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Vaginal Dryness

Desert

What is Vaginal Dryness

Woman worried about her vaginal dryness

Vaginal dryness, also called atrophic vaginitis, is experienced when the vaginal area lacks adequate moisture. Normally the walls of the vagina are lubricated with a thin layer of moisture. Sexual arousal increases blood flow which further stimulates the secretion of fluids, providing extra lubrication. Menopause can cause a disruption in the production of protective fluids in the vagina. This is caused by the depletion of hormones during perimenopause and menopause. Lower estrogen levels causes the walls of the vagina to become thinner; therefore, women are more prone to irritation and discomfort during both sexual intercourse and activities of daily living. Symptoms can range from mild and tolerable to significant and debilitating. 

Common Symptoms of Vaginal Dryness 
  1. General discomfort
  2. Burning or stinging sensation
  3. Irritation or itching
  4. Pressure 
  5. Light bleeding during or after intercourse 
  6. Painful intercourse
  7. Frequent or painful urination
  8. Discomfort when wearing pants

Vaginal dryness can be a difficult subject to talk about despite being a common menopausal symptom for many women. Vaginal dryness can have significant impacts on personal relationships, activities, quality of life and sexual function. Unlike other common symptoms of menopause, such as night sweats and hot flashes that can resolve over time, vaginal dryness often requires treatment to resolve. 

Causes of Vaginal Dryness

The most common cause of vaginal dryness in menopausal women stems from the decrease in estrogen levels. This decrease in estrogen can lead to atrophy. Atrophy is when the tissues in the vaginal area, including the vulva, become thinner and drier as secretions are diminished, which also decreases natural lubrication. 

It is also important to note that a decrease in estrogen can cause the pH level to change in the vagina. The environment of the vagina is typically more acidic which can help protect from things like bacteria. The decline in estrogen occurs with a correlating increase in pH which can lead to irritation and a higher chance of infection.

Other Causes of Vaginal Dryness
  1. Autoimmune diseases 
  2. Infections (bacterial, viral, or sexually transmitted)
  3. Certain medications (e.g., some allergy and cold medications, antidepressants)
  4. Some cancer treatments
  5. Smoking and alcohol 
  6. Douching
  7. Allergic reactions to chemicals in soaps, detergents, etc.

Emotional Factors: 

  1. Stress
  2. Anxiety and depression 
  3. Relationship problems

 

Approaches for Treating Vaginal Dryness 
  1. Lifestyle changes
  2. Medications 
  3. Alternative supplements 

 

1. Lifestyle Changes

When considering ways to help treat vaginal dryness, it is wise to start with the options that have the lowest risk of side effects. Lifestyle adjustments are a great first-line option for women as they can be safer and more cost-effective than other treatments. 

Implementing a healthier diet, managing stress, and communicating with your partner can be key steps in resolving vaginal dryness. 

Things to avoid to help improve symptoms of vaginal dryness include: 

  1. Douches 
  2. Bubble baths
  3. Scented soaps and lotions around the sensitive vaginal area
  4. Antihistamine medications
  5. Caffeine and alcohol

2. Medications for Treating Vaginal Dryness

Treatments for vaginal dryness, dyspareunia (painful intercourse), and vaginal atrophy (thinning, drying, and inflammation of the vagina due to the loss of estrogen) include topical vaginal estrogen, hormone therapy, vaginal suppositories, personal lubricants, and moisturizers. [3]

Vaginal Hormone Treatments

Pills in a bottle with a flower in the background

Hormone creams are applied to the vagina and include a medication that requires a prescription. These medications are aimed at restoring the thickness of the vaginal walls, increasing blood flow to the vagina, and helping the vagina to become more flexible and “stretchy”. Ideally, pain and discomfort may be reduced, especially during intercourse. 

Hormone treatments generally come in the form of compounded or commercially available creams, tablets, or rings that are inserted into the vagina. Studies have indicated that estrogen creams and rings can work well in relieving vaginal dryness [1, 2]. Vaginal delivery of hormones often does not improve other estrogen-related menopause symptoms such as hot flashes and night sweats because they work in a localized area. 

Examples of Medications for Vaginal Dryness 
Tablet or Capsule Ring Cream
Vagifem, Yuvafem, or Imvexxy

Osphena 

Estring, Femring Premarin, Estrace 

 

The pharmacists at Coast to Coast Compounding can discuss various options and pricing for vaginal treatments, including a variety of bases which are specially formulated to be preservative, irritant, and paraben-free.

There are other options that can reduce discomfort and improve the quality of life for women who don’t want to use medications to relieve vaginal atrophy and dryness.

3. Alternative Options

Vaginal Moisturizers vs Lubricants

Vaginal moisturizers and lubricants are commonly recommended as a first-line option for women with mild vaginal dryness symptoms.

Picture of lubricant

While both vaginal moisturizers and lubricants are non-hormonal options used to help replenish moisture in the vagina, they have their differences. Knowing how and when to use each one appropriately will help greatly in deciding which one will be right for you. 

Vaginal moisturizers can be used regularly to help relieve continuous discomfort from dry, sore, and uncomfortable vaginal dryness, particularly around the vulva. The moisturizing effect can support healthy vaginal tissue and mimic the effects of natural vaginal secretions (which are often greatly reduced during menopause). Moisturizers should be applied at least 2 hours prior to intercourse and are a great option for women who want to have the ability to be spontaneous when it comes to intercourse. 

Examples of Moisturizers 
  1. Replens
  2. Vagisil Moisturizer
  3. Feminease
  4. Moist Again
  5. K-Y Liquibeads

If sexual intercourse becomes uncomfortable or painful during menopause and is the main issue, vaginal moisturizers alone may not be sufficient to ease it. Many women find that they also need to use lubricants for comfort. This is largely due to having less estrogen, which acts as a natural lubricant in the vagina. [4] Vaginal lubricants can be used immediately prior to intercourse and reapplied as needed to help increase the amount of moisture and comfort. Unlike moisturizers that can have lasting effects, lubricants are used for moisture needed only for a shorter duration. Lubricants may be water-based, silicone-based, or oil-based.

A happy man and woman sitting in bed

Examples of Lubricants 
Water-based  Silicone-based  Oil-based
Astroglide

K-Y Jelly

Pjur

ID Millennium

 

Elegance Women’s Lubricant

 

It’s important to choose the right lubricant or moisturizer that fits your needs. Not all lubricants and moisturizers are appropriate for all situations. For instance, oil-based lubricants are not a good option when using condoms or toys in the bedroom. Knowing why you are using them and what results you expect are the most important part of choosing a product that fits your lifestyle. 

Supplements

Supplements and alternative treatments are options for those who want to avoid hormone therapy and still target the root cause of their vaginal dryness. Alternative treatments and supplements can be used to rebalance the hormone changes that contribute to vaginal dryness. Supplements may provide a more simple and convenient method to gaining relief from vaginal dryness. It is important to note that supplements and alternative treatments are not risk-free and you should consult your doctor or pharmacist before starting a new supplement. 

Common Treatment Options

Hormonal Non-hormonal (lubes & moisturizers)
Address the root of the cause for vaginal dryness, hormone imbalance Can provide extra moisture to aid in relief from vaginal dryness without the use of hormones
SupplementsCompounded Medications
May or may not be associated with addressing the underlying cause of vaginal dryness by increasing moisture or introducing plant-based estrogensPersonalized medications to meet the needs of individual patients (e.g. preservative- or paraben-free)

Which Is Right for You?

Woman thinking

Each of these approaches in relief of vaginal dryness is not exclusive. It is important to take many things into consideration when deciding what is right for you. Some women may find that a combination of options, such as a healthier lifestyle along with alternative therapy is the best and most effective option in dealing with vaginal dryness. 

References

  1.  https://www.ncbi.nlm.nih.gov/pubmed/9031963
  2. https://www.ncbi.nlm.nih.gov/pubmed/10430010
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819835/#CIT0020
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819835/
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