Vaginal Dryness

Vaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Vaginal dryness is a hallmark sign of vaginal atrophy (atrophic vaginitis) — thinning and inflammation of the vaginal walls due to a decline in oestrogen. Along with vaginal dryness, you might also have itching and stinging around the vaginal opening and in the lower third of the vagina..

Vaginal moisture

Natural lubrication produced by glands at the neck of the womb (the cervix) keeps the vagina supple and moist. The moisture moves slowly down through the vagina, keeping it clean and removing dead cells. The vaginal moisture is slightly acidic and this helps to keep the area healthy, preventing infections such as thrush. It is perfectly normal for the majority of women to notice a slight white vaginal discharge. During sexual excitement the Bartholins glands (two glands at the entrance of the vagina) produce extra moisture to aid sexual intercourse. However, a quarter of women aged 50-59 experience vaginal dryness problems during sex and 16% experience pain, as vaginal dryness can make intercourse uncomfortable. In addition, there is a possibilitt that additional vaginal lubrication is produces by fluid that seeps through the walls of the blood vessels encircling the vagina. So that when you're sexually aroused, more blood flows to your pelvic organs, creating more lubricating vaginal fluid, in addition to that produced by the cervical and Bartholin’s glands. Hormonal changes during your menstrual cycle, childbirth, breast-feeding and menopause, may however disrupt these processes and affect the amount and consistency of vaginal moisture and secretions

Symptoms

Vaginal dryness may be accompanied by signs and symptoms such as: itching, Burning, Soreness, Pain or light bleeding with sex or Urinary frequency or urgency. Vaginal dryness affects many women, although they frequently don't bring up the topic with their doctors. If vaginal dryness affects your lifestyle, in particular your sex life and relationship with your partner, consider making an appointment with your doctor. Living with uncomfortable vaginal dryness doesn't have to be part of getting older.

Causes

Decreased oestrogen levels

Menopause - Reduced oestrogen levels are the main cause of vaginal dryness. This occurs around menopause, including premature menopause, where menopause occurs before the age of 40 years. Oestrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining. Oestrogen levels can fall for a number of reasons: Menopause or perimenopause, Childbirth, Breast-feeding, Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy, Surgical removal of your ovaries, Immune disorders or Cigarette smoking – all affect oestrogen level and can cause vaginal dryness

Before the menopause - Around 17% of women aged 18-50 experience problems with vaginal dryness during sex. Many women may experience vaginal dryness during sex because they are not sexually aroused – this is often caused by insufficient foreplay or psychological reasons such as stress. Other reasons for vaginal dryness before the menopause can be linked to hygiene products such as feminine sprays and harsh soaps, swimming pool and hot tub chemicals and some washing powders. Certain drug treatments such as allergy and cold medications and some antidepressants, can also dry out mucous membranes, including vaginal tissues, as below:

Medications

Allergy (anti-histamine) and cold medications (decongestants), as well as some antidepressants, can decrease the moisture in many parts of your body, including your vagina. Anti-oestrogen medications, such as those used to treat breast cancer, also can result in vaginal dryness.

Douching

The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated.

Medical Conditions, like Sjogren's syndrome

In this autoimmune disease, your immune system attacks healthy tissue. In addition to causing symptoms of dry eyes and dry mouth, Sjogren's syndrome can also cause vaginal dryness

Emotional issues

If you are suffering from depression or under tremendous stress, you may also notice some degree of vaginal dryness, especially if associated with loss of sexual interest, or if this also affects your libido. Dryness and lack of arousal can also be a signal of unresolved problems in a relationship

Tests and diagnosis

Diagnosis of vaginal dryness may involve: thorough pelvic assessement, where your doctor visually inspects your external genitalia, vagina and cervix and inserts gloved fingers into your vagina to feel (palpate) your pelvic organs for signs of disease. Other test may include vaginal swabs, to take a sample of vaginal secretions to check for signs of vaginal inflammation (vaginitis) or to confirm vaginal changes related to estrogen deficiency.

Treatments and drugs

Vaginal oestrogen therapy

In general, treating vaginal dryness due to menopause or lack of oestrogen is more effective with topical (vaginal) oestrogen rather than oral oestrogen. Oestrogen applied to the vagina can still result in oestrogen reaching the bloodstream, but the amount is minimal. Vaginal oestrogen also doesn't decrease testosterone levels — important for healthy sexual function — the same way oral oestrogen can. Vaginal oestrogen therapy comes in several forms: Vaginal Oetrogen Cream, Ring (Estring), or Tablets (Vagifem)

Lifestyle and Home Remedies For Vaginal Dryness

Lubricant or Moisturiser

Lubricants (K-Y, AquaGel). Water-based lubricants like these lubricate your vagina for several hours. Apply the lubricant to your vaginal opening or to your partner's penis before intercourse. Moisturisers such as Replens® and Sylk®. imitate normal vaginal moisture and relieve dryness for up to three days with a single application. Use these as ongoing protection from the irritation of vaginal dryness.

Pay attention to sexual needs

Occasional vaginal dryness during intercourse may mean that you aren't sufficiently aroused. Make time to be intimate with your partner and allow your body to become adequately aroused and lubricated. It may help to talk with your partner about what feels good. Having intercourse regularly also may help promote better vaginal lubrication.

Avoid certain products

Though you may be willing to try just about anything to relieve your discomfort, avoid using the following products to treat vaginal dryness, because they may irritate your vagina: Vinegar, yogurt or other douches, Hand lotions, Soaps, Bubble baths

Lifestyle Issues - Boost your water intake. Your first step should be to check your hydration. We should all consume at least ten 8-oz glasses of water a day. This simple step can be surprisingly helpful. Follow a hormone-balancing diet. Give your body the support it needs to make and balance your hormones, starting with your nutrition. The low-fat, high-carb diet many women follow literally starves the body of the nutrients it needs to make sex hormones. The oestrogen needed for vaginal lubrication is made from cholesterol, for example — something women on low-fat diets are severely lacking. You might also think about adding soy and flax seed, which are good sources of phytoestrogens (plant oestrogens).

ATROPHIC VAGINITIS

Atrophic vaginitis is vaginal dryness due to thinning tissue and decreased lubrication. This is more of a problem occurring around menopause, although it can happen whenever there is reduced or lack of oestrogen – whatever may be the cause of this.

Symptoms

  • Painful Sex. This may occur because the vagina is smaller, drier and less likely to become lubricated during sex than before the menopause. Also, the skin around the vagina is more fragile, and this can make the problem worse.
  • Vaginal Soreness - if the vulva or vagina is sore and red. Vaginal soreness, including itching or burning sensations.
  • Vaginal discharge. There may be a white or yellow discharge. Sometimes this is due to an infection. Infection is more likely if the discharge is smelly and unpleasant.
  • Vulval Itching. The skin around the vagina is more sensitive and more likely to itch. This can make you prone to scratching, which then makes the skin more likely to itch, and so on. This is called an itch/scratch cycle which can become difficult to break, and can be distressing.
  • Urinary problems. Atrophic vaginitis may contribute to various urinary problems. This is because of thinning and weakening of the tissues around the neck of the bladder, or around the urethra (opening for urine). For example, urinary symptoms that may occur include an urgency to get to the toilet, and recurring urinary infections, or simply burning sensation on urination due to thining of the membranes.
  • Light bleeding (Post Menopausal Bleeding) may occur on its own, or after intercourse.

Treatments (see also under Vaginal Dryness) link

Not all women have all of the above symptoms. Treatment may depend on which symptoms are the most troublesome. Because the problem is mainly due to a lack of oestrogen, it can be helped by replacing the oestrogen in the tissues.

Hormone Replacement Therapy (HRT)

This means taking oestrogen in the form of a tablet, gel, implant or patches. This may be the best treatment for relieving the symptoms, but some women don't like the idea of taking HRT. There are advantages and disadvantages of using HRT.

Vaginal (Topical ) Oestrogen – Oestrogen cream, pessary or vaginal ring containing oestrogen restores oestrogen to the vagina and surrounding tissues without giving oestrogen to the whole body. Usually the treatment is used every day for about two weeks, and then twice a week for a further three months. After this the effect of the treatment may be assessed by your doctor. This treatment usually works well but the symptoms may recur some time after stopping the treatment. Repeated courses of treatment are often necessary.

Lubricating gels

If vaginal dryness is the only problem, or hormone creams are not recommended because of other medical problems, lubricating gels may help. There are two gels which are available in the UK that are specifically designed to help the problem of vaginal dryness. They replace moisture. They are Replens® and Sylk®.