Vaginal Dryness

What Happened To My Vagina?

Genitourinary syndrome of menopause (GSM) is the name given to the collection of signs and symptoms that many postmenopausal women experience.  Patients may experience vaginal dryness, burning, fissures (cuts or cracks in the vagina) or pain with intercourse and this is usually related to a decrease in estrogen and other vital hormones.  The changes due to the hormonal changes affect the labia major, labia minora, clitoris, the vaginal opening, the vagina proper, the urethra and bladder.  As we evolve as women these changes may sneak up on us.  The usual discussion at the gynecology visit may not include these changes and so it is important to raise these issues with your provider.
Lets look at some ways we can help to alleviate the symptoms experienced by many women.  To be clear women who experience these symptoms are not all post menopausal.  Their symptoms may be secondary to other medical conditions or medications they are taking including but not limited to chemotherapy.
Most patients who are experiencing symptoms may not want hormonal therapy to start, and for those we can start with vaginal moisturizers or lubricants.  Is there a difference between these two?   The answer is yes.  Vagina moisturizers are recommended to be used 2-3 days per week routinely.  They are not used exclusively with sexual activity.  Some examples are Replens, Moist Again, K-Y Liquibeads and Vagisil Moisturizer.  Lubricants are usually used only at the time of sexual activity.  The lubricants can by divided into water, silicone and oil based.  Oil based lubricants cause the breakdown of latex condoms.  Examples of water based lubricants are Astroglide, Slippery Stuff and K-Y Jelly.  Examples of silicone based lubricants are Pjur and ID Millennium.  An example of an oil based lubricant is Elegance Women’s Lubricant.  In many cases these may help to manage the vaginal dryness and make intercourse tolerable but they will not reverse the root cause of the vaginal dryness.  Vaginal estrogen (pills, rings, creams, capsules…), in its many forms however is superior in treating and managing vaginal dryness and the other symptoms described above.  Though some patients have personal objections others may have cancers and other conditions which make estrogen use contraindicated. 
Adequate estrogen therapy however restores the normal acidic vaginal pH and its associated bacteria.  The vaginal tissue becomes thicker and has more lubrication  and distensibility.  It’s not only about the vagina though, women in this state may experience more urinary tract infections and may have issues with overactive bladder.  The vaginal estrogen therapy with its twice weekly dosing can reverse this.  It will not reverse urinary incontinence on the other hand.  The amount of estrogen that circulates in your system from the vaginal application is much less than what it would be when the estrogen is taken in patch or pill form.  
In patients who cannot use estrogen or decline its use, newer laser or radio-frequency devices are being used to treat vaginal dryness.   It has not being established as standard of care but many women report improvement in their symptoms.  Laser therapy usually consists of 3 laser treatment sessions spaced every 4-6 weeks.  The reported improvement is caused by increased blood supply and improved tissue growth.  The risks of use are vaginal burns, scarring, pain during intercourse and chronic vaginal pain.  Some patients who experience vaginal narrowing and shortening may be advised to use vaginal dilators as well to help keep it open and functional. 
In the current medical environment it is important to let your doctor know what you are going through.  Every doctor may not be aware of all the options.  It is your right to seek a second opinion and get your problem addressed.  Many couples are unable to continue sexual intercourse because of the associated vaginal pain.  A male partner may empathize but could never understand the physiological changes women go through.  Some begin to suspect their partners are no longer attracted to them.  Accusations of infidelity and other abusive language may follow.  Many patients suffer in silence, but as we shed light on this let us support one another and share ways in which we can rise as  women and overcome together.