Word from the expert: Dr. Fiammetta Trallo – Intimate sexual disorders

Sooner or later comes the menopause… and intimate sexual disorders

Menopause is a natural event and sooner or later we all have to face it.
The cause is a decrease in the production of oestrogen hormones by the ovaries. In some women it is more pronounced, in others less, which is why we do not all have the same symptoms or have them to a greater or lesser extent.
What is certain is that we feel a change in our whole body. The most conspicuous phenomenon is the cessation of menstruation, but from the genital apparatus to the blood vessels, from the brain to the bladder, to the muscles, bones and skin, our physique is affected by this mutation.
If menopause-related osteoporosis is much talked about and prevention becomes a fundamental weapon, to alleviate the annoying hot flashes, especially at night, there are many effective products, including natural ones, little is said about changes that emerge in a more subtle way and that tend not only to persist but also to worsen: sexual intimacy disorders.

Foto Intervista Dottoressa Fiametta Trallo_2

We talk about it with Dr. Fiammetta Trallo, specialist in gynaecology and obstetrics


How do women deal with intimate disorders?

Intimate and sexual disorders are widespread among women, especially in pre- and post-menopause, but also in post-partum and after cancer therapies. Very few women, however, recognise the symptoms and consult a specialist to find a solution. Very often they do not even talk about it with friends or sisters because they confide very little about these intimate topics. And this is not good. They often find it difficult to talk about it even with their gynaecologist.

In my personal experience I also prefer to investigate with direct questions before even starting the examination on the gynaecological couch. In this way, I try to put my patients at ease by being available to listen not only to gynaecological problems but also to those related to the sexual sphere. When the hormone deficiency of the menopause alters sexual function, the discomfort is primarily psychological with repercussions on the quality of the couple’s relational life.

What are vulvo-vaginal disorders due to hormone deficiency?

Formerly referred to as vulvo-vaginal atrophy, today it is more correctly called uro-genital syndrome, because the bladder and vagina are in close contact and their wellbeing is mediated by oestrogen hormones, which are lacking or significantly reduced during menopause.

Hormone deficiency reduces the production of collagen throughout the body, a valuable substance that controls the elasticity of the body’s tissues. The effects “can be seen on the face and felt in the most intimate parts”. The vulvo-vaginal mucosa thins and both lubrication and elasticity are reduced. And from there, symptoms such as burning, itching and dryness can become a more or less constant intimate discomfort that generates pain during intercourse. Impaired sexual function can make any form of pleasure beyond desire difficult. Reaching orgasm becomes a feat. And the drop in libido due to hormonal deficiency is made worse. Let us remember that it is not enough to do what the mind wants, we must also see what the body can do! If the pleasure organ is not able to function properly, desire alone is not enough.

The risk is to enter a “vicious circle”: the woman avoids intercourse because of the emotional and physical discomfort she feels and this leads to a diminishing desire for sexual intimacy.

The bladder is also affected. Hormonal decline alters the dynamics of bladder filling and emptying and generates urinary discomfort: incontinence, increased frequency, urgency and a sense of incomplete emptying. Another disorder is post-coital cystitis. It appears 24-48 hours after sexual intercourse due to trauma to the thinned urogenital tissues and may be associated with vulvo-vaginitis.

What solutions do women have at their disposal to combat intimate and sexual disorders?

It is important to have a correct diet and hygiene style, one can use long-term natural therapies and short pharmacological therapies in the acute phase, but above all, I have obtained excellent results with the latest generation of laser therapy for vaginal photorejuvenation with long-lasting benefits. I have been using DEKA’s MonaLisa Touch™ CO2 laser treatment for many years, to the great satisfaction of my patients. And mine too, both as a gynaecologist who helps women solve a not insignificant problem and because I too have undergone this therapy and obtained considerable benefits.

MonaLisa Touch™ restores vaginal lubrication and elasticity and improves the function of the bladder and pelvic floor, restores the vaginal mucosa conditions typical of the fertile age and the aesthetics of the intimate parts with long-lasting effects. It is a highly effective, painless, non-invasive and non-injection therapy, does not stimulate hormone production even locally, and is free of side effects. An excellent alternative to minor surgery, which is not always risk-free, and hormone therapies, especially for women who do not want to or cannot take them.

How does MonaLisa Touch™ work?

Using a special vaginal probe, laser beams are emitted inside the vagina. The transmitted energy increases blood circulation, brings more nourishment and stimulates the production of collagen and elastic fibres through the reactivation of fibrocytes into fibroblasts, the cells responsible for the proper functioning of tissue elasticity including vulvo-vaginal and urinary tissues.
It is not, therefore, a mere assembly of residual elastic fibres, but a true ex-novo production of collagen and cellular matrix.

The mucous membrane is thus regenerated and consequently rejuvenated, becoming hydrated, lubricated and elastic again, with a significant improvement in sexual response and urinary symptoms.

As confirmed by histological studies, one month after the first session the vaginal mucosa already shows clear signs of rejuvenation as well as significant thickening of the mucosa.

This concludes our interview with Dr. Fiammetta Trallo. We will soon publish the second part.

Vulvodynia, Francesca’s story

DEKA Intimate - IntimateStory Francesca
“After sexual intercourse I felt such pain that I could not walk. Francesca’s vulvodynia: “I changed 8 gynaecologists in one year”

 

There are many stories of girls suffering from “invisible diseases” affecting the pelvic floor that are still little known even in the medical field. Francesca decided to tell her story: “My head is always ready to feel pain. Immediately after every intercourse I would get cystitis”

“I started to have cystitis after sexual intercourse. But then the discomfort lasted for the following weeks. My head is always ready to feel pain”. Francesca was diagnosed with vulvodynia and pelvic floor contracture. She is a 32-year-old Roman girl who, when she started to notice the first symptoms, tried to talk to her family and doctor but: “It took a long time before someone started to understand me, I felt extremely lonely”.


“I started to have the first pains in 2020”, says Stefania. Immediately after every intercourse I would get cystitis, which was always treated with antibiotics. But then the bacterial infections, such as candida, also started. During intercourse I feel burning and like pins inside my vagina”.
A pain that seems to be “unbearable” at times. “There are periods when I cannot have sex, others when the discomfort is “bearable”. And when I succeed I feel “powerful”. But most of the time I don’t enjoy the moment, my head is always ready to feel pain, which remains so strong in the following weeks that I struggle even to walk”.

 

With this type of disease, contact with certain types of tissue is also difficult: “I cannot wear jeans, but neither any other loose trousers. I have to wear trousers with a low crotch and sweatpants”.
It was difficult to reach a diagnosis quickly. “I was desperate”, she continues. I changed about 8 gynaecologists in the area in one year. No one understood what I had: all they talked about was mucous membrane changes that needed to be revitalised. Or they would tell me that I had nothing, that maybe I had just had a love disappointment and that it was therefore a psychological problem”.

 

It is only after a year that Francesca finally finds an answer from a specialised gynaecologist. “Thus began my course of physiotherapy and rehabilitation for the pelvic floor with Dr. Arnold, a treatment based on special electromagnetic stimulation (TOP FMS) that consists of sitting in a very comfortable chair!”
So far I have done five sessions, I still have to do at least a couple more, but I feel that my pelvic floor muscles are much more relaxed.
The treatment is pleasant and it was a discovery to feel the pelvic floor muscles, they are muscles I didn’t even think I had and yet they are essential!
The feeling is really one of liberation and I am also starting to let go even during sexual intercourse.”

Word from the expert: Dr. Antonella Curcio – Vulvodynia

DEKA Intimate Word from the expert - Dr. Antonella Curcio
Let’s not resign ourselves to chronic pelvic pain

“The diagnosis of chronic pelvic pain is an admission of diagnostic and therapeutic failure”: this is a harsh statement by Dr. Antonella Curcio, a gynaecologist who has been dealing with women’s intimate health for over 40 years, with a focus on listening to the painful situations that patients very often report to her.
Vulvodynia is a chronic pain syndrome that affects 12-15% of women in the world population. In Italy, a woman consults at least 7 doctors to get a correct diagnosis and about 30% fail to get it. A pathology that heavily affects women’s quality of life, social and couple relationships and that often remains hidden behind many taboos.

 

We talk about this with Dr. Antonella Curcio, gynaecologist and expert in gynaecological endocrinology, menopause and urinary incontinence in Florence

What do you mean by “diagnostic and therapeutic failure”?

By the time a woman comes to develop chronic pelvic pain, she has already had one or more ongoing pathologies for years. Pain is a symptom that is too often disregarded in a simplistic and frequent way in relation to the female patient who “has pain in her head”.
Chronic pain activates a kind of perverse loop, which, like a cyclone, is self-feeding, increasingly affecting a woman’s sexuality and, in particular, her sexual identity, sexual function and relationship.
If we do not understand this and do not intervene in time, the fire – because inflammation is a biochemical fire – changes its face and spreads. The tissue damage caused by the inflammation extends to the nerve fibres to the point of creating a kind of short circuit in the pathways of the transfer of the electrical impulses of pain. And so the pain appears to be of far greater intensity than one would expect.

What can we do not to get to this point?

First of all, the woman must not resign herself to the pain and ask (and demand) help from specialists.
We physicians must pay the utmost attention in the framing of the pathology and its management to achieve results in line with expectations. Listening to patients is fundamental, making them feel at ease even when talking about sensitive topics, without imposing a sometimes mortifying anamnesis. This is a very important point in dealing with the pathology of pain, which in many cases is related to pelvic floor hypertonus caused by the body’s defensive contraction in the event of pain.
Today we have therapeutic opportunities offered by technology, scientifically tested, which help us to improve the quality of life of patients.

A lot is said about vulvodynia, even creating some confusion. It is a very complex pathology, involving physical, pathological and psychological aspects. What resources are available to combat vulvodynia related to pelvic floor hypertonus?

I use the Dr Arnold device, a therapeutic chair that, thanks to its specific protocol for decontracting the muscles, is effective in improving vulvodynia related to pelvic floor hypertonus. In a nutshell, using this protocol results in a kind of technological physiotherapy: Dr Arnold emits electromagnetic waves that selectively stimulate muscle bundles, inducing very intense contractions and producing a relaxation of muscle tone until the tissue is rebalanced. The patient during the treatment, thanks to the induced contractions, also learns about mostly unknown muscles. This is why we talk about re-educational treatment and rehabilitation.
The results are excellent, also because the patient, dressed and comfortably seated, is very relaxed, feels no pain or discomfort and this contributes to the machine’s decontracting action.

Word from the expert: Dr. Maurizio Filippini – Urinary incontinence

DEKA Intimate Word from the expert - Dr. Maurizio Filippini
Let’s dispel a cliché: urinary incontinence is not a natural occurrence that we have to resign ourselves to

We’re at the gym, jogging or a bike workout, loading groceries into the car, picking up a child, a cough, a little more laughter and there’s that drop of urine we can’t hold back.
We are active, dynamic women who do not want to give up our daily activities, social and sexual life.
So we pretend nothing happened, we wear a panty liner, then a menstrual pad, our frustration increases, we resign ourselves.
Today, urinary incontinence is a significant health problem worldwide, with a social and economic impact on women and society and severely affecting quality of life: daily activities, emotional state, social relationships, sexual activity.
In Italy there are about five million people suffering from incontinence, more than half of whom are women, with an average of 1 in 3 over the age of 40.
In fact, it seems that urinary incontinence peaks between the ages of 45 and 59; it is therefore not just a disease of old age. And, fortunately, there are remedies to counteract it.

 

 

Incontinenza urinaria rimedi

 

We talk about it with Dr. Maurizio Filippini, gynaecologist, Head of the Functional Module of Gynaecological Endoscopy at the ISS of the Republic of San Marino

Why is it that, despite being a problem that affects a large number of women, little is said about urinary incontinence?

Until recently, women had no perception of the problem. Most regarded urinary incontinence as a para-physiological situation, it was experienced almost as a condition of old age or as a post-natal symptom.
It can often happen after childbirth, but mostly resolves itself after a while. The vast majority of women, on the other hand, begin to leak urine between 40 and 50, still young, with an intense social life and sexually active.
And it is clear how embarrassing and debilitating it is for them and how much it can also affect them psychologically.
From my experience, I have noticed that they struggle to expose the problem spontaneously, almost as if there were some kind of taboo.
However, when asked directly, they always answer truthfully and report the problem and show a desire to solve this disabling symptom that leads to a very difficult relationship life.

What are the traditional treatment options for improving urinary incontinence?

To date, traditional techniques for improving urinary incontinence mainly involved physiotherapy-type devices. Kegel exercises, the kinesiotherapy invented by Dr. Kegel, allow the physiatrist or physiotherapist to perform contraction and relaxation movements in order to train the pelvic floor muscles to strengthen all the muscles under the urethral plate and thus encourage less urine leakage.
In addition to these traditional physical exercises, there are also other methods, such as the use of vaginal cones. A cone is inserted into the vagina and, naturally, the muscles of the vagina are trained to hold the weight and this training strengthens the muscles of the perineum.
Another type of traditional technique is the so-called external electrostimulation. Electrodes are applied at the level of the perineum that help an electrical contraction, hence a motor neuron response, and here again it is a question of training the muscles to be able to retain urine.
Today we have available the new magnetic field device Dr. Arnold from DEKA DEKA

What is Dr. Arnold and what is its principle of action?

Dr. Arnold is a non-invasive medical device that uses magnetic energy to create fields that impact the entire perineal tissue.
It creates an electromagnetic field that allows the muscle to contract, but with a much more effective contraction than is done manually by a physiotherapist or electrostimulation, because it can reach a high intensity that is usually difficult to achieve with voluntary contraction.
And this is how it is able to intervene on mild prolapses and urinary incontinence.
The treatment is non-invasive, has no side effects, the patient will only feel muscle fatigue, as after high physical activity, and is absolutely comfortable. It involves the patient remaining dressed and sitting in the chair.

…continues with the next appointment.

 

The treatment that resolves the most common symptoms

Women's intimate health DEKA Intimate

Vaginal atrophy is a very common condition, especially among menopausal or postpartum women, but it can also occur early on. The most common symptoms are vaginal dryness, laxity, burning, pain during sexual intercourse and mild urinary incontinence. To all this, however, there are remedies. Let’s discover the MonaLisa Touch™ treatment together.

 

What is MonaLisa Touch™ treatment?

MonaLisa Touch™ is an intra-vaginal treatment that improves the condition of the mucosa lining the walls of the vagina through minimally invasive laser-assisted procedures. MonaLisa Touch™ is not an aesthetic treatment, because the action of the laser restores the functionality of vaginal tissues that have been lost over time.

For which women is MonaLisa Touch™ laser treatment most suitable?

For any woman who wants to prevent or treat the effects of an oestrogen drop at the intimate level (during the menopause, or after childbirth, after cancer treatment or following eating disorders such as anorexia). The most common symptoms are vaginal dryness, laxity, burning, pain during sexual intercourse and mild urinary incontinence. MonaLisa Touch™ is the ideal treatment for those seeking an effective but less invasive procedure than traditional surgical or pharmacological techniques.

 

Salute intimate femminile DEKA Intimate

What kind of results can I expect?

Treated patients report a decrease in dryness, burning and itching immediately after the first treatment. Improved sensitivity during sexual intercourse is therefore a natural consequence. There is also a reduction in symptoms related to urinary incontinence (mild, stress incontinence).

Is it painful?

No, the treatment does not require any anaesthesia. The sensation felt is just a small vibration.

How many treatments are needed?

Treatment usually involves three applications about a month apart, but sometimes, depending on the pathology and clinical situation, a fourth treatment may be necessary.

After how long is it possible to resume sexual activity?

Three to four days of rest is usually recommended before resuming regular sexual activity. However, your doctor will be able to give you more specific instructions based on the outcome of the treatment.

Can MonaLisa Touch™ also treat a dilated vagina?

The generic term “wide vagina” (or dilated vagina) usually refers to a condition where the size of the diameter of the vaginal canal has increased. Often this is caused by natural but traumatic events such as childbirth or the relaxation of tissues due to the natural ageing process. In these cases, it is very important to assess the cause and the actual condition of the vaginal canal in order to rule out problems such as vaginal prolapse or muscular involvement. With the fractional CO2 laser, it is possible to treat those cases where the “wide-vagina” is due to a loss of mucosal tone.

Are there any risks?

No, MonaLisa Touch™ is a safe treatment that is performed on an outpatient or day hospital basis. Most women who have tried it report only transient side effects such as slight redness or swelling that usually resolve with a day or two of rest.

How does recovery take place?

Most women report slight local sensitivity following laser treatment and in the days immediately following the session. Many report returning to their normal routine one to three days later. During the healing process, you may be advised to refrain from lifting weights or to avoid particular activities such as hot baths and exercise: your doctor will give you more specific advice on what to do to speed up recovery.

How long do the effects of the treatment last?

The results are immediate, already after the first treatment, and are bound to improve over the following months. The regeneration process that is triggered lasts 40-60 days after which it is advisable to repeat the treatment.

Are there any contraindications?

There are no absolute exclusion criteria for the MonaLisa Touch™ other than those related to severe local and systemic pathologies. In principle, all women who suffer from intimate discomfort such as dryness, burning, itching or laxity can benefit from it, but your doctor will determine your compatibility with this treatment.