How to Treat Vaginal Dryness, Painful Sex, & Keep Things Running Down There During Menopause
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Turns out, hot flashes and night sweats are not the only uncomfortable symptoms that many midlife women experience.
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Vaginal dryness, a name that says it all, may be the least discussed menopausal symptom. While it can occur during perimenopause, the years-long lead up to menopause, it’s most common in postmenopausal women, says urologist, pelvic surgeon, and Flow Advisor Kelly Casperson, MD, host of the podcast ‘You Are Not Broken.’ “It can happen years after menopause,” she adds, explaining, “I think that’s why a lot of people don’t relate it to menopause. Sometimes it’s delayed.”
Menopausal symptoms such as hot flashes or insomnia, are caused, generally, by hormone changes that occur around the time a woman reaches menopause, the official end of fertility. As a woman enter perimenopause, estrogen levels fluctuate, until, eventually, the ovaries stop producing the hormone.
While there are other potential contributing factors – such as medication, having diabetes, cancer treatment, or using scented soaps or other products around the vagina – most of the moderate to severe symptoms are age-related. As levels of the hormone decrease, vaginal lubrication may diminish. And then, as natural lubrication lessens, the tissue thins, becomes more delicate and vulnerable to infection, such as urinary tract infections (UTIs) and problems like overactive bladder (OAB).
Why is vaginal lubrication important?
Lubrication isn’t essential only for sex; layers of moisture in and around the vagina and vulva protect the genitals, reduce friction, and generally help things run smoothly. What’s more, the natural fluids help facilitate more mundane daily tasks such as walking, sitting, putting on pants, and peeing comfortably.
Estrogen is the hormone that triggers, one way or another, a cascade of complex functions and secretions that ultimately help the vagina maintain moisture, elasticity, and thickness.
Yet once estrogen levels start to dip, things don’t necessarily operate as smoothly and seamlessly as before. There’s more friction, resistance, and inflammation; less moisture, flexibility, and elasticity.
Whether or not you are having sex, vaginal dryness is a progressive problem that will worsen without treatment, says Stephanie Faubion, MD, MBA, director of Mayo Clinic Women’s Health and medical director of the Menopause Society.
Signs and Symptoms of Vaginal Dryness
When vaginal dryness occurs, some women experience pain sitting, peeing or putting on pants, according to the American College of Gynecologists (ACOG). Some of the signs and symptoms of vaginal dryness include:
Vaginal or vulva irritation
Burning sensation when urinating
Discomfort or pain during sex
Light bleeding or soreness after sex
Feeling of tightness
Uncomfortable awareness of the vagina and vulva
Vulvar itching
Urinary frequency, urgency, and urge incontinence
How to Treat Vaginal Dryness
There are a range of options when it comes to treating vaginal dryness. Here are some of the most common one:
Vaginal Moisturizers and Lubricants
Applied into the vagina about 3 times a week, vaginal moisturizers typically include a hyaluronic acid that helps the vaginal tissue retain moisture. Dr. Faubion likes to say that vaginal moisturizers are like “face cream for the vagina.” Brands such as Replens and Revaree are applied into the vagina, with an applicator or as a vaginal suppository.
Lubricants, on the other hand, are reserved for use right before sexual activity. If you have mild symptoms, these over-the-counter products, such as K-Y jelly or Astroglide, may help you manage discomfort.
Natural products such as coconut oil work too, but may cause a reaction, warns Jennifer Lang, MD Flow Advisory Council member, an OBGYN and CEO of Buzz Labs, who advises women to do a skin patch test before inserting anything into the vagina. Additionally, she notes, there are preservative-free forms of both products. (When using a condom, remember that oil-based lubes can damage condoms and lead to breakage.)
Estrogen Therapies
The FDA has approved estrogen therapy for the treatment of vaginal dryness. “Unlike non-prescription moisturizers and lubricants that can help you manage symptoms and feel more comfortable, estrogen therapies address the cause of dryness,” says Dr. Casperson. Essentially, estrogen therapy can reverse the loss of lubrication.
While some women may worry about taking hormones in general, Dr Lang stresses that low-dose vaginal estrogens are extremely safe. “In my opinion as a gynecologist, and also as a fellowship trained gynecologic oncologist, I feel very, very comfortable using low dose vaginal estrogen in people even with personal histories of hormone driven cancers,” she says.
It’s also worth noting, adds Dr. Casperson, that topical estrogen is local and doesn’t enter the bloodstream.
Non-hormonal Medications
There are also other types of medications that can help vaginal dryness. These include:
Dehydroepiandrosterone (DHEA) or Prasterone turns into estrogen and testosterone in the vagina. It comes in the form of a suppository that is inserted into the vagina once a day.
Ospemifene Another prescription option, Osphena, is a selective estrogen reuptake modulator (SERM). It is not an estrogen, but it acts similarly to estrogen in vaginal tissue. This drug is used to treat women with moderate to severe dyspareunia (painful intercourse) and moderate to severe vaginal dryness. It is not a vaginal medication but a pill that is taken orally.
Benefits of Treating Vaginal Dryness
With treatment, “there’s a huge benefit in terms of daily comfort level,” says Lang, describing the immediate effect moisturizers and estrogen can have. What’s more, she says, treatment reduces the risk of urinary tract infection, a problem that is much more common, and worrisome, with age. “UTIs can lead to severe health problems in older women,” she notes. Finally, pain or discomfort with sexual activity will be immediately reduced with use.
With so many ways to treat these symptoms, why is vaginal dryness underreported and undertreated? “I think women are afraid that their doctors won’t know what to do, or that there is nothing to help them,” Faubian says. Or, she says, they may not know who exactly to go to.
Most health care providers, including primary care physicians, midwives, and gynecologists, should be able to recognise and treat vaginal dryness, according to Dr. Casperson.
Partner with a Doctor You Trust
One of the best ways to prepare for long-lasting health is to make sure you have the right doctors in place. At midlife, some women shift from an ob/gyn to a gynecologist, ideally one who is a menopause specialist or experience treating patients in menopause.
“If your doctor tells you nothing can be done for vaginal dryness, you need a new provider,” says Dr. Faubion. While you shouldn’t need to seek out a specialist to get treated for vaginal dryness, if you need to find a new provider about an urgent women’s health issue, the Menopause Society maintains a database of certified menopause practitioners who are accepting new patients. Other options include word of mouth, local listservs or ACOG’s doctor finder. Services such as ZocDoc can be helpful, too, as you can search by location, symptom, and health insurance accepted.
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