Vaginal Dryness: What Are Its Causes And What You Can Do
November 11, 2019
Do you have vaginal or vulvar dryness, burning, decreased lubrication, or pain? You are not alone.
These symptoms are part of a process called Genitourinary Syndrome of Menopause (GSM). GSM occurs because of the natural decrease in estrogen in the vagina, vulva, and bladder that occurs with menopause. With declining estrogen, the vaginal tissue can become thinner and more easily irritated.
GSM also can cause urinary symptoms like pain with urination and recurrent urinary tract infections.
About 30 percent to 50 percent of postmenopausal women experience these symptoms. Unfortunately though, women do not generally discuss these problems with their health care providers.
Steps to Take For Vaginal Dryness
The first thing to do is tell your health care provider. There are a number of treatment options that can help relieve your symptoms.
Medications that your provider can prescribe include vaginal or oral medications.
Vaginal estrogen is a topical treatment that helps with the thickness and elasticity of the vulva and vagina. Estrogen can be formulated in different ways to deliver it to the vagina and vulva -- the area that needs it -- without the slight risk of taking systemic estrogen. There are creams (sold under the brand names Estrace and Premarin), vaginal tablets (sold under the brand names Vagifem and Yuvafem), and the vaginal ring (sold under the brand name Estring). All of these treatments are effective, and you should choose based on your personal preference and lifestyle.
Ospemifene is an oral tablet that treats painful intercourse caused by GMS. It is a selective estrogen receptor modulator (SERM), meaning that it is not estrogen, but acts on estrogen receptors, causing the estrogen effect. Prasterone (DHEA or Intrarosa), is a vaginal tablet taken nightly for pain with sex caused by GMS in menopause. Stopping these medications will cause the symptoms to return, so unfortunately the medications need to be continued to keep the symptoms from returning. Discuss with your provider what your options are if you are a breast cancer survivor, as some of the options have not been studied in women who have had breast cancer.
Non-medication options include vaginal stimulation, which can help keep vaginal tissues healthy by increasing blood flow. Over-the-counter options include vaginal moisturizers that help with vaginal and vulvar dryness, and lubricants that can be used during sexual intercourse. Safe products to use include the brands Uber lube, Yes, and Good Clean Love.
Lastly, vaginal laser treatment has shown promise in many studies of improved symptoms of GMS. A narrow cylinder is placed into the vagina, and the laser makes shallow microscopic nicks in the vaginal skin that promotes healing and tissue regeneration. The treatment is quick, painless and well-tolerated. It is not covered by health care insurance, though, so it is an out-of-pocket expense.
GSM is very common and there are treatments that are available to increase your quality of life. There are many options that you can try, so take the time to find the right one for you.
Corinne Bazella, MD, FACOG specializes in obstetrics and gynecology at University Hospitals Cleveland Medical Center.
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