Vulva and vaginal health is important to our overall health because we want to be able to sit comfortably, move comfortably, enjoy penetrative sex (if you choose; with or without a partner) comfortably—and a healthy pelvic floor helps prevent urinary tract infections (UTIs), incontinence and pelvic organ prolapse for the next three-to-five decades!
Vulva and vaginal dryness occurs most often in postmenopause (12 months period-free) after:
estrogen (the hormone responsible for keeping our eyes, mouth, skin, joints and vaginas lubricated) declines, and after
hyaluronic acid (a naturally occurring molecule in our skin cells) also decreases significantly.
Vulva & vaginal dryness can occur at other times in our life too—one of the biggest culprits is the birth control pill, which disrupts hormones in order to prevent a pregnancy--but can also disrupt other areas of health too. Other reasons for vulva & vaginal dryness include fluctuating hormones during postpartum, overuse of pantyliners and other absorbent pads, a side effect from cancer treatments, certain medications or other health conditions.
The bad news is vulva & vaginal dryness, if left untreated, does not get better with time. This is really important because many women have been socialized to believe hormone changes are something we have to “just get through” without realizing there are longer-term health implications if action to prevent and/or treat is not taken.
The other really bad news is that 80+% of vagina owners in postmenopause are currently trying to navigate life while enduring dryness, and a significantly low number (~4%) are currently receiving a viable treatment!
The good news is there is a full menu of options for both preventing and treating vulva & vaginal dryness, including some new developments in the last couple of years!
And, what women really need to know is this: prioritizing vulva, vaginal & pelvic health improves a woman’s overall quality of life—it positively impacts sexual health, confidence, how active we can be, relationships and even our cognitive function. Yes, we need to make certain nothing impedes our physical movement as we age; therefore prioritizing vulva and vaginal health helps take care of our brain health!
How to prevent or treat vulva & vaginal dryness
Engage in sexual activity (with or without a partner) ONLY when comfortable
Do not embrace a “use it or lose it” approach to vaginal health; it's a myth. While healthy sexual activity (with or without a partner) and regular orgasms keeps blood flow and energy directed to our pelvic region, please do not engage in penetration if you already experience dryness and/or pain. Continue reading for available treatment options.
Practice regular pelvic floor exercise
See a pelvic floor physiotherapist at least once or twice per year (same as you visit the dentist!) Also look into the online educational opportunities with the Vagina Coach. Our pelvic health must be a priority as it is responsible for our bladder health, bowel health, sexual health and more. It’s important for all women to exercise their pelvic floor correctly and consistently, and this requires the guidance of a professional.
Moisturize
As part of a regular routine, you can prevent and treat vaginal dryness by moisturizing your vulva and vagina with hyaluronic acid. Hyaluronic acid is a naturally-occurring molecule, but it starts to decline in our 30s and 40s. Hyaluronic Acid has also been a popular ingredient in skincare products since 2003. In 2013, Swiss gynecologist, Dr. Petra Stute, showed how hyaluronic acid is as effective for treating vaginal dryness as localized estrogen therapy (a physician-prescribed form of hormone therapy--often in the form of a cream, suppository or ring-- applied directly to the vagina delivering estrogen back to the body.)
In May 2021, the International Society of Gynecologists recommended vaginal moisturizer as the first line of treatment for vaginal dryness. This is because hyaluronic acid is a naturally-occurring compound made by our own bodies, but it starts to decline around age 30-40 and then more significantly in post-menopause.
In July 2022, the North American Menopause Society recommended a non-prescription moisturizer first, and then add vaginal hormone therapy (vaginal estrogen therapy or other therapies such as vaginal dehydroepiandrosterone or oral ospemifene.)
A vaginal moisturizer is not the same thing as a lubricant
Lubricants provide a temporary barrier to friction and should be used for in-the-moment pleasure and fun, but they do not offer long-term benefits.
A vulva & vaginal moisturizer, on the other hand, works as an “investment” to restore natural moisture back into the skin cells of the vulva and vagina wall.
In 2019, members of the Menopause Chicks Community asked me to research new options for treating vaginal dryness as they were frustrated by the lack of vaginal health education, the lack of conversation with their health care professionals, and too many women were assuming vaginal dryness was something they had to tolerate. It was impacting women’s overall quality of life (members cited reoccurring UTIs, discomfort wearing clothing and relationships ending as the top three reasons for wanting a solution for vaginal dryness.)
Other members were frustrated by the lack of over-the-counter options as they were spending money on products that had great marketing, but the ingredient lists were long and full of preservatives and additives.
We took this challenge to a team of integrative pharmacists who developed a non-prescription vaginal moisturizer that contains hyaluronic acid and a little vitamin E.
Localized estrogen therapy, DHEA (prasterone) therapy or oral ospemifene
Localized Estrogen Therapy:
Localized estrogen therapy is a form of hormone therapy where bioidentical estradiol or estrone is applied to the vagina via a cream, gel, ring or suppository. It is a prescription available from any health care provider with prescribing rights. Localized estrogen can be used alone or in combination with other hormone therapy (systemic estradiol, progesterone.)
DHEA Therapy:
DHEA is short for dehydroepiandrosterone, also known as prasterone. Treatments containing DHEA for vulva and vaginal atrophy have been available in the United States for years and Intrarosa (brand name) was recently approved as a prescription option in Canada. Prasterone administered locally in the vagina is an inactive precursor of sex steroids that enters the vaginal cells and is converted intracellularly into estrogens and androgens, depending upon the level of enzymes expressed in each cell type, thus exerting beneficial effects on the symptoms and signs of vulvovaginal atrophy through activation of the vaginal estrogen and androgen receptors. Also new: an oral treatment for vaginal dryness under the brand name Osphena (ospemifene) Some prefer an oral option as it helps them to remain compliant, especially if they are used to taking other oral medications/supplements in the morning, for example.
Don’t give up
Everyone is at a different age and stage of dryness. The only option not on the menu is giving up! Many women choose to moisturize with Hyaluronic Acid AND use localized estrogen or DHEA therapy (approved as a prescription option in Canada in 2022.)
A lot of members of the MenopauseChicksCommunity.com do well with both; they combine treatments either by alternating moisturizer and localized hormone therapy every other day, or between morning and night. Speak with an experienced health care provider about the potential benefits of hormone therapy (systemic and vaginal) for you.
A Glossary for your vulva & vaginal health
Vaginal Atrophy (atrophic vaginitis):
Vaginal atrophy is the thinning, drying and inflammation of the vaginal walls that occurs in over 80% of women when both hyaluronic acid and estrogen decline postmenopause. Vaginal atrophy not only makes sitting and moving uncomfortable, but it can lead to painful penetrative sex and distressing urinary issues, such as reoccurring urinary tract infections (UTIs), incontinence and pelvic organ prolapse.
Vulva & vaginal dryness:
Dryness is one symptom of atrophy. The vulva and vagina are skin cells and while dryness is commonly associated with the decline of hyaluronic acid and estrogen postmenopause, dryness can also be the result of fluctuating hormones postpartum, during perimenopause, some women experience while taking the birth control pill and other medications and it can also be attributed to overuse of pantyliners and pads. Vulva and vaginal dryness also affects women post-hysterectomy/oophorectomy and those undergoing treatment for breast cancer, other cancers and health conditions.
Genitourinary Syndrome of Menopause (GSM):
I’m not a fan of this term as most women and health professionals are not familiar with it/don’t use in regular conversation. Women are most likely to describe an experience of “dryness” or “pain with penetration” vs. “Doctor, I think I’m experiencing GSM.”
It's important though! Genitourinary syndrome of menopause is a “umbrella” term first coined by the North American Menopause Society in 2019 to describe all the pelvic-related issues that women face after estrogen declines postmenopause, and affects the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. Examples include vulva dryness, vaginal dryness/atrophy, urinary incontinence, pelvic organ (bladder, uterus, rectum) prolapse and being susceptible to infection, such as urinary tract infections (UTIs.)
Hyaluronic Acid:
Hyaluronic Acid is a naturally-occurring molecule that our body makes on its own. It starts to decline in our 30s & 40s (about 10% per decade) and then more significantly postmenopause. Hyaluronic Acid was made popular by the beauty and cosmetics industry starting in 2008 as an ingredient in moisturizing creams and serums. In 2013, Dr. Petra Stute, a Swiss gynecologist, led the research for confirming hyaluronic acid is as effective as vaginal estrogen for the treatment of vaginal dryness.
Localized Estrogen Therapy:
Localized estrogen therapy is a form of hormone therapy where bioidentical estradiol or estrone is applied to the vagina via a cream, gel, ring or suppository. It is a prescription available from any health care provider with prescribing rights. Localized estrogen can be used alone or in combination with other hormone therapy (systemic estradiol, progesterone.)
DHEA Therapy:
DHEA is short for dehydroepiandrosterone, also known as prasterone. Treatments containing DHEA for vulva and vaginal atrophy have been available in the United States for years and Intrarosa (brand name) was recently approved as a prescription option in Canada. Prasterone administered locally in the vagina is an inactive precursor of sex steroids that enters the vaginal cells and is converted intracellularly into estrogens and androgens, depending upon the level of enzymes expressed in each cell type, thus exerting beneficial effects on the symptoms and signs of vulvovaginal atrophy through activation of the vaginal estrogen and androgen receptors. Also new: an oral treatment for vaginal dryness under the brand name Osphena (ospemifene) Some prefer an oral option as it helps them to remain compliant, especially if they are used to taking other oral medications/supplements in the morning, for example.
Lubricant:
Lubricants are temporary catalysts that reduce friction, ease sexual activity (with or without a partner) and they promote fun and pleasure. Lubricants are not treatments for vulva/vaginal dryness as they don’t have long-term benefits, so if the question is: “Moisturizer or lubricant?”, the answer is: both. The World Health Organization recommends a lubricant with a pH of, or close to, 4.5 and osmolality of less than 1200 mOsm/kg. These levels are the same as the vaginal tissue naturally.
Spark any questions? Email me at shirley@MenopauseChicks.com
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