A friend of mine, at the age of 55, was in a new relationship that was heading towards sexual intimacy. Concerned because she had not had sex in three years, and knowing from experience that it could be a painful encounter because of vaginal dryness, she asked me—a sexually active woman in a twenty-seven-year marriage—what I used to combat that discomfort.
I had a great recommendation, based upon my own experience. The first time I had painful intercourse with my husband, I was astonished. Vaginal dryness came on seemingly overnight, and our lovemaking had to be halted. The next morning, I called my gynecologist’s office and asked to be worked in that day. You see, I love having regular sex with my husband, and I was certain there was a medical remedy to keep that viable, and there was.
My doctor prescribed Vagifem 10 mcg, and after using that small vaginal suppository only a few times, I was back to normal, and so was our sex life.
Vagifem is an estrogen replacement suppository consisting of estradiol. It treats the underlying cause of menopause-related vaginal changes by helping to replenish the vagina’s lost estrogen. It’s used primarily after menopause to treat changes in and around the vagina, including atrophic vaginitis (dryness and soreness in the vagina) and dyspareunia (pain during sexual intercourse.) It is also beneficial in preventing UTIs. The cells lining the vagina are basically the same cells that line the urethra and the bladder. When the vagina is dry, the bladder is dry, and UTIs occur with greater frequency.
There are other such treatments for these afflictions, including patches, ointment, and vaginal rings; but the Vagifem suppository has been very effective for me, so I happily recommended this simple treatment to my friend. She saw her doctor, got a prescription, and began using it. When sexual intimacy occurred the following week, she experienced no discomfort with her new beau. Wonderful, right? I mean, here’s a medical solution for a painful condition, a remedy that can be prescribed by your doctor, and it is covered by insurance.
Until it isn’t.
That same friend called me a few days ago to tell me that her insurance company would no longer cover the cost of Vagifem. She said her out-of-pocket cost for a 90-day supply (24 tablets) would now be $425. My insurance company still covers it under my grandfathered plan, but I have a high deductible, so my out-of-pocket cost for a 90-day supply is $546. But because it is a covered medication, it at least goes towards my deductible. Not so for my friend. The total cost is now hers to bear. Thankfully, my friend and I can afford Vagifem, but many women cannot.
The Affordable Care Act did a great thing in mandating that plans in the Health Insurance Marketplace cover contraceptive methods and counseling for all women, as prescribed by a health care provider. Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider, even if a woman has not met her deductible. If her employer is granted an exemption to pay for a plan that covers the cost of birth control based on religious reasons (Hobby Lobby) the insurer will provide birth control coverage to the company’s female employees at no additional cost to the company. Birth control addresses both pregnancy prevention and women’s health issues, such as regulating periods, stopping menstrual migraines, easing endometriosis, helping with polycystic ovarian syndrome, and reducing the risk of endometrial cancer. Vaginal estrogen replacement medication address multiple symptoms related to women’s health, so why shouldn’t it be covered as well?
In doing some research, I ran across plenty of forums with discussions that date back years, with post-menopausal women complaining that their health insurance would not cover treatment for their symptoms, because they consider “hormone-level decline a normal part of aging.”
Medicare Part D covers much of the cost for Vagifem, but atrophic vaginitis and dyspareunia occur in women much younger than 65. So why would some private insurance companies not cover a medication that is essential in alleviating a post-menopausal woman’s painful dryness symptoms? Are vaginal dryness, UTIs, atrophy and the related pain not legitimate medical conditions?
Or is it just that the vaginas of women who can no longer reproduce are considered—well, not worthy of consideration? Are we just supposed to dry up and blow away?
Aging takes enough of a toll on women mentally and physically, and our desire to stave off this particular painful biological effect of aging should not take a large financial toll as well. Aging gracefully simply cannot occur if a woman who wants to have sex cannot do so without pain. Which makes me wonder: How did insurance companies arrive at the conclusion that women should personally bear the cost of treating the medical conditions known as atrophic vaginitis and dyspareunia? Which executives decided that women not of child-bearing age should pay such a high price to maintain a healthy vagina, one that is still primed for pleasurable intercourse? This isn’t plastic surgery, an optional choice for looking younger. This is a medical issue of alleviating pain and maintaining the health of the most vital area of our feminine realm. It should not be optional based upon affordability.
If we remain healthy, we can enjoy sex long into our “old age,” given the availability of erectile-dysfunction pills and vaginal atrophy treatment. If women want to enjoy sex after menopause, but before age 65, they may have to pay dearly for it. Our sexuality is being devalued by tight-fisted insurance companies. The ACA gives us the right to appeal such insurance company decisions through an internal appeal or an external review. If every woman who is denied coverage for FDA-approved atrophic vaginitis remedies appealed, we might be able to reclaim our right to painless sex for decades before we are eligible for Medicare.