you to have sexual relations daily without pain.

A physical therapy specialist may be able to help you manage and improve your vaginismus symptoms with personalized treatment techniques and lasting results in order to overcome your condition. Gain full control of your perineal muscles to greatly reduce vaginal pain.

References

Pelvic Floor Therapy: I Thought My Body Was Broken Until I Tried. (2018, June 4). Healthline. https://www.healthline.com/health/womens-health/pelvic-floor-physical-therapy-what-to-expect#Two-months-later

‌ Vaginal Dilator Exercises for Psychosexual Therapy Information for patients. (n.d.). https://www.ouh.nhs.uk/patient-guide/leaflets/files/30804Pexercises.pdf

Urology Care Foundation https://www.urologyhealth.org/

Do you need to order vaginal dilators so you can start your pelvic floor therapy process? Made in the USA. Visit www.vuvatech.com 

VuVa Helpful Links:

How do Neodymium Vaginal Dilators work? 

7 Reasons for a Tight Vagina and How to Loosen 

How to use Vaginal Dilators 

How to Relax Vaginal Muscles, Vaginismus & Sex 

Vaginal Stretching – Keeping in Shape with Dilators 

Do Dilators Really Work? Yes, and They can Improve Your Sex Life!

Shop for VuVa Vaginal Dilators

Tara Langdale Schmidt is the inventor of the VuVa Dilator Company. She has pelvic floor dysfunction herself and wanted to create a dilator set that is made in America that women can trust. VuVatech has been in business since 2014 and has helped over 50,000 women all over the globe. She patented the Neodymium Vaginal Dilator, that is clinically proven to help with blood flow and nerve pain.

Podcast Episode 22: Tara Langdale-Schmidt

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