(From my “A2W Aging to Wisdom” series, explorations of the joyful ways to go through life.)
By now millions have seen the ads or heard the TV and radio commercials — directed primarily to sexually-active menopausal and post-menopausal women — touting relief for a condition known as vaginal (vageegee) dryness. The medical community refers to this as vaginal atrophy. This condition can create significant pain during intercourse and lead many women to avoid intercourse because of anxiety and fear of the discomfort and pain. What the ads choose not to disclose, however, is the high cost of regaining and maintaining a vibrant vageegee.
Women who are particularly at risk include those who: 1) recently gave birth 2) are post-menopausal 3) had their ovaries removed and 4) had treatments for cancer, such as chemotherapy. The reason: Without ovaries producing estrogen at sufficient levels, the vaginal and genital tissues gradually thin. The diminished tissue health can lead to tearing, and with any open wound, inflammation and infection can occur. So it is not uncommon for women with atrophy to also experience recurring urinary tract infections, which can then create serious kidney problems.
Recurring infections and pain that prevents women from engaging in intercourse compounds the atrophy because of an ironic cycle. The benefit of intercourse — beyond the obvious pleasure when everything is going fine — is from the friction/massage as regenerative nourishment from blood bathes the tissues of the entire genital area. Frequent sexual intercourse can help to keep a vageegee vibrant, plump and lubricated. But if a woman is miserable with a urinary tract infection or the sexual activity causes her pain, then the destructive cycle can quickly take hold.
Turning to medical intervention for a remedy is highly recommended, but treatments present a new set of challenges and considerations.
As if the nomenclature — atrophy — isn’t distressing enough to the ear, the cost for treating the atrophy is offensive to the purse even with insurance policies willing to cover some forms of available treatment. The first challenge to revitalizing the affected tissue is choosing from among a number of options. What may or may not be right for an individual will be determined by health status, age and other factors. This requires an exam by a physician who can recommend the most appropriate treatment, which often, but not always, will result in a prescription.
The least expensive of these options is estrogen replacement in the form of vaginal tablets and vaginal cream. These come with risks and side effects: from increased risks of cancer, stroke or blood clots, to dizziness and nausea. With insurance the tablet or cream solutions can cost around $50 a month. Factor in the cost of the initial physician office visit, and you can see why many women simply cannot afford to deal with their vaginal atrophy. If you don’t have insurance, or have a policy that is considered less than premium, the costs skyrocket to obscene levels.
How obscene? Prescription pricing without insurance coverage is referred to by pharmacies as the cash price. A pharmacy in my neighborhood put the cash price of a prescription for vageegee cream at $356.95; a prescription for vageegee tablets was even higher, at $455. Many women find the tiny tablets (Vagifem) way more convenient and less messy, but again, factoring in the trade-offs and personal preferences may require experimentation with both of those forms over a period of time.
The vaginal ring (Estring) is another option, but only for those women comfortable with the risks and possible side effects of estrogen replacement, and with the idea of inserting a ring deep into their vageegee that will stay there for 90 days. The ring releases a low dose of hormone over three months and then needs to be removed and replaced with a new one. Ring prescriptions generally are written for three refills, though some physicians may allow refills for a year or more. The cash price for one ring (anywhere from $300-$450) may vary widely between dispensers and whether or not coupons/sales are available. My pharmacy’s cash price is $440.00 but with my insurance coverage, for example, it would cost $150 — which amounts to $50 per month.
Still, hormone replacement even administered by the less risky tablets, cream or ring (as compared to oral administration) may not be advisable for all women due to other health factors. Some women who have had various forms of cancer may not be candidates for hormone replacement. For those women, and for others who may not have had a positive experience with hormone replacement, there is another treatment using a laser. The trademark on this procedure is called — I am not making this up — MonaLisa Touch.
The process involves three office visits and each treatment, reportedly painless, lasts a few minutes. Patients have a wand-like instrument inserted into their vagina and a carbon dioxide-fueled laser is activated. This initiates bodily processes that generate more collagen and blood flow for healthy pink, moist tissue. As with many treatments, it comes with risks and side effects and at a staggering cost: about $3,000 since, you guessed it, it is not covered by insurance.
An argument can and should be made to the insurance companies that because they cover treatments for men who are suffering with an enlarged prostate, a condition with some similarities to urinary tract infections, i.e. pain, discomfort and frequent urges to pee, that women should also have better insurance coverage for their vaginal health.
Countering atrophy can help to reduce kidney infections and protect kidney function. And with wider access to screening and more affordable preventative treatments that insurance companies are required to cover, more women will seek relief and be able to help reduce the cost of their own medical expenditures. This will also contribute to the reduction in the need for antibiotics to treat kidney infections, and even more expensive insurance coverage for kidney treatment as women continue in their golden years.
Taxpayers and the government would also see a return on investing in women’s health, happiness and vageegee wellness and that would give everyone a Mona Lisa smile.
— Giselle M. Massi copyright May 7, 2016