Category: Vaginal Dryness

A taboo within a taboo?

11/30/2019

Many of the symptoms of menopause can ebb and flow over time and we can often get a break from the intensity of symptoms by tweaks we make to our life style and/or medication. There is one symptom though that does not get better with time unless we proactively take steps to address it and possibly worse is the fact that we are not talking about it...AT ALL. I am finding women are not discussing this major symptom even with their closest friends and very often not even with their GP.
Yes it is the subject I have been raving on about on social media for the last while and one that needs to be talked about more. It is a taboo within a taboo if that is even possible....the dryness that can hit your body from top to toe as you progress from Perimenopause onto Menopause. Let's say it loud and clear so we start talking...Vaginal Dryness.

What is Vaginal Atrophy ? What really is Vaginal Dryness?

Vaginal Atrophy (atrophic vaginitis) is the thinning, drying and inflammation of the vaginal walls that can occur during perimenopause/menopause as oestrogen reserves decline. Vaginal atrophy is also referred to as vaginal dryness and both refer to the same condition - with perimenopause comes the gradual decline in oestrogen - this has a direct impact on the tissues that respond to oestrogen. We are well versed in the changes to the menstrual cycle we see as the uterine lining changes and eventually periods stop. It's not just the uterine lining that gets thinner but also the tissues of the vagina and the vulva as they too rely on oestrogen. The supply of oestrogen before perimenopause ensures the vaginal tissues are thick, moist and elastic, when the levels of oestrogen start to decline these tissues become thinner, less elastic and more susceptible to friction and in essence are more easily injured. Think of oestrogen as being your internal lubrication for all areas of your body. The drop in oestrogen reduces this much needed lubrication and these changes can cause vaginal dryness, itchiness, UTI's (urinary tract infections), more frequent toilet breaks, painful smears/sex and loads more symptoms.

Vaginal Dryness happens to 1 in 3 women in their lifetime

What to look out for:

Bladder symptoms - frequency/going more often, stress incontinence (leakage), recurrent infections (UTI's), itchiness, not comfortable compared to before.
Is sex uncomfortable?
Did you find your recent smear test more uncomfortable compared to before?
Bleeding outside your period with or without sex
Itching **Please do not self diagnose it as thrush unless you have checked and see visible signs of thrush**
Vulva burning/inflammation
Watery vaginal discharge
Vaginal prolapse - this can be felt by a bulging sensation in the vaginal walls
Vaginal infections - as the acid balance changes you can be more susceptible to infections.

Read Jane Lewis's leaflet here for more info

Treatment Options

First Step:

Open up about your symptoms - so many women feel shy discussing this condition with their friends let alone their GP so I would urge you to talk about it.
Talk to your GP - don’t self diagnose. If required your GP may refer you to a gynaecologist for a physical exam. This may involve a pelvic exam, during which your doctor feels your pelvic organs and visually examines your external genitalia, vagina and cervix. Your doctor may also check for signs of pelvic organ prolapse — this is indicated by bulges in the wall of your vagina - from pelvic organs such as your bladder or rectum or stretching of the support tissues of the uterus. A urine test may also be taken if you have urinary symptoms. Some gynaecologists may also do an acid balance test, which involves taking a sample of vaginal fluids or placing a paper indicator strip into your vagina to test its acid balance.
The GP/Gynaecologist will perform the above to rule out the following:
- Local vaginal infection, for example infections like bacterial vaginosis, trichomonas, candidiasis, endometritis. Infections like these can occur at the same time as vaginal atrophy as it predisposes the vagina to bacterial infection.
- Trichomonas ( a common sexually transmited disease) and bacterial vaginosis (overgrowth of bacteria in the vagina) also give a more alkaline result on pH testing (pH>4.5).
- Other causes of vaginal bleeding or postmenopausal bleeding.
- Unchecked diabetes may cause vaginal or urinary symptoms.
- Vaginal irritation caused by certain soaps, panty liners, spermicides, condoms, biological washing powder or tight-fitting clothes.
Familarise yourself with your vulva ( your vagina is internal and cannot be seen) - this isn't something we are good at doing but it is essential to start doing it on a regular basis. We have become very good at checking our breasts on a regular basis - this self check needs to extend to the vulva so you are familiar with how it looks and what to be aware of. If you can I would encourage you to take a mirror and look, get familiar with your vulva.

Moisturise:

Vaginal Moisturiser - A moisturiser will hydrate the tissues and is an essential step. Please take the time to look at the ingredients in anything you are putting into your body - select a moisturiser with good ingredients and ensure it is unperfumed. I am currently using Yes VM and find it excellent - you can use applicators or tube (if buying the tube it is worth investing in an applicator from Amazon). Use it as symptoms dictate - best time to use is at bedtime - start daily and then spread out as you need.
Moisturiser's effects are more longer lasting than lubricants generally lasting 2-3 days.
Smear test - a great tip if you have no symptoms of VA but are concerned re smear is to moisturise daily for 5 days prior to having your smear test. If you have ongoing symptoms then you will have worked out a treatment plan with your GP/Gynae and ideally you should aim to have your smear after about 4-6 weeks of local oestrogen and then it is advisable not to use any oestrogen or some of the moisturisers 48 hours before.

Lubricants:

Lubricants come in several forms - water, oil, silicon based and natural oils. They are similar to the vaginal moisturiser but have shorter action. They will be absorbed quicker if you are very dry so this is where the moisturiser adds more value. Any water based product has to contain preservatives for the stability of the product - some women can be more sensitive to different ingredients so it is important to find what works best for you. As I am always saying 'We are all different' so you need to find what suits your body.
Silicon based lubricant - silicon does not occur naturally in the body and does not let the skin do what it should do naturally - in my view its not ideal to put into your vagina but personal perference here.
Yes Oil Based was created to overcome this - it is not hydrating but will protect the tissues and make it more subtle. (*Please note oil based lubricants cannot be used with condoms only water based lubricants).
With Vagifem (if prescribed - see more below) - it's a personal choice whether to use a moisturiser or a lubricant.
Sex - it is essential to lubricate both you and partner. I would suggest applying the oil based lubricant on you first - this will protect the tissues. Then apply water based lubricant on your partner - this has a natural effect and PH benefits. Remember the slippery the better, this will prevent friction for you. These are just some suggestions - you will need to navigate this yourself and find what works best for you and your partner.
Orgasms - with your partner or without are very helpful - they provide essential blood flow to the area.

Hormone Replacement Therapy (HRT):

Discuss with your GP about using local oestrogen therapy which is 'local' treatment to the affected area and results in a much smaller amount of oestrogen compared to systemic oestrogen treatments. This can be in the form of a vaginal ring, cream or a vaginal tablet. Vaginal ring for example Estring is a soft flexible ring which you can insert yourself - it is inserted into the upper part of the vagina. Vaginal creams such as Estrace which are inserted via applicator at night time (or as prescribed by your GP). Vagifem (an oestrogen table inserted via an applicator) is very common here in Ireland and many women find it provides great relief. It is a form of local estrogen - and in essence it provides a signal to the body to hydrate the area. Generally women find improvements in a few weeks of starting treatment. It is also good to use a vaginal moisturiser in combination with Vagifem.
Discuss other forms of systemic oestrogen treatments with your GP.

Natural Oils & Vitamins:

Sea Buckthorn Oil
Omega 7 - less well known that Omega 3 & 6. Omega 7 is famed for its beneficial properties that can help the mucous membranes and it is well known for its help with vaginal dryness. Omega 7 comes from Sea Buckthorn, a berry bush naturally found in Asia and Europe, ongoing studies and results show it helps maintain the health and integrity of the mucous membranes in the vagina. It has been used in Asian traditional medicine for over 1,000 years. The seed oil contains omega-6 and omega-3, while the oil from the plant flesh is one of the few rich sources of omega-7 essential fatty acids (EFAs). It is also good for the immune system in general due to its antioxidant content.
Natural Oils - Many women find Extra Virgin Coconut Oil, Vitamin E oil and almond oil can be very beneficial. These can be used as a lubricant too. Coconut Oil comes with the added benefit of having anti bacterial qualities. Vitamin E can help with many of the physical symptoms of menopause, especially hot flashes and dryness. It can also be helpful for anxiety, heart palpitations, shortness of breath, fatigue, dizziness and insomnia. Vitamin E contains small amounts of oestrogen and is very important for the proper functioning of the blood and for the production of oestrogen, which might be the reason it is particularly effective with reducing or stopping hot flashes.
Vitamin D is crucial in menopause and here in Ireland most people have to supplement this with an oral spray as we do not get enough sunshine in Ireland! Current research indicates it's effectiveness in helping vaginal dryness - this is based on using vaginal suppository. I have not heard of any such available product in Ireland but I would highly recommend taking an oral Vitamin D spray as this is essential for overall immune health.

Dilators:

Dilators can be a very good addition to your treatment plan for vaginal atrophy. They are graded very small to large and can benefit you in several ways. If you are undergoing cancer treatment/pelvic radiotherapy where potentially there can be damage to local tissues using a dilator will help prevent scaring and contraction of tissues (discuss with your oncologist). If you are experiencing painful sex/Vagimus (which might be anxiety or might be physical - lichen sclerosus), you body anticipates the pain and all the muscles of the vaginal will contract - this becomes a cycle of fear, contraction & pain -what a graded dilator will do is retrain the body that this isn’t painful. They can also be useful before a smear if you are anxious about it or not sexually active. It is important to cover with a lubricant. In terms of dilators silicon dilators are best.

Post Cancer Care:

If you have undergone cancer treatment and your form of cancer indicates you cannot use local oestrogen like Vagifem then the first line treatment is a non hormonal vaginal moisturiser. It is important this product does not contain parabens - it is worth looking at Yes VM in this case. If you find using a vaginal moisturiser does not bring relief then please ensure you talk to you GP to look for alternative supports.

Some final thoughts:
Personal Choices: It is important to remember that your vulva may need extra moisturiser and/or lubricant - what you use here is a matter of personal choice. Many women report different success with a wide variety of products so trial and error until you find what works for you.

Smoking: if you smoke you should try stop. Smoking reduces blood circulation and your vaginal area needs a good blood flow.

Perfumed Products: Avoid perfumed toilet paper - we don't need it ! Same with sanitary pads - avoid perfumed.

Clothing: If you find your skinny jeans and underwear are uncomfortable then it is advisable to switch clothing until you have gotten a handle on the issue.

A few weeks ago I did a live chat on Instagram with Jane Lewis of My Menopausal Vagina and I will tell you it took me weeks to clear through all the comments and questions that came off the back of our chat. It has shown me yet again how big this symptom is and the one that we really need to get talking about more - Jane is doing tremendous work in the UK to open this up and we are all benefitting from this - I would highly recommend reading Jane's book - it is essential reading for all women!

I will be doing a Live Instagram with Eleanor from Yes Yes in January so keep an eye out for that and also a follow up with Jane Lewis.

Yes VM - an excellent product to use in your treatment protocol.

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