In menopause it is common to suffer from vaginal dryness, poor lubrication, pain during intercourse, hemorrhoids. But not everyone knows that many ailments of vaginal and vulvar discomfort, also after the age of 50, may depend on a hypertonus of the pelvic floor (or levator muscle), a muscle region closely linked to female health and well-being, still little known and underestimated today. And not all gynecologists make an evaluation of this structure, which instead must always be carried out during the visits and integrated into the diagnosis and therapy. We talked about it with the Dr. Elena Bertozzi, Pelvic Floor Physiotherapist of the Italian Association of Physiotherapists, who has been following women for a long time in the rehabilitation of the levator muscle after childbirth and in menopause.
Menopause, pelvic floor and estrogen drop
«When I visit my patients I like to think of a conservative treatment to try to keep tissues and intimate area strong and elastic. A muscle elasticity of the pelvic floor that is normally given by theestrogen, which in menopause gradually decreases until it is exhausted. And the side effects of this lack are dryness, stiffness and dyspareunia (pain during and / or after intercourse), vaginal and vulvar discomfort which can also lead to recurrent infections », explains Dr. Bertozzi.
Pelvic floor in health. Also for pleasure
Pelvic floor health is paramount. From it depends the elasticity of the vulva, vagina, good urination and defecation. But not only. Pleasure also depends on its functional state. Yes, because it is the seat of sexuality and if contracted or lax, neglected following childbirth or stressed by physical, emotional and hormonal factors, it can cause various types of discomfort. Until the impossibility of having an orgasm.
Here all the advice of Dr. Elena Bertozzi on Menopause on Instagram.
New technologies for menopause
In menopause (but also after childbirth) it is essential to resort to two combined approaches. “On the one hand, the new technologies (laser, radiofrequency, oxygen therapy) which have different principles of action but with the common goal of regenerating, reactivating and restoring the lubricated and toned vulvovaginal mucosa ”, explains Bertozzi. These technologies can also be combined. “Already after the first treatment, the result is that it lasts over time because they succeed in reactivate a normal physiological process of birth and regeneration of collagen. Estrogen is the starter that activates the production of collagen, and in menopause there is none ».
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He laser
Monnalisa Touch o Erbium CO2 they are performed by the gynecologist, usually 4 sessions are done (one a month), they have an abrasive action on the mucosa to physiologically allow tissue regeneration. That’s why he waits a month before doing another session. The effect, however, stops at the mucosa.
Radio frequency
It is done by the physiotherapist and has regenerative action: stimulates the production of new collagen fibers, increases tissue trophism and vascularity. It can be associated with the portion, which carries in depth a molecule chosen by the therapist, usually hyaluronic acid low molecular weight. The effect is long lasting. The tissue appears regenerated and deeply hydrated, and vaginal and vulvar comfort begins to improve in the following days. The protocols are quite flexible, usually the physiotherapist recommends the frequency based on the situation. This technique works in depth, gets to work up to the muscle and has a muscle relaxant effect.
Dr. Bertozzi is also one of the consultants of the Instagram profile Manupausa, on which the founder Manuela Peretti dedicates almost every day a space dedicated to a problem linked to menopause and addressed by ad hoc specialists. A mine of scientific information focused on the various aspects that women around 50 must face.
Oxygen therapy
It is theHigh concentration oxygen delivery via a probe into the vagina (98% versus 21 in the air), which has a highly therapeutic effect. “It’s a bit like putting the vagina in the hyperbaric chamber. Oxygen is a very powerful regenerative, antiseptic and antibacterial. It is even less invasive. It lasts 15/20 minutes and takes advantage of thebiorevitalizing and re-epitizing therapeutic effect of tissue and mucosa.
All of these approaches can also be used in combination. These technologies are very expensive and there are still few NHS centers that have these technologies. The cost is about 100/150 euros per session.
Massage, stretching and menopausal exercises
These new technologies must always be associated with the approach of physiokinesitherapy: manual treatments of massage, stretching and exercises of the pelvic floor which are learned from the physiotherapist and which aim to preserve and maintain elasticity and muscle tone. Which in the long run, if left untreated, can lead to incontinence and prolapse. Pelvic floor training and exercises serve to maintain active and functional tone which is also debilitated due to estrogen deficiency. «On youtube there are many videos with the exercises, but be careful! You risk doing the wrong ones. It is the physiotherapist who has to recommend the right ones for each case. The importance of checking the exercises with a professional to understand if they are being done correctly. A diagnosis is needed first: hyper or hypo tone are different and must be treated differently ”, warns Dr. Bertozzi.
When to contact the physiotherapist
When you experience symptoms of discomfort, such as burning, dryness, pain in intercourse, thinning of the vulvar area and you see that something is changing in your personal and sexual life, it is essential to visit the physiotherapist. But it must be a physiotherapist who specializes in pelvic floor rehabilitation. “There’s a register of physiotherapists, an order and a group of physiotherapists specialized in pelvic rehabilitation: GIS pelvic floor specialist interest group. The list with geolocation is online », recommends the expert.
How the first visit takes place and how to understand that you are in the right hand
The physiotherapy examination of the pelvic floor is not just a gynecological examination. «The first visit includes a first part of inspection and testing of sensitivity, degree of atrophy and muscle activation. Important is the part of the dialogue with the patient and the evaluation scale to verify the starting phase », explains Bertozzi. Then the physiotherapist proposes tailor-made strategies for the woman. “I always tell my patients that ‘menopause is forever’, and we professionals must provide and guarantee women health, well-being and autonomy”.
Therapy continues at home
«After a first approach of a few sessions in the office, the therapists teach the woman how to start and continue therapy at home. For example with specific exercises (Pelvic floor muscle traning) for prevention and health care of the pelvic floor. More stretching, massage and use of aids to do at home ”, adds the expert.
Exercises and stretching maneuvers, massage also with the use of tools (toys, dilators for the home) are taught by the physiotherapist and then repeated regularly, at home, in a quiet moment. «A menopausal woman who has a hypotonic deficit with symptoms of incontinence and pelvic heaviness can do the exercises at home. For example with Perifit, a device with a probe connected to Blootooth and to the app to do the exercises », explains Bertozzi. “For the hypertonic instead, dyspareunia and tissue stiffness need to relax. In addition to the manual massage, a toys or a dilator or a probe type Ellen which is swollen in the vagina even with hot water and increases in volume, so as to relax and enlarge gently. It is also used in post surgery. Enlarges and elasticises the vaginal canal. The path can be integrated with oral or egg supplements, hormones recommended by the gynecologist ”, concludes Dr. Bertozzi.
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