The neck of the bladder and the vagina develop from the same lump of tissue in the embryo. One group of cells divides into two to produce these two structures. It is not surprising, therefore, that when the vaginal tissues change and become less acid, the neck of the bladder does too. The tissues become thinner, less flexible, and more easily irritated, and infection becomes more common at this stage. Frequency of urination may become a symptom, and, in some cases, this is more marked after intercourse. Women may also develop what is known as an irritable bladder.
Oestrogens As with oestrogenisation of the vaginal tissues, infections are avoided, so too are urinary symptoms with this treatment. The tissues become stronger and healthier at the bladder outlet. Many patients describe an improvement in this problem with oestrogen treatment and sleep through the night when previously they had been frequently woken to empty their bladder. I treated one woman who, because of X-ray treatment for another complaint, had had her ovaries destroyed. Bladder problems had not been a presenting symptom. Her presenting symptoms had been of hot flushes, depression and loss of libido. We gave her implants of an oestrogen plus testosterone mixture and these fully relieved her symptoms. After several implants she reported to us that one of the ways she recognised her implant was running out was that she was woken three to four times a night to empty her bladder. One of the greatest boons she felt from the treatment she was receiving was that she had an uninterrupted nights sleep.