Vaginal dryness is a symptom of menopause that can damage your quality of life and affect your sexual relationship, but it is one that most women do not report to their physicians.  The reasons for our reluctance to complain range from embarrassment to thinking it is an inevitable occurance that we must accept. But if vaginal dryness or other symptoms of vaginal atrophy are troubling you, there is something you can do about it. 

One of the downsides of menopause is the thinning of the vaginal and urinary tissues as estrogen declines. This tissue thinning causes many symptoms that can be upsetting, uncomfortable or just plain embarrassing. 

What Are the Symptoms?

When estrogen declines during the menopausal years, many of your body's tissues begin to have less elasticity.  This is particularly true for the tissues that make up your urinary tract and genital areas.  Slowly, the vagina and urinary tract become less flexible, less lubricated and more easily injured.  Some of the symptoms of this loss of elasticity include:

 

• Pain or bleeding with sexual activity
  
  
• Vaginal dryness or burning
  
  
• Urinary incontinence
  
  
• More frequent bladder infections
  
  
• Burning or urgency with urination
  
  
• Watery vaginal discharge

  You might notice that you begin to leak small amounts of urine when you cough, or that sex has become uncomfortable or painful.  It may begin to burn when you urinate, or you may notice a thin, watery discharge that you didn’t have before.  These are signs that you might be suffering from vaginal atrophy. 

What Can You Do About Vaginal Atrophy?

There are several ways to deal with vaginal dryness and the other symptoms of vaginal atrophy; the most effective treatment for vaginal atrophy is hormone therapy. Replacing the estrogen that your ovaries are no longer producing is the best, most proven way to reverse these symptoms. You can do this with:

 

• Systemic estrogen.  If you have other menopausal symptoms such as hot flashes or mood changes, you may want to consider a low dose of estrogen provided in a pill, patch or cream.  This hormone therapy can replace natural estrogen as your body adjusts to menopause, easing your symptoms.
  
  
• Local estrogen. If vaginal dryness or urinary symptoms are your only complaint, you might consider estrogen that is delivered through a cream, tablet or ring placed directly into the vagina. The estrogen is usually absorbed only in the genital area, and does not have a more general impact. 

  Even local hormone therapy does have some risks.  If the hormonal route is one you think is good for you, discuss it with your medical provider. 

If you are not a good candidate for hormone therapy, or if you just want to deal with symptoms using non-hormonal methods, here are some things you can try: 

 

• Vaginal lubricants. Vaginal lubricants can make a big difference with vaginal dryness, particularly during sexual activities. There are water-based and silicone-based products, the water-based being less likely to cause allergic reactions, and the silicone-based lasting a little longer. There are a number of choices, and sorting out which personal lubricant to use may take a little time.
  
   
• Vaginal moisturizers. Vaginal lubricants are good for short-term use, but it often helps to use vaginal moisturizers as well. Moisturizers work for several days, and can make the vaginal and surrounding tissues more pliable and stronger.  Applying them every other day or every third day can help ward off dryness and decrease symptoms.
  
   
• Keep having sex. Continuing with sexual activity is a great way to bring blood to the area and nourish your vaginal cells. Talk to your partner about the discomfort you are having, and discuss ways to stay close.  Lots of foreplay and gentle stimulation, as well as masturbation, can keep the area lubricated and healthy.  Don’t force anything that causes pain, but don’t let this change in your body take away the pleasure and intimacy that sex brings to a relationship.
  
   
• Learn pelvic floor exercises. Pelvic floor exercises like the Kegel exercise  and some of the core Pilates exercises are excellent for keeping your genital area strong.  They are helpful for keeping sex fun and pleasurable, and also for dealing with urinary incontinence.  Your workout may be invisible to others, but it can make a big difference in your genital health.

Unfortunately, the jury is still out on natural and herbal remedies for menopause. While some women report great relief with wild yam progesterone creams, or black cohosh, the research still does not definitively support those treatments.

What’s On The Horizon?

Menopause research is ongoing, and there are some promising selective estrogen receptor modulators (SERM) medications being tested for the treatment of vaginal dryness and atrophy.  Some of these medications have been used for the management of osteoporosis, but others are being developed that may be able to treat other menopausal symptoms as well. 

 

 

Any doctor, nurse practitioner or other provider who works regularly with menopausal women will be aware of vaginal symptoms as a possible problem. Those professionals can be your best source of current treatments and can talk over your personal risk factors and symptoms. You have a right to be comfortable and to continue to enjoy your body and your life, so even if you feel a little uncomfortable bringing up the topic of vaginal dryness, you have a lot to gain by doing so. Don’t let shyness keep you from getting the help you need. 

 

_Sources: 

Boston’s Women’s Health Book Collective, Our Bodies, Ourselves: Menopause, Touchstone/Simon and Shuster, New York. 2006. 

North American Menopause Society, (NAMS), Menopause Guidebook: Helping Women Make Informed Healthcare Decisions Around Menopause and Beyond, 6th Edition , North American Menopause Society, 2006. Retrieved 22 Feb, 2008. 

van der Laak, JAWM, et al, “The effect of Replens® on vaginal cytology in the treatment of postmenopausal atrophy: cytomorphology versus computerised cytometry”, J Clin Pathol, June, 2002; Vol. 55 No.6: 446–451, Retrieved 22 Feb, 2008.