Menopause
Vaginal Dryness
Most woman, as many as 90%, don’t seek treatment for their symptoms, which include not only dryness, but also irritation and pain during sexual intercourse.
Vaginal dryness can occur in women of all ages, but it becomes much more common after menopause. About one-third of women experience it at menopausal onset and that number only grows as women age.
While other menopausal symptoms, such as hot flashes, typically decline over time, vaginal dryness tends to linger because it results from physical changes in the vagina — specifically atrophy of tissues, which become thinner, drier, and less flexible because of estrogen loss.
The urogenital diaphragm – the vagina, bladder, urethra, and pelvic floor) are densely populated with estrogen receptors. Estrogen keeps these organs healthy.
Estrogens maintains thickness to the layers of cells that line the vaginal wall. Specifically, the superficial layers which is rich in glycogen (sugar) that help to support healthy pH which in turn supports normal secretions and moisture.
Estrogen supports the natural folds in the vaginal wall called rugae which are rich in collagen, elastin and hyaluronic acid all of which give the vagina elasticity.
Women going through menopause decrease their production of estrogen, leading to less moisture production and thinner, dryer vaginal walls.
While other menopausal symptoms, such as hot flashes, typically decline over time, vaginal dryness tends to linger because it results from physical changes in the vagina — specifically atrophy of tissues, which become thinner, drier, and less flexible because of estrogen loss.
This leads to loss of the thick outer layer of cell, a loss in sugar which supports normal pH and moisture producing normal vaginal flora.
There is a loss of collagen and elastin in the lower layers which decrease the elasticity of the vagina.
Genitourinary Syndrome (GSM)
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.
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.
Symptoms of GSM
- feel sore, burning, or itchy in and around your vagina.
- feel pain or discomfort during sex.
- Soreness in your vulva
- need to pee more often than usual.
- keep getting urinary tract infections (UTIs)
Symptoms similar to those of GSM are sometimes caused by another condition. There are a few dermatological conditions that may cause similar symptoms, including lichen sclerosus, which causes thin, patchy white skin on the genitals, and lichen planus, which causes purplish, itchy bumps on mucous membranes and other areas of the body.
Once other conditions are ruled out, the doctors and County Obstetrics and Gynecology can work with you to find solutions for GSM, whether that includes a vaginal moisturizer, vaginal estrogen, or another treatment.
Moisturizers and lubricants often help.
Lubricants vs. moisturizers
Lubricants
Vaginal Lubricants reduce friction. during sexual activity and can lessen pain or discomfort. A main reason to use these products is to make sex more comfortable, but they can also assist with arousal and pleasure. Lubricants are used when you need them — at the time of a sexual encounter.
Choosing and using Lubricants:
Lubricants can be water based, silicone based or oil based. We suggest glycerin-free and paraben-free options, while avoiding ones that are sticky. Some brands are Astroglide, K-Y jelly and Sliquid, and there are many others.
Many of the lubricants with additives that try to “stimulate or arouse,” can cause burning discomfort and should be avoided, especially if you are already dealing with vaginal discomfort.
Moisturizer
Vaginal moisturizers add moisture around and inside the vagina.
Vaginal moisturizers are used regularly over time, not specifically in the moment of a sexual encounter.
Over-the-counter moisturizers can be inserted into the vagina to add a protective barrier, coating the vulnerable lining. Improved moisture lessens discomfort, similar to using moisturizers on your face or legs.
There are two types. Internal moisturizers are inserted into the vagina, where they help build up vaginal tissue. External moisturizers are made for the vulva.
The key to moisturizer is how you use it. It can’t help if it is left in the tube unused.
The product can be massaged into the vaginal walls with a clean finger, much like you would apply a moisturizer to your face.
Moisturizers require frequent — 3 to 7 times a week — and consistent use. Also, you must use moisturizers multiple times a week for many weeks to see results. If you stop, the symptoms of dryness or discomfort will likely return.
Choosing and using Moisturizers:
There are many varieties of vaginal moisturizers available. Brand names are K-Y Liquibeads, Replens, Sliquid and others. Avoid common allergens that you are sensitive to (fragrances, parabens, benzyl alcohol, propylene glycol and lanolin to name a few).
Those with hyaluronic acid are popular but can be expensive.
While these products do not change the underlying cause of your symptoms, particularly the cellular changes in the vaginal tissue. Estrogen therapy and other Food and Drug Administration-approved medications can get at the root cause of the problem much more effectively.
Contact one of our specialist at County Obstetrics & Gynecology if irritation and pain during sex don’t improve after 2 months of use, or if you have other symptoms.
Topical estrogen
Topical vaginal estrogen treats symptoms of vaginal atrophy without increasing levels of estrogen levels in your bloodstream. It’s available in a cream, a vaginal pill or a ring.
Most people need the cream daily for several weeks, but then 2-3 times per week.
The research has found that the vaginal estrogen tablet and the vaginal moisturizer both relieved symptoms in the women who used them by 50% to 70%
Hormone Replacement Therapy may provide the best treatment option for the best results.
Hormone Replacement Therapy
Hormone therapy steadies the levels of estrogen and progesterone in the body. It is a very effective treatment for hot flashes in women who are able to use it.
Treatments can be tailored to each individual woman depending on the nature and severity of your symptoms, age, and overall health.
For more information on the symptoms and treatment options call the office of County Obstetrics & Gynecology to schedule a consultation.
VAGINAL REJUVENATION
Hormone-Free Non Surgical Treatment
FEMILIFT
Femilift is a minimally-invasive technique that uses laser technology to revitalize atrophied genital tissue. The Femilift procedure can restore vaginal lubrication and elasticity and relieve discomfort experienced during sexual intercourse.
The Femilift procedure can alleviate these symptoms, including:
- Vaginal dryness
- Genital irritation, burning, or itching
- Painful intercourse
How does the Femilift work?
The specially designed laser handle directs a tiny carbon dioxide fractional laser at the vaginal walls, which stimulates collagen production. The tissue can then regenerate, growing healthier and more elastic, which improves vaginal lubrication and allows for a more comfortable and enjoyable sex life.
The course of treatment consists of three sessions, six weeks apart. The sessions take no longer than 5 minutes, and most patients experience no pain or discomfort. If you wish, your doctor can apply a local anesthetic cream before the procedure.
The risks of fractional CO2 Laser treatment are virtually nonexistent. Femilift is one of the safest medical procedures available.
Patients can return to their normal activities upon returning home from the procedure. However, you should avoid sexual intercourse for 48 hours. You may experience some redness or swelling for a day or two, but you shouldn’t expect severe pain or tenderness.
Most patients have been very happy with their results and have reported significantly less itching, burning, dryness, and pain during sex. Although the full treatment takes three sessions, you may start to see some improvement in your condition after the first session.