September 10, 2022
Although vaginal dryness can happen at any age, it is one of the most common symptoms associated with menopause, with about 1 in every 3 women going through menopause experiencing this uncomfortable symptom. Although some physicians consider vaginal dryness to be one of the more minor consequences of menopause, for a woman who is experiencing it, it’s anything but minor and can wreak major damage on her sex life.
But what causes vaginal dryness and what can be done about it?
Normally, a woman’s vaginal walls stay naturally lubricated with a thin layer of clear watery fluid, with the hormone estrogen playing a vital role in maintaining this fluid, and also keeping the vaginal walls elastic and thick. At menopause, estrogen levels sharply decline, and the vaginal walls grow thin, inelastic, and dry. This constellation of symptoms is known as vaginal atrophy. Symptoms include burning, itching and discomfort in your vaginal area, and sexual intercourse may be painful or impossible due to discomfort.
If you suspect you may be suffering from vaginal atrophy, you should see your gynecologist. Your physician will perform a vaginal exam to check for redness or thinning and to rule out other causes of your symptoms.
There are other causes of vaginal dryness besides menopause. Some medications, including certain antidepressants and cold/allergy medications can be the culprit, as can douching. For some women, the problem is caused by not enough foreplay prior to intercourse, which does not give her body the time it needs to produce enough natural lubrication. There are also other causes for a decline in estrogen including childbirth and breastfeeding, removal of the ovaries via surgery, chemotherapy or radiation treatment for cancer, and treatment with anti-estrogen medications used to treat endometriosis or uterine fibroids.
The most commonly prescribed medication for vaginal dryness due to low estrogen levels is topical estrogen, used either as a cream, a vaginal tablet or vaginal ring. The cream is applied with an applicator, usually daily for one to two weeks, then one to three times a week as directed by your physician. A vaginal tablet is used much like the cream and is inserted with a disposable applicator daily for two weeks, then twice a week until it’s no longer needed. The vaginal ring is inserted by your physician, and is made of a soft, flexible material that releases a stream of estrogen directly to the vaginal walls. This must be replaced every three months.
Some estrogen medications can have side effects, such as breast pain or vaginal bleeding. For some women, estrogen medications for vaginal dryness are not suitable. Reasons include a history of uterine cancer, undiagnosed vaginal bleeding, a current diagnosis of breast cancer, or pregnancy and breastfeeding.
If you would prefer not to use medications containing estrogen there are other things you can do. These can help but may not be as effective. Vaginal moisturizers are sold over the counter at most drugstores and supermarkets and do not contain estrogen which is only available by prescription.
You can ask your physician about a once-a-day oral drug, ospemifene, that thickens the vaginal tissue and makes it less fragile. But this drug can also thicken the lining of your uterus and raises the risk of blood clots and stroke.
Be sure you have adequate foreplay prior to sexual intercouse so your body has time to become fully aroused and produce natural lubrication. Use of a water-based lubricant can help as well. Avoid using douches, scented soaps, bubble baths and lotions in the vaginal area as all of these products can make vaginal dryness worse.
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