“It hurts too much to have sex,” I told my doctor. “I like it very much.”
I was sitting in a hospital gown on the exam table at my family doctor’s office in Santa Fe, New Mexico. It was the same table where I had sat through both of my pregnancies and where, three years earlier, I had been diagnosed with breast cancer.
“I’m so sorry,” my doctor said. “I know what it’s like to go through menopause. Especially since you went through it overnight.”
She was the one who diagnosed me with cancer. I found a small lump on my right breast and immediately called her office. Our date was Halloween 2017 and she was dressed as Snow White, wearing full face paint and a black wig.
“You’re one of the lucky ones,” he said, as I sat down at the table and cried. “You don’t need chemotherapy and you’ll be fine.” My doctor was right — I was lucky. I had caught it early, and with breast cancer, early detection is everything.
My treatment consisted of a mastectomy, reconstructive surgery and 10 years of targeted hormone therapy — to kill the estrogen in my body and reduce the risk of the cancer coming back. The goal of these hormone treatments—for premenopausal women—is to get you in a sling during menopause. It worked. In a matter of weeks, I went from a healthy, menstruating 37-year-old woman to a post-menopausal, flare-up cancer survivor with bone pain. I got vaginal irritation, which I would later learn was vaginal atrophy. The only thing that wasn’t atrophying was my post-surgery breasts — they looked more perky than ever. But while my breasts felt 16 again, my vagina felt 61. It was a total mess.
“It hurts,” I complained. “Just… all the time. And especially during sex.”
“Menopause makes it very uncomfortable—almost impossible—to have successful intercourse,” she said matter-of-factly. “Have you heard of vaginal resuscitation? A colleague of mine in Albuquerque offers laser therapy at her practice. I think you’d be a great candidate for that.”
Courtesy of Anna Sullivan Reiser
An hour later I was home, googling laser vaginal resurfacing. Finally, I found a reliable women’s health care website with treatment information. Above the medical description was a photo of a smiling woman in her 60s, wearing a pink button-down shirt. She had done the treatments and seemed to be enjoying the ‘successful intercourse’.
The type of vaginal revitalization treatment I was considering, “gently rejuvenates” the vagina by delivering a type of treatment known as fractional CO2 (carbon dioxide) laser energy to the soft tissues of the vaginal wall and providing a hormone-free treatment for the vagina. atrophy. Vaginal atrophy—for those who haven’t yet traveled to the Sahara desert of menopause—is next-level vaginal dryness. It’s a side effect of menopause — practically a guarantee. For many women and people with vaginas, vaginal estrogen creams can provide adequate relief for pain during intercourse caused by vaginal atrophy. For women like me—who proactively kill the estrogen inside their bodies with mega-drugs—research is still ongoing on estrogen creams, rings, and pills and whether they are safe to use. Right now, it’s not something I’m comfortable with.
I was excited to discuss what I had learned with my husband. In the midst of raising two toddlers—while also recovering from a life-threatening illness—dealing with sexual dysfunction was on our to-do list, but our marriage had yet to be in crisis. Together we identified two major drawbacks to the treatment. The first was the price. Laser treatment consists of three sessions, spaced a few months apart. I was given $3,000 total for the three sessions. Insurance does not cover the cost of vaginal resuscitation, although you may be able to get reimbursement through a flexible spending account (FSA). I don’t have one of those.
The second concern was risk. Most of the sites I researched did not mention any risks involved with the treatment. But there is, of course, risk when you decide to have your vagina lasered. Some women have experienced excruciating pain during treatment and — in very rare cases — suffered vaginal burns. Nevertheless, and being one of the lucky ones who had access to the treatment and could afford it, I decided to give it a try.
Courtesy of Anna Sullivan Reiser
A few weeks later, I was taking the desert mesas on my way to Albuquerque for my first laser treatment. When I arrived at the small gynecology clinic, I was greeted by a young receptionist. I told her in a quiet voice that I was there for vaginal resuscitation. He asked me to repeat myself. I did it. She laughed nervously and asked me to wait. I watched her consult a colleague before returning to the window. “Sorry,” he said, amused. “I’ve never heard that before.” I gave her a look that was meant to say, Menopause is coming to you too, young lady.
Finally, I was led into an exam room and given a gown. A nurse came into the room and put a numbing cream on my lips. As I waited for him to go numb, I spotted the laser treatment in the corner of the room. It was a tall machine with a long, thin stick. It looked like something you might see in a dentist’s office. Then the gynecologist – an older, soft-spoken, hippie woman – came in and told me how excited she was to have the chance to do the treatment. “Have you used the laser before?” I asked nervously. “Only sometimes,” she replied. I tried to ignore the sudden wave of panic that came over me. He opened the machine and it made a loud, vibrating noise. As I lay down, a tagline from an old Virginia Slims commercial came to mind: You’ve come a long way baby.
The initial treatment went well. For a few days, I had light vaginal bleeding, which was to be expected. The laser creates tiny micro-abrasions in the vaginal wall, increasing blood flow and stimulating the growth of new blood vessels – essentially breathing new life into your vagina. I didn’t feel any pain during the treatment, although it was a bit uncomfortable and uncomfortable. After the first session, I noticed something right away. My vagina looked happier. Actually, it didn’t hurt – not at all.
My gynecologist told me to have sex between sessions to maintain my new elasticity. I felt so empowered by the positive results of the first treatment that I couldn’t wait to jump into bed with my husband. But when it came time to go to work, I was extremely disappointed to find that the penetration remained very painful.
“I’m sorry,” I said to my husband after we tried – unsuccessfully – to have sex. “I can’t do this, it hurts too much.” I was in tears. We were both disappointed. Would I ever have sex again?
Courtesy of Anna Sullivan Reiser
I brought this question up to my next appointment in Albuquerque. My gynecologist told me to wait to finish all three treatments before jumping to any conclusions. But the results from the second treatment were not so remarkable. And the same was true for the third and final treatment. It seemed to me that the main benefits of vaginal rejuvenation appeared after the first treatment. It had a very positive effect on the overall wellness of my vagina, but it didn’t fix the painful symptoms I was experiencing during intercourse.
Six months after my initial visit to the doctor, I returned to the exam room detailing my experience. My doctor and I agreed that research and devoting more resources to women’s health has a long way to go. Most women cannot afford expensive laser vaginal treatments and instead, learn to normalize their pain or simply avoid talking about it.
Did vaginal resuscitation correct the painful symptoms I experienced during sex? No. Am I comfortable using an estrogen cream? Again, no. But I think about the waiting room at the Dana Farber Cancer Center — and I guess I can live with that. The question is why should I? Why is there a little blue pill for erections and not an effective cure for vaginal dryness? Again, it looks like we’ve been given the pivot.
Before I left, my doctor wrote me a prescription for Lidocaine, a numbing cream.
“Put it on twenty minutes before sex, it really helps,” she said. Before leaving the room he turned and gave me a half smile, as if to say: welcome to menopause, we’ve come a long way baby. But do we have?
There are a few other estrogen-free vaginal atrophy treatments out there – and maybe someday I’ll try them. Currently, my partner and I are exploring what “successful contact” means to us. Penetration is just one way to have sex — there are plenty of fun things to do.
After I hit menopause, we were forced into these awkward but ultimately fruitful conversations – and in many ways they brought us closer. We’ve redefined what sex and intimacy look like to us — and that feels like success.
Anna Sullivan Reiser is an author and mental health therapist. She writes for The Insider and co-hosts the upcoming podcast “Healing + Dealing,” which shines a spotlight on youth survival. She lives in Santa Fe, New Mexico, with her husband and two children. You can contact her at annasullivanreiser.com or follow on instagram @healinganddealingpod.
