Vaginal Dryness in Menopause

Vaginal Dryness in Menopause, its causes, and the new ways we treat it

Vaginal dryness can be a problem for many postmenopausal women. About one-third of women experience it at menopausal onset, and that number only grows as women age.

Vaginal dryness is a hallmark sign of the genitourinary syndrome of menopause, also known as atrophic vaginitis or vaginal atrophy. With this condition, vaginal tissues become thinner and more easily irritated — resulting from the natural decline in your body’s estrogen levels during menopause.

Vaginal dryness might not impact your day-to-day activities, but it can lead to itching or stinging. Many women also report that it has negatively affected their sex life, leading to decreased sexual activity and causing frustrations for both partners.

Painful intercourse can then have a knock-on effect, contributing to a loss of sexual desire and causing sexual problems. The relief of symptoms often leads to increased sexual desire and arousal and better sexual health.

Pain during other times – in many cases, vaginal dryness does not only cause pain during sex. It can make it uncomfortable to sit, stand, exercise, urinate, or even work. Vaginal dryness can affect everyday life, whether women are sexually active or not. This can have a detrimental effect on the quality of life.

Some minimally-invasive effective treatments for vaginal dryness can help ease the symptoms and restore vaginal health.

Glands and their role in vaginal moisture

Natural lubrication produced by glands at the neck of the womb (the cervix) keeps the vagina supple and moist. The moisture moves slowly down through the vagina, keeping it clean and removing dead cells. The vaginal moisture is slightly acidic, and this helps to keep the area healthy, preventing infections such as thrush. It is perfectly normal for the majority of women to notice a slight white vaginal discharge.

During sexual excitement, the Bartholin’s glands (two glands at the entrance of the vagina) produce extra moisture to aid sexual intercourse. However, a quarter of women aged 50-59 experience vaginal dryness problems during sex, and 16% experience painful sex.

What are the Causes of Vaginal Dryness?

During a woman’s childbearing years, the hormone estrogen is involved in lubricating the walls of the vagina. Estrogen also assists in keeping the vaginal walls healthy and supple. However, women going through menopause decrease their production of estrogen, leading to less moisture production and thinner, dryer vaginal walls. Doctors refer to this condition as atrophic vaginitis. The deterioration of vaginal health can lead to pain during intercourse and bladder issues such as urinary tract infections, frequent urination, and urinary stress incontinence.

What are the Treatments for Vaginal Dryness During Menopause?

To remedy vaginal dryness and painful intercourse (dyspareunia) associated with the genitourinary syndrome of menopause, your women’s health doctor might recommend:

• Vaginal moisturizers (K-Y Liquibeads, Replens, and others) are applied every few days to moisturize and keep vaginal tissues healthy.
• Vaginal lubricants (Astroglide, K-Y jelly, Sliquid, others), applied at the time of sexual activity to alleviate pain during intercourse.
• A low-dose vaginal estrogen cream, tablet, or ring to reinvigorate vaginal tissues. Even if you’re using systemic hormone therapy pills or patches, your doctor might recommend a low-dose vaginal estrogen treatment if vaginal dryness and related symptoms persist. If you’ve had breast cancer, talk with your doctor about the risks of vaginal estrogen therapy.

Regular sexual activity or vaginal stimulation — with or without a partner — also helps maintain healthy vaginal tissues in postmenopausal women.

For years the simplest way to treat vaginal dryness is to replace the estrogen lost during menopause with topical estrogen therapies. When applied directly to the affected area, estrogen hormone therapy can assist with lubrication without putting as much of the hormone into your bloodstream as regular hormone replacement therapy.

Women who need relief from other significant menopausal symptoms, such as hot flashes and night sweats, may want to consider higher-dose hormone therapy that raises estrogen levels throughout the body. However, for women without those other menopause symptoms, vaginal estrogen should be used since it is concentrated where it is needed and minimizes blood levels and possible side effects of estrogen on the rest of the body.

Additionally, severe vaginal atrophy may respond more quickly to vaginal estrogen therapy than to hormone pills or patches that deliver estrogen throughout the body.

There are three main types of topical estrogen:

New Technology to the Rescue

A new treatment option called “Mona Lisa Touch” has recently come to the United States and is now available to our patients. This is quite revolutionary because it is almost 100% effective and requires no drugs.

The Mona Lisa Touch is a quick, painless laser treatment that delivers controlled energy to the vaginal tissue.  It stimulates collagen production and is safe for those who are unable to use hormones.  The full treatment requires three visits, 6 weeks apart, and takes less than 5 minutes per visit.  No anesthesia or pain medication is needed.

Are there any Non-medical Options for Vaginal Dryness?

If estrogen therapy isn’t right for you and you are not able to afford alternative treatments, then over-the-counter lubricants, such as Astroglide, could be of benefit with no side effects. These water-based lubricants are inexpensive, safe to use with condoms, and are widely available at drugstores.

Discussing vaginal dryness with a healthcare professional can be daunting; however, it is often well worth it as they will be able to help.

Gynecologists do not recommend douching as a treatment for vaginal dryness. Avoid using douches, bubble baths, scented soaps, and lotions around the sensitive vaginal area. These products can worsen dryness. Douches, as well as heavily fragranced lotions and soaps, can dehydrate your vaginal walls and compromise vaginal health.

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