The battle to keep skin from succumbing to the impact of time is generally fought through the regular slathering of moisturizer on your face, neck, and legs—but there are reasons to also focus on your vagina. Here’s why: As estrogen declines, the vaginal cells shrink and become dehydrated, contributing to post-menopause, paper-thin, dry tissue.
However, simply putting water in the vagina won’t do the trick any more than washing your face will prevent wrinkles. The challenge of a true vaginal moisturizer is to get the cells that line the vaginal walls to suck the water in.
What’s the difference between vaginal moisturizers and lubricants?
Let’s start with the fact that vaginal moisturizers and lubricants are not the same thing. Lubricants do not alter vaginal tissues; they just provide a slippery barrier to reduce friction at the time of intercourse. A moisturizer, on the other hand, is intended to change the water content of the cells (hence “moisturizer”), resulting in tissues that are more elastic, thicker, and have the enhanced ability to produce fluid. A true long-acting moisturizer is used in anticipation of intercourse, not at the time of intercourse.
Here’s where it gets confusing. Just because a product is labeled as a moisturizer, don’t assume that it is going to hydrate vaginal tissues. The majority of products that are labeled as “personal” or “feminine” moisturizers are not even intended to be put inside the vagina. These products have no long-acting effect on vaginal walls or vaginal lubrication. They are actually intended to lubricate or soften vulvar tissue outside the vagina, but you would never know that from the way the products are labeled.
Just as a face cream can promise to make you look ten years younger with regular use, a “feminine” moisturizer can claim to make intercourse more comfortable. Unlike with prescription medications, the companies that market these products are under no obligation to the Food and Drug Administration (FDA) to conduct scientific studies to prove that a product does what it claims to do.
In addition, if a lubricant is labeled “for vaginal use,” the FDA requires specific safety trials, including testing the product in animal vaginas to ensure that there are no harmful effects—which adds an enormous expense to product development. It’s cheaper and easier for manufacturers to just avoid the word “vagina” altogether on their labeling.
In addition, many lubricants that are intended to go inside the vagina are labeled as “moisturizers” because manufacturers think that makes the products sound more appealing. Purchasing a “feminine moisturizer” may be far more comfortable for women who are also buying a hand or face moisturizer than it would be for them to go shopping for a “lube” that’s clearly intended for sexual purposes. The manufacturers are operating under the assumption that “nice, church-going, married women buy moisturizers. Hussies buy lubes.” It’s misleading and confusing—and as a tactic, it works.
The only true vaginal moisturizers are products that are meant to be inserted inside the vagina to increase the water content of cells so that the vaginal walls produce more natural lubrication. Any product labeled “for external use only” is not a vaginal moisturizer.
Two kinds of over-the-counter options have been shown in scientific clinical studies to actually change vaginal tissue, increase intracellular water, and decrease painful intercourse: Replens Long-Lasting Vaginal Moisturizer and products that contain hyaluronic acid, such as Hyalo Gyn Vaginal Hydrating Gel and Revaree Vaginal Moisturizer.
How do long-acting vaginal moisturizers work?
Replens Long-Lasting Vaginal Moisturizer contains polycarbophil, a bio-adhesive gel that adheres to the vaginal wall and promotes intracellular water absorption. Polycarbophil is also a weak acid that buffers vaginal tissues to lower the vaginal pH to between 3 and 4.5, allowing repopulation of lactobacilli (healthy vaginal bacteria). Most important, it has been shown in scientific clinical trials to increase vaginal elasticity and lubrication.
Hyaluronic acid vaginal gels and suppositories are the other category of over-the-counter long-acting moisturizers that are used to alleviate vaginal dryness. Hyaluronic acid is naturally produced by the body in the skin, connective tissue, and eyes, and works by binding to water to retain moisture. Although commonly used to prevent wrinkles in skin, it has also been found useful in increasing wrinkles in your vaginal wall. (Vaginal wrinkles are a good thing! They’re called rugae, accordion-like folds that allow for maximum elasticity and stretchability. After menopause, those rugae become flatter and may even disappear, taking that elasticity with them.) In a small clinical trial, hyaluronic acid worked as well as estriol (a weak form of estrogen), but not as well as topical estradiol, to relieve vaginal itching, burning, and painful intercourse.
I am often asked which type of product works better. There have been no scientific studies that compare the two options. I can tell you anecdotally that both work well, and it is a matter of personal preference.
How to use a long-acting vaginal moisturizer
Consistency is critical. If you use one of these moisturizers only once in a while or in anticipation of weekend sexual activity, don’t bother. Like all products to restore vaginal tissue, these products are only effective if used regularly.
And though the product instructions recommend twice-weekly use, many women need to use one more frequently: up to four times per week. This is particularly the case if someone is going through chemotherapy. Be sure and take some of the gel and apply it to the opening of the vagina as well. And, yes, you may well still need to use a lubricant at the time of intercourse.
The pros and cons of vaginal moisturizers
To sum it up, here are the advantages of these moisturizers:
They are readily available over the counter, so no visit to the doctor and no prescription required.
The gel can be applied to the outside area of the vagina as well.
And here are the cons:
Moisturizers are not covered by insurance and over time can be expensive.
Moisturizers work best in cases of mild atrophy.
They require consistent twice-weekly application, but sometimes greater frequency is necessary.
They can be messy, and there is an occasional discharge.
Many women find that a long-acting moisturizer is all that they need to alleviate vaginal dryness. Having said that, if you don’t get relief, you may have to go to your doctor to get a prescription product.
Excerpted from the new book, Slip Sliding Away: Turning Back the Clock on Your Vagina, by Lauren Streicher, M.D. (Dr. Streicher was not paid by the products she mentions.)
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