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As a woman approaches menopause, the levels of estrogen in the tissues of the vulva and the lining of the vagina diminish. This causes a condition known as vaginal atrophy. The tissues around the vulva and lining of the vagina become thin, dry, and lose their elasticity. Additionally, vaginal secretions diminish (resulting in decreased lubrication), and the loss of estrogen increases the pH level to a more alkaline one that is more susceptible to infection.
Left untreated, the symptoms may worsen and the vaginal tissues can become inflamed and result in a condition called atrophic vaginitis. In this condition, the vaginal tissues are extremely fragile and prone to injury, tearing, and bleeding during sexual intercourse, and even during gynecological examinations. Atrophic vaginitis is extremely painful and it often can render sexual intercourse no longer feasible.
Women who are in perimenopause should be mindful of the symptoms they are exhibiting and consult a healthcare professional if unusual symptoms manifest themselves. Not all vulvovaginal problems are due to decreased estrogen levels. There are wide a variety of possible causes that may require medical attention.
Examples include vaginal infections; bacterial vaginosis; sexually transmitted diseases such as gonorrhea, chlamydia, or herpes; skin conditions such as vulvar eczema or lichen sclerosus; Crohn’s disease and inflammatory bowel disorder, pelvic radiation therapy; allergic reactions; and irritation from tampons and birth control devices
Vaginal Dryness Treatment
There a wide variety of treatment options for vaginal dryness.
Over-the-Counter
- Water based vaginal lubricants decrease friction and case ease discomfort during intercourse. Examples include: K-Y Personal Lubricant, Moist Again, Lubrin, and Astroglide.
- Vaginal moisturizers may be preferred by women who have symptoms of irritation that is not limited to just sexual activity. Moisturizers act directly on tissue to relive dryness and they help prevent recurring vaginal infections by maintaining a healthy acidic vaginal environment. Examples include: Replens and K-Y Long Lasting Vaginal Moisturizer.
- Vitamin E Oils – research shows that application of vitamin e oil can provide lubrication and relief from vaginal itching and irritation without adverse side effects
Prescription
Severe vaginal dryness and atrophy that does not respond to vaginal moisturizers may require a course of estrogen therapy. Because lack of estrogen is the primary driver behind the symptoms, estrogen replacement therapy is often extremely successful in restoring thickness, elasticity, and vaginal moisture. Improvement typically happens within a few weeks of starting the therapy. All forms of estrogen are approved for this use, whether ingested or applied topically. Find out more about hormone replacement therapy here.
Things to Avoid
- General purpose lotions & moisturizers – These were not designed for use in the special vaginal environment and often contain ingredients such as alcohol and perfumes that can irritate vaginal tissue. Oil based products such as petroleum jelly and baby oil can also cause irritation, and they also damage latex based contraceptive devices.
- Vinegar douches, and antihistamines – All of these are known to have a drying effect and can make your symptoms worse.
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