By Carita Rizzo
“Have you tried lube?” an OBGYN once asked me, in all earnestness, when presented with my long-standing issue of painful intercourse. I didn’t know whether to laugh or cry. After dealing with discomfort for two decades, being faced with the doctor version of, “Have you tried restarting your phone?” wasn’t reassuring.
For women, both statistically and anecdotally, being dismissed by a medical professional is more the rule than the exception. An overwhelming 93 percent of women reportedly feel dismissed when seeking medical help. In my case, the general consensus was that my issue existed in my head. “Well, we know you’re able to dilate,” shrugged one doctor, while another prescribed me Xanax. One went as far as to suggest “things would loosen up down there,” after I give birth – a male doctor, natch, as no woman would suggest childbirth as a way to improve your sex life.
But, at the age of 46, everything changed. For the past year, social media has inundated me with posts about perimenopause, many of them from newly minted peri influencers like Dr. Mary Claire Haver and urologist Kelly Casperson M.D. After seeing posts addressing vaginal atrophy, now referred to as GSM (Genitoutary Syndrome of Menopause), which is caused by low estrogen, I asked my OBGYN if I could try topical estrogen for my vaginal pain. Within four days, my steady companion of 20 years was no longer there.
While relieved, I was also angry. How did it take so long to diagnose something that could be cured in days, and why did I have to do it myself? “It’s not an uncommon scenario. A doctor not recognizing that these symptoms can happen to younger women comes back to lack of education,” says Dr. Kim Einhorn, a board-certified OBGYN and founder of MP Collective. In-person services like Einhorn’s, and the rise of telehealth services geared towards women, is a response to this issue.
Finding a solution to my problem was also a matter of confluence, says Dr. Janette Gray, a San Diego-based internist specializing in hormone therapy and the author of The Truth About Sex Hormones. “The medical system is very disease-oriented. Women may have vague symptoms that are not necessarily categorizable as a disease. You’ve got to have a diagnosis that you can put a label to and maybe even an ICD 10 code, and GSM is a diagnosis,” she says. “The other thing is that the Women’s Health Initiative, which came out 23 years ago, is finally being debunked.’”
In the noughties, my treatment options were a set of dilators nestled inside each other like Russian dolls and benzodiazepines. Now there are numerous solutions and therapies available for sexual challenges, including drug therapy outside of estrogen, to alleviate vaginal pain. It is also important to note that sexual dysfunction can stem from several sources, which often overlap. “You have to be with somebody that can think outside of the box and knows what to look for,” says Dr. Einhorn. You also have to have a medical expert that cares about whether or not women enjoy sex.
It is obvious from studies alone that gender bias in the healthcare system has not changed since I was in my 20s, as over a quarter of women report having been told their symptoms are due to stress or anxiety. But women are increasingly advocating for their own health. “This generation is solution-driven and much more involved in their own healthcare,” says Dr. Einhorn. “My mother’s generation, there was a stoicism there. They were told to grin and bear it, and they did for the most part. But Gen Z, Gen X, and millennials are definitely not of that mindset, and they want answers from their doctors.”
Women have turned to social media as well as platforms like Reddit, with peer-to-peer support not only providing emotional reassurance but also informing conversations with health providers. We have also entered an era where women in the public eye, like Naomi Watts, Drew Barrymore, and Halle Berry are discussing their experiences with perimenopause. Berry recently opened up about her own vaginal dryness and painful intercourse, which has led to a partnership with menopause wellness company Joylux. “When Halle Berry goes through something, it normalizes everything,” says Dr. Einhorn.
It was a celebrity’s account of menopause that finally made Alanna, 46, demand solutions after five years of not feeling like herself. At the age of 41, she went to a doctor because she knew something wasn’t right, but her symptoms, which included heart palpitations, were dismissed. Over the years, Alanna’s health got progressively worse. “My daily level of rage was off the charts. I’m amazed everyone in my family is still alive and that I’m still married,” she says. “And my anxiety got so bad. I felt like my world just shrank and shrank. I was like, who am I? This is not me.”
When she picked up British TV host Davina McCall’s book, Menopausing, it felt like an epiphany. “I was just like, ‘Oh my God, this is my enlightenment. How come nobody told me about this? How come nobody talks about this?’” At 46, Alanna went on a mission to find the right form of HRT to treat her symptoms, which also led to her getting anxiety medication. “I literally feel like I’ve gotten my life back,” she says. “Now I feel completely empowered, particularly in regard to perimenopause, because there is so much information that’s starting to be available.”
Information shared via social media, celebrity spokespeople, and the internet can be life changing. But why are the professionals who are supposed to help us constantly letting us down? “Medicine is a volume game,” says Komel Caruso, co-founder of HerMD, a telehealth platform delivering comprehensive women’s health services. “Providers have to see a lot of patients because insurance reimbursements don’t cover the cost of running a medical practice. And delivering babies is highly reimbursed on the insurance side, so there are markedly more appointments available for patients who are pregnant.” Other women’s health concerns can land on the back burner. “Only 30 percent of GYNs are trained in menopause and sexual health,” says Caruso. “But that’s up from 20 percent just five to ten years ago.”
There are, of course, those working in medicine who are trying to give women the care and attention they deserve. Caruso and her sister Dr. Somi Javaid, both in their 40s, have made this their mission, first inspired by their mother narrowly surviving a quadruple bypass, after repeatedly having been dismissed by her doctors while presenting clear signs of a heart attack, and later by Javaid’s foray into traditional healthcare, the realities of which, Caruso says, “really hit her in the face.” “We said there’s got to be a better way,” says Caruso. “We need to create a model where patients feel heard and seen.” HerMD, in addition to gynecological and menopause support, also focuses on women’s sexual health in general. “It’s really important to us,” says Caruso. “A healthy sex life is a barometer for your overall health and wellness.”
That kind of support often falls outside of the traditional insurance model. Dr. Einhorn, for example, has transitioned to a concierge-type practice, which allows her patients the time and care she deems necessary. “The healthcare system today is not giving the doctors the time that they need to see these patients. These patients are complicated,” she says. “It’s doing the doctors and the patients a disservice by making us see patients in 15 minutes.”
As systemic change remains challenging, women advocating for themselves will continue to be key for their health, sexual or otherwise. “We tell our patients, no one knows your body better than you,” says Caruso. Thankfully, the information avalanche, especially when it comes to women’s health in the third half of their lives, shows no signs of slowing down. “I think this is a movement,” says Dr. Gray. “I have been doing this for 25 years and just in the last year, there’s real traction. It’s very exciting.”