- Question from Carol: Will the incontinence associated with menopause and after breast cancer ever diminish?
- Answers - Mindy Goldman, M.D. Although incontinence is more common during the menopausal years, incontinence is not a normal part of menopause. There are many causes of incontinence, and it's important to have this evaluated by a physician who specializes in incontinence. For some women, their incontinence may be related to loss of estrogen around the urethra and portions of the vagina, and some women may find local forms of estrogen such as the Estring helpful. We don't have studies that actually show this, but I have found that for many women the Estring really helps.
- Marisa Weiss, M.D. Sometimes you can get incontinent because of a urinary tract infection or also because of irritation through sex because of the friction. It can be very helpful if you can urinate before and after you have intercourse or before or after you engage in other forms of sexual stimulation, as it can reduce your risk of developing a urinary tract infection.
- Mindy Goldman, M.D. In addition, after you have sex and have emptied your bladder, I recommend wiping the vagina well with a towel to keep the area as dry as possible. This also helps to minimize risks of infection.
- Marisa Weiss, M.D. Many women will use a panty liner in case of a little leak. There are some liners that are more comfortable and others that are more irritating. Do you recommend a particular brand?
- Mindy Goldman, M.D. I don't necessarily recommend a particular brand, but usually ones that are not scented. For many women, the scents may be irritating and can actually worsen their symptoms. If someone is soaking through more than one pad per day, particularly a full thickness pad, it's important to see your gynecologist or a uro-gynecologist who specializes in treating incontinence. There may be simple solutions such as pelvic muscle training exercises or medications that may help to treat incontinence. In some cases, surgery may be indicated as well. So it's important to have this evaluated.
- Marisa Weiss, M.D. For some women who may have lost some of their libido and their ability to have an orgasm, they may require a lot more stimulation of the clitoris in order to reach sexual arousal and possibly orgasm. Sometimes with all this extra stimulation, the urethra which is located close to the clitoris can also be over-stimulated. If this is your situation, good communication with your partner and a "roadmap" of the different small but very important structures down there can be useful. Stimulation can be directed to the areas most pleasurable to you, and the urethra can be avoided as much as possible, and then you'll have less irritation and subsequently less urinary infection.
On Wednesday, July 21, 2004, our Ask-the-Expert Online Conference was called Managing Menopausal Symptoms. Mindy Goldman, M.D. and Marisa Weiss, M.D. answered your questions about how to manage menopausal symptoms, including hot flashes, vaginal dryness, loss of libido, and more.
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