Vaginal Dryness

Vaginal Dryness: Overview

Alternative names: Vaginal Atrophy, Atrophic Vaginitis, Genitourinary Syndrome of Menopause (GSM)

Nearly every woman will experience vaginal dryness, or atrophy, at some point in her life.  It is most often associated with the normal decline or fluctuation in the female hormone estrogen, which can be triggered by giving birth, breastfeeding or menopause.

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Incidence; Causes and Development; Contributing Risk Factors

Although the condition is more common in older women, it can occur at any age.

As many as 80% of women suffer from vaginal atrophy during and after menopause.  These figures may be even higher in reality since a lot of women are too embarrassed to see their physician when experiencing symptoms.  The older a woman becomes, the more likely it is that she will experience vaginal dryness.

Prior to menopause, mucus and fluids that are naturally produced by glands in the womb keep the tissues and skin surrounding the vagina moist and supple.  The production of these fluids is affected by the female hormone, estrogen.  Estrogen also plays a role in the lining and elasticity of the tissues surrounding the vagina.

Less estrogen is produced by the ovaries after menopause, causing the thinning of vaginal tissues and a reduced amount of mucus-producing glands.  These hormonal changes eventually result in a less supple or elastic vagina that is more prone to dryness.  It can happen months or years after menopause and varies greatly between different women.

Menopause is not the only reason for vaginal dryness and it can be observed in women of any age due to an array of factors.  These include:

  • hormonal changes just prior to menstruation
  • pregnancy
  • breastfeeding
  • diabetes
  • Sjogren's Syndrome
  • cancer
  • chemotherapy or radiation treatment
  • surgery
  • depression
  • stress
  • fatigue
  • smoking
  • intense exercise
  • douching too often
  • anti-estrogen medicines
  • antidepressants, contraceptives, anti-acne medication or similar drugs
  • feminine hygiene products
  • soaps, shower gels, deodorants, douches, or other products containing allergens, fragrances or dyes that disrupt the vaginal chemical balance
  • using tampons

Vaginal dryness can result from the surgical removal of the ovaries.  This leads to a decrease in estrogen levels in the body and causes a less elastic and thinner vaginal wall.

Signs and Symptoms

Telltale signs of vaginal dryness include:

  • pain or discomfort during sex
  • white/yellow vaginal discharge
  • itch and irritation in the genital area
  • urinary problems
  • abnormal bleeding

Diagnosis and Tests

Usually symptoms such as dryness, itching or discomfort during intercourse are sufficient to assume that vaginal dryness is the cause.  A pelvic examination is commonly performed to rule out other conditions such as infection that might cause similar symptoms.  This examination can also determine the thickness of the vaginal wall and its effect on vaginal dryness.

Treatment and Prevention

Treatment depends on the underlying cause of vaginal dryness.  In most cases it is caused by a lack of estrogen and therefore estrogen supplements in the form of a cream, gel, or vaginal tablet are often prescribed.  This is known as Hormone Replacement Therapy, or HRT.  Although this treatment works well in most cases, the symptoms may occur again after the treatment is stopped.

Other treatments include vaginal lubricants and moisturizers, psychotherapy (for vaginal dryness caused by previous sexual trauma), and smoking cessation.

Complications

Although complications are uncommon, they can occur.  Women suffering from vaginal dryness are at a slightly higher risk of contracting an STD due to the vulnerability of the skin in the genital area, as well as other bacterial or yeast infections.

Other possible complications include:

  • lesions or fissures
  • reduced sex drive or loss of interest in intercourse
  • difficulty reaching orgasm
  • lower self-esteem

Signs, symptoms & indicators of Vaginal Dryness:

Symptoms - Reproductive - General

Risk factors for Vaginal Dryness:

Hormones

Estrogens Low

The most common cause of vaginal dryness is lack of estrogen.

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Vaginal Dryness suggests the following may be present:

Laboratory Test Needed

Recommendations for Vaginal Dryness:

Botanical / Herbal

Korean Ginseng

In one trial, panax ginseng for two to three months at 100mg of a standardized extract three times daily greatly improved vaginal dryness and painful intercourse in all of the women studied.  Doses were then tapered to a maintenance level.

Women with a history of vaginal dryness and painful intercourse were asked to volunteer for biopsies of the vaginal mucosa.  When examined microscopically, the biopsy specimens showed typical atrophy, with thinned epithelial layer and little to no mucous production.  Macroscopic examination prior to biopsy of course showed the same changes.  Tissue appearance and mucus levels returned to normal levels by the end of the study.

Although this research was not "double-blind" the biopsies and microscopic changes (as well as symptom remission) are definitely significant.  (Wright) finds this approach very useful and reliable in practice, usually recommending 100 milligrams of a standardized extract three times daily until the objective is achieved.  Quantities can often be lessened thereafter to a "maintenance level".

Hormone

Estrogen Replacement

Systemic hormone replacement can provide relief, as can a plant-derived safe estriol cream used locally.

Natural Progesterone

Some cases of vaginal dryness will improve with progesterone but small amounts of supplemental estrogen may be required.

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