Thursday 23 July 2020
Too many women suffer from vaginal dryness silently—but it’s a highly fixable issue.
Even the most healthy, satisfying sex life can be knocked off course by vaginal dryness, whether it’s temporary or long-lasting. Lack of lubrication—and the vaginal itching, burning, irritation, and painful sex that often follow—can happen for a variety of reasons and at various life stages.
It’s a particular problem after menopause, but breastfeeding, chemotherapy, and radiation can each result in cellular damage and low estrogen levels, which in turn sabotage the ability of vaginal tissue to stay lubricated and elastic. And some medications (antihistamines and decongestants, for example) can have a negative impact as well.
Too many women, though, suffer silently, not realizing that this is a highly fixable issue. And doctors often don’t broach the topic or aren’t familiar with treatment options. So let me help with answers to some common questions.
My doctor suggested I try a vaginal lubricant. How do you use these, and which one is best?
Lubricants are used at the time of intercourse to reduce friction. I recommend silicone types: They’re more slippery and last much longer than water-based ones (so you don’t need to use as much) and don’t irritate the area. While water-based lubricants are less expensive, many are gloppy and sticky, and they may contain a propylene glycol preservative, which can be irritating. Apply the lubricant on your partner and on the opening of your vagina before intercourse.
What are vaginal moisturizers, and how are they different?
Lubricants don’t alter vaginal tissues; they just make them more slippery. A long-acting over-the-counter moisturizer, on the other hand, increases the water content of the cells, making vaginal tissues thicker, more elastic, and better able to produce lubrication. They need to be used two to five times a week and should be inserted in the vagina and applied around the vaginal opening. Two with proven clinical results: polycarbophil gel (Replens Long-Lasting Vaginal Moisturizer) and hyaluronic acid vaginal gel (Hyalofemme).
What about vaginal estrogens?
Sometimes a woman’s vaginal walls are so thin and dry that a prescription medication is needed. One option: local vaginal estrogens. Before you think, Oh, no, estrogens! Breast cancer, blood clots, bad stuff..., know that there are no proven safety issues with these products. There are three types: vaginal creams (inserted and spread on outer areas), vaginal tablets (inserted twice weekly), and vaginal rings (which last three months).
Are there treatments for women who want to avoid estrogen?
One option is ospemifene, a daily pill—taken orally, not vaginally!—that activates estrogen receptors in vaginal tissue to alleviate painful intercourse in post-menopausal women. The FDA recently approved a daily vaginal suppository, prasterone, or DHEA, which also works inside vaginal cells to increase lubrication and elasticity. And finally, many doctors now offer FDA-cleared medical CO2 laser treatments in their offices, to stimulate and regenerate vaginal and vulvar cells. These treatments should be performed only by a gynecologist, not by a plastic surgeon or dermatologist.