The author celebrating her 40th birthday in Ojo Caliente, New Mexico.
“It really hurts to have sex,” I told my doctor. “Like, a lot.”
I was sitting in a hospital gown on the exam table at my family practitioner’s office in Santa Fe, New Mexico. It was the same table where I’d sat through both of my pregnancies and where, three years earlier, I’d been diagnosed with breast cancer.
“I’m so sorry,” my doctor said. “I know how it feels to go through menopause. Especially since you went through it overnight.”
She was the one who diagnosed me with cancer. I’d found a small lump on my right breast and called her office immediately. Our appointment fell on Halloween 2017, and she was dressed up as Snow White, wearing full face paint and a black wig.
“You are one of the lucky ones,” she said, as I sat on the table and cried. “You don’t need chemotherapy, and you’re going to be okay.” My doctor was right — I was lucky. I’d caught it early, and with breast cancer, early detection is everything.
My treatment consisted of a mastectomy, reconstruction surgery and 10 years of targeted hormone therapy — to kill the estrogen in my body and lower my risk of recurrent cancer. The goal of these hormone treatments — for pre-menopausal women — is to slingshot you through menopause. It worked. Within a matter of weeks, I went from being a healthy 37-year-old menstruating woman, to a hot-flashing, bone-aching, post-menopausal cancer survivor. I suffered vaginal irritation, something I’d later learn was vaginal atrophy. The only thing not atrophying were my post-operative breasts — they looked perkier than ever. But while my boobs felt 16 again, my vagina felt 61. It was a total mindfuck.
“It hurts,” I complained. “Just... all the time. And especially during sex.”
“Menopause makes it very uncomfortable — nearly impossible — to have successful intercourse,” she said matter-of-factly. “Have you heard of vaginal rejuvenation? A colleague of mine, in Albuquerque, is offering laser treatment in her practice. I think you’d be a great candidate for it.”
The author taking a selfie during her first mammogram appointment. "I didn't know at that time what was ahead of me," she writes.
An hour later I was home, googling laser vaginal rejuvenation. Eventually, I found a reputable women’s healthcare site with information on the treatment. Above the medical description, there was a photo of a smiling woman in her 60s, wearing a pink button up shirt. She had done the treatments and seemed to be enjoying “successful intercourse.”
The type of vaginal rejuvenation treatment I was considering, “gently rejuvenates” the vagina, by delivering a type of therapy known as fractional CO2 (carbon dioxide) laser energy to the soft tissues of the vaginal wall and providing a hormone-free treatment for vaginal atrophy. Vaginal atrophy — for those who have not yet journeyed into the Saharan 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 sufficient relief for the pain experienced during intercourse caused by vaginal atrophy. For women like me — who are proactively killing the estrogen inside their bodies with mega medications — the research remains ongoing about estrogen creams, rings and tablets, and whether they are safe to use. Right now, it’s not something I am comfortable with.
I was excited to discuss what I’d learned with my husband. In the throes of parenting two toddlers — while also recovering from a life-threatening illness — addressing sexual dysfunction was on our to-do list but hadn’t yet become a crisis in our marriage. Together we defined two major drawbacks to the treatment. The first was the price tag. The laser treatment consists of three sessions, distanced a few months apart. I was quoted $3,000 in total for the three sessions. Insurance does not cover the cost of vaginal rejuvenation, although you might be able to get reimbursed through a flexible spending account (FSA). I don’t have one of those.
The second concern was the risk. Most of the websites I researched did not mention any risk 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 the treatment and — in very rare cases — suffered vaginal burns. Despite all that and because I was one of the lucky ones to have access to the treatment and could afford it, I decided to try it.
The author and her husband, Alex, at the Inn in Vermont where they got married. "This was on our 8th wedding anniversary," she writes.
A few weeks later, I was taking in the desert mesas on my way to Albuquerque for my first laser treatment. When I arrived at the small gynecology practice, I was greeted by a young and chipper receptionist. I told her in a quiet voice that I was there for vaginal rejuvenation. She asked me to repeat myself. I did. She giggled nervously and asked me to wait. I watched her consult with a co-worker before returning to the window. “I’m sorry,” she said with amusement. “I hadn’t heard of that before.” I shot her a look that was meant to say, menopause is coming for you too, young lady.
Eventually, I was led to an examining room and given a gown. A nurse entered the room and applied a numbing cream to my labia. As I waited to go numb, I spotted the laser treatment in the corner of the room. It was a tall machine with a long, slender wand. It looked like something you might see at a dentist’s office. Then the gynecologist walked in — an older, soft-spoken, hippy-ish woman — and told me how excited she was to have the opportunity to perform the treatment. “Have you used the laser before?” I asked nervously. “Only a few times,” she responded. I tried to ignore the sudden wave of panic that washed over me. She turned on the machine and it made a loud, vibrating noise. As I laid back, a tagline from an old Virginia Slims commercial popped into my mind: You’ve come a long way, baby.
The initial treatment went well. For a few days, I experienced some light vaginal bleeding, which was to be expected. The laser creates tiny micro-abrasions on the vaginal wall, increasing blood flow and stimulating the growth of new blood vessels — essentially bringing new life to your vagina. I didn’t feel any pain during the treatment, although it was a bit uncomfortable and awkward. After the first session, I noticed something right away. My vagina seemed happier. In fact, it didn’t hurt ― at all.
My gynecologist told me to have sex in-between the sessions, to help maintain my new elasticity. I was feeling so bolstered from the positive results of the first treatment, I couldn’t wait to jump into bed with my husband. But when it came time to get down to business, I was extremely disappointed to find out 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 both were frustrated. Would I ever have sex again?
The author, her husband and two children on Halloween 2017, a few hours after her doctor diagnosed her with breast cancer. "We are trick-or-treating on Canyon Road in Santa Fe, New Mexico," she writes.
I brought this question to my next appointment in Albuquerque. My gynecologist told me to wait to finish all three treatments before coming to any conclusions. But the results from the second treatment weren’t all that noteworthy. And the same was true for the third and final treatment. It seemed to me the major benefits of vaginal rejuvenation occurred after the first treatment. It had a very positive effect on the overall wellbeing of my vagina but didn’t fix the painful symptoms I was experiencing during intercourse.
Six months after my initial doctor’s visit, I was back in the examining room detailing my experience. My doctor and I agreed that researching and devoting more funds to women’s health has a long way to go. Most women can’t afford expensive vaginal laser treatments, and instead, are learning to normalize their pain or simply avoid talking about it.
Did vaginal rejuvenation fix the painful symptoms I experienced during sex? No. Do I feel comfortable using an estrogen cream? Again, no. But I think of the waiting room at the Dana Farber Cancer Center — and I guess I can live with it. The question is, why should I? Why is there a little blue pill for erections and not an effective medication for vaginal dryness? Yet again, it seems we have been given the shaft.
Before I left, my doctor wrote me a prescription for Lidocaine, a numbing cream.
“Put this on twenty minutes before sex, it really helps,” she said. Before she left the room she turned and gave me a half smile, as if to say, welcome to menopause, we’ve come a long way, baby. But have we?
There are a few other non-estrogen vaginal atrophy treatments out there — and maybe someday I’ll try them. For now, my partner and I are exploring what “successful intercourse” means to us. Penetration is only one way of having sex — there are lots of fun things to do.
After I was catapulted into menopause, we were forced into these awkward but ultimately fruitful discussions ― and in many ways, they’ve brought us closer together. We’ve redefined what sex and intimacy look like to us — and that feels like a success.
Anna Sullivan Reiser is an author and mental health therapist. She writes for The Insider and is co-host of the upcoming podcast “Healing + Dealing,” which shines a spotlight on young survivorship issues. 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.