Treating Vaginal Dryness

Uncomfortable symptoms of the vagina and vulva (outer lips of the vagina) are common in women of all ages, but increase with menopause. Vaginal atrophy is the medical term that describes vaginal dryness and discomfort in postmenopausal women. Symptoms of vaginal atrophy may significantly affect your quality of life, sexual satisfaction and relationship with your partner.

Menopause-related vaginal symptoms may affect you early in your menopause transition or start after several years of decreased estrogen levels. Unlike hot flashes, which generally improve with time, vaginal symptoms typically worsen with time due to both aging and a prolonged lack of estrogen.

Menopause and aging cause changes to your vagina and bladder, including:

• Vaginal tissue becomes thin, dry and less elastic, and secretions decrease — both of which can lead to pain during intercourse or pelvic exams. 
• Changes in the urethra’s acidity make it more inviting for bacteria, which leads to increased urinary tract infections and discomfort during urination. 
• Women with discomfort from vaginal atrophy often have less frequent intercourse, which can cause the vagina to become shorter, narrower and less elastic. This can cause involuntary tightening of vaginal muscles (vaginismus), a learned response to pain that often contributes to uncomfortable intercourse.

Treating Vaginal Dryness and Atrophy

While symptoms of vaginal dryness and atrophy can uncomfortable, the good news is that effective treatment options are available — including low-dose estrogen creams applied directly to the vagina, as well as non-hormonal treatments. Non-hormonal and hormonal treatments can be combined for optimal symptom relief.

The Menopause Education Program at El Camino Hospital provides you with information, care and support to help you transition through menopause confidently and comfortably.

Non-Hormonal Remedies

The following non-hormonal remedies may provide relief for vaginal dryness and discomfort:

• Vaginal lubricants – Reduce discomfort with sexual activity when the vagina is dry by decreasing friction during intercourse. Water-soluble products are effective, as well as olive and coconut oils. 
• Vaginal moisturizers – Line the wall of the vagina and maintain vaginal moisture. Like your face or hands, your vagina should be moisturized on a regular basis — several times weekly, at bedtime.
• Regular sexual stimulation – Promotes blood flow and secretions to the vagina. Sexual stimulation can improve vaginal health.
• Pelvic floor exercises – Can both strengthen weak vaginal muscles and relax tight ones.
• Expanding your views of sexual pleasure – Options such as extended caressing, mutual masturbation and massage. Trying different options can help make painful intercourse more comfortable or allow you to remain sexually intimate without intercourse.

In addition, vaginal dilators can help stretch and enlarge the vagina, especially if sexual activity is infrequent and the vagina has become too short and narrow for intercourse. In addition to regular use of vaginal estrogens, lubricants and moisturizers, several months of daily “exercises” with lubricated vaginal dilators can help. Dilators can be purchased from pharmacies and medical supply stores and used with the guidance of a gynecologist, physical therapist or sex therapist.

Vaginal Estrogen Therapy

Low-dose topical estrogen is an effective and safe treatment available by prescription. Improvements usually occur within a few weeks; although, complete relief may take several months.

Topical estrogen is applied directly to your vagina to:

• Increase the thickness and elasticity of vaginal tissue.
• Restore a healthy pH level.
• Increase vaginal secretions.
• Relieve vaginal dryness and discomfort with sexual activity.

Low-dose vaginal estrogen products are available by prescription as vaginal creams (used two or three nights weekly), a vaginal estradiol tablet (used twice weekly) and an estradiol vaginal ring (changed every three months). All are highly effective. You may wish to try several different methods and choose the one you prefer.