Women Physicians
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 Index   --   WPGYN Newsletter  --  Volume 11, Issue 3,  July 2014

Barb Dehn Publishes Book on Menopause

Help!  My Va-Jay-Jay is Dry Dry!

My thoughts on the Hobby Lobby Decision

What's the Story on Routine Pelvic Exams?

We Need Your Help

Barb Dehn Publishes Book on Menopause


Our own Barb Dehn, RNP, MS, who has been a nurse practitioner with Women Physicians for over 20 years, is sharing her wealth of experience and the experiences of her patients in a new book—The Hot Guide to a Cool Sexy Menopause. 


Barb has become well-known locally and nationally for her common sense approach to women’s health. She makes guest appearances on television, lectures at conferences and popular events, and writes for news and health journals including her own popular health blog at www.NurseBarb.com.  She also founded Blue Orchid Press, which produces innovative and award winning Personal Guides to Health on topics ranging from Fertility to Pregnancy to Menopause.   


“Finally! There is a book on Menopause that made me feel NORMAL and that I wasn’t crazy.”
— Maya K.

The average age of menopause is 51, but there is a wide variation with the periods ceasing anywhere from 45 years old to 55 years old.  Symptoms range from none at all to incapacitating.  This book guides you through what symptoms to expect and how to deal with them. 

“Other books on menopause confused me with all the medical jargon.  This book was easy to understand. I already feel better.
— Carolyn A.

Some menopausal symptoms start during the crazy hormonal ups and downs when the periods are changing or stopping.  Others, like vaginal dryness, kick in after the periods have stopped all together, and get progressively worse.  Enjoy a sample of Barb’s writing and get some great tips on vaginal dryness in the feature article of this newsletter—”My Va Jay Jay is Dry Dry!”

“This is the Best Menopause Book Ever! I’m only 45, but these things are happening
to me. I used to think that Menopause controlled me, but now I’m in control.
— Lauren S.

Living and loving don’t stop at menopause.  The tips in this book will help you maintain your health and well-being into the golden years.  

Available on Amazon, Barnes and Nobel and for E-readers.



Help!  My Va Jay Jay is Dry Dry!


By Barbara Dehn, RNP, MS


Vaginal dryness: No one told me about this!

When you buy your ticket on the hormonal roller coaster, affectionately known as menopause, I have some bad news: Sorry, you probably won't be making a stop at splash mountain. Nope, menopause brings lots of unexpected twists and turns and one big secret, your Va Jay Jay will be a lot dryer.


Ok, using correct terminology, the vagina gets a lot drier and less able to expand and stretch and, well, have fun.



Can You Say Sahara?


Yes, there will be more wrinkles, but you knew that. What many of my patients are surprised by is how dry their skin is, especially in their vaginas. The once healthy, pink, soft and flexible, stretchy accordion-like folds begin to thin out and are less flexible. And, what's worse, now that you don’t have to worry about pregnancy, all of a sudden, your ability to lubricate recedes like a middle-aged man’s hairline.


Infections are More Common


Sorry to say, that when the vagina is dry, it means that the pH will also be off balance allowing less of the good health bacteria (lactobacillus) to grow and more of the bad bacteria that cause vaginal and bladder infections to flourish. This means that the pH which is normally slightly acidic will be slightly alkaline.These conditions are a set up for more vaginal and yes, even bladder infections, as opportunistic bacteria in the vagina travel toward the urethra and bladder. It's not fun!




What to Do?

Do not wait!  Do not make the mistake of thinking that this will get better on it's own. It doesn't.  It just gets worse. Don't walk, run to your health care provider to discuss treatment options to restore the tissues to how they were before menopause.There’s good news. Even if you’re not interested in hormones to treat hot flashes and night sweats, the good news is that a minimal amount of vaginal estrogen used regularly does not increase your risk of breast cancer, blood clots, stroke or any of the other serious side effects that are associated with hormone treatments for hot flashes and night sweats. It's because the dose is much, much lower. A non-estrogen pill taken daily is also available to treat vaginal dryness.



Hormonal Options:

Vaginal estrogens:

Vagifem - Used every night for 2 weeks, then these small vaginal tablets are inserted 2 times/week

Estrace & Premarin Cream -  Directions can be customized. Typically it's recommended that women use an applicator to insert 1-2 grams into the vagina every other night for 2 weeks, then to use 1-2 grams in the vagina 2 times/week. These creams can also be rubbed into the delicate labial tissue on the outside of the vagina.

Estring - A flexible ring of estrogen that is inserted into the vagina. This slowly releases a small amount of estrogen over the next 90 days. Women don't feel it inside and can easily use a finger to remove it and reinsert every 3 months.


Oral non-estrogen (SERM)

Osphena—a pill taken daily which causes changes in vaginal tissues just like estrogen, but it is a SERM (selective estrogen receptor modulator) so it behaves like estrogen in some tissues but like an anti-estrogen in other tissues.  It should not be used if you are at risk of blood clots or stroke and it occasionally causes hot flashes. 


All of the prescription treatments restore the normal ratios of the vaginal cells and the normal pH to premenopausal levels. 


Over-the-Counter Options to Re-moisturize

 There are a few vaginal re-moisturizers that I highly recommend to my patients:

Replens - This is used every 2-3 days to help restore vaginal moisture. There are no hormones in this and it is a nice option for women who can't use any hormonal treatment.

Luvena -  This is 100% natural and uses no alcohol, plus, it's very slippery. It can also be used as a personal lubricant.

Omega-3 Fish Oil – Everything gets drier in menopause from your eyes to your private girl parts. Consider taking 1-2 Fish Oil capsules each day.



 You're not alone if you need a lubricant. 50% of women of all ages do too!

Astroglide - developed by NASA, but not for sex in space.

Luvena - is edible.  Could be fun!

Carrageenan - has aloe and agave and is very effective.

Olive oil, coconut oil, wheat germ oil - anything that you can use in cooking, you can use in the bedroom.

Slippery stuff - always gets high ratings.



You can find many more helpful products through MiddlesexMD, a great resource for women at midlife.

 Stay cool.                        

Nurse  Barb



My Thoughts on the Hobby Lobby Decision


· Erosion of evidence-based medicine.  IUDs do not cause abortions.

· Interference in the physician-patient relationship.

· Limiting access to contraception causes more unwanted pregnancies and abortions.

· Contraceptive decisions do not belong in corporation boardrooms. 

It’s WRONG for Women’s Health!                                          Katherine Sutherland, MD




What’s the Story on the Pelvic Exam?


The American College of Physicians, a group of specialists in internal medicine, just came out with a Practice Guideline stating that annual pelvic exams do not have proven benefits for healthy asymptomatic women. They based this primarily on studies showing no improvement in outcomes for ovarian cancer or BV (duh). Furthermore women find them uncomfortable. Using evidence-based medicine, they conclude there is no reason to do them. It reminds me of the statement by the American Task Force on Preventative Medicine that there is no data showing that health outcomes are improved when doctors advise patients to use sunscreen, therefore doctors should not advise patients to use sunscreen! That is like saying there are no randomized controlled studies proving that jumping off skyscrapers is bad for your health! Do we really need a randomized controlled trial to reach that conclusion?  Logic would dictate that the absence of proof of a benefit does not disprove a benefit.  It may simply be a matter that the wrong endpoints were studied. 

The American College of Obstetricians and Gynecologists has a much more reasonable approach which is detailed in their recent Practice Advisory. They agree the data supporting the routine pelvic exam is based on a wealth of experience of gynecologists rather than on randomized controlled studies, but that most gynecologists, including me, have had numerous experiences where the pelvic exam has revealed unanticipated findings that were important for women's health.  Examples include endometriosis, fibroids, benign cysts, vaginal infections, and cancers. But since there is no proof of benefit, the decision to do the pelvic exam can be based on a mutual agreement between the patient and the physician.

Molly Cook, MD, a general practitioner who served on the ACP Clinical Guidelines Committee, said she must make choices during the limited time she has with patients: "That 20 minutes is really crowded, and I want to use my time in ways that are particularly going to benefit women."  As most of you know, I schedule more than time than that for my annual well-woman exams, and I prefer to be comprehensive rather than to cut corners. 

The statement by the ACP does not address pap smears, which all agree are beneficial to health when done periodically. It does not address the benefits of the Well-Woman appointment as an annual visit with the physician, which includes serial measurements of blood pressure, weight, height, review of medicines and family history, and exam of the the thyroid and breasts and stool occult blood exam. At different stages of life, the well-woman exam provides an opportunity to discuss STD prevention, contraception, fertility, sexual function, mood changes, and hormone changes including menopause.

So what is my bottom line recommendation? I strongly recommend continuing the annual well-woman visit. I do not recommend pelvic exams on women less than 21 years-old, but, in general, I feel routine pelvic exams are more likely to be beneficial than harmful in most other age groups. Exceptions would be circumstances like women with a phobia regarding pelvic exams. If you prefer to avoid the pelvic exam with your next annual well-woman visit, and you have no pelvic risk factors or symptoms, please bring it to my attention, and I will be happy to skip the pelvic exam. But, of course, it will be hard for me to assure you that your pelvis is “healthy” without doing a pelvic exam!


We Need Your Help


· Please bear with us as we train our new medical receptionist. 

· Parking continues to be a major problem.  Please allow adequate time to park, and fill out paper work before your scheduled exam.  

· Please request other providers to copy us on your lab and radiology results. 

· Sign up for Patient Fusion which will give you direct access to  your pap smears and  most lab tests which we order.   This can be done during your next appointment






El Camino Women's Medical Group provides comprehensive Obstetric & Gynecologic care for patients throughout the Bay Area. Minimally invasive surgery, infertility, women's mental health, and the MonaLisa Touch are just a few of the specialized services we offer.
The MonaLisa Touch treatment is available at El Camino Women's Medical Group. Call the office (650-396-8110) or email Shar (Shar@ElCaminoWomen.com) for more information.
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