“It’s like the Sahara desert…What happened to my vagina?”  This is a frequent question posed by my patients who are distressed and looking for answers to help solve this issue.  In the past, they were enjoying sex –  now it’s painful and more of a dreaded act than satisfying one.  Words like “sandpaper” or “knives cutting into me” are commonly used to describe this discomfort. Many patients become depressed, lose hope and suffer relationship problems due to this condition.

The bad news – many women don’t talk about it – even with their Gyn doctors. ​ The good news – we CAN talk about it AND there are many therapies that can alleviate the pain.

Vaginal dryness leading to painful sex is also known as Vaginal atrophy or genito-urinary symptoms of menopause (GUSM).  It is a very common condition affecting millions of women in the menopausal range as well as perimenopausal women.   Sadly, only a small fraction of women, an astoundingly low 7%, seek out treatment from their physicians.   

Let’s get your mojo back and return your vagina to happier times!

First, let’s understand WHY this is happening.  It has to do with menopause – when estrogen levels plummet causing the vaginal tissues to change and perimenopause when fluctuating hormones wreak havoc too!

To better explain this, let’s look at the vaginal tissue during the premenopausal time vs. the postmenopausal time:

Premenopausal                                                                      Postmenopausal

Good blood flow                                                                    Decreased blood flow

Lining is thick and moist                                                        Thin, dry lining

Vaginal walls are elastic                                                         Diminished vaginal elasticity

Lubrication is present                                                            Absence of lubrication

Now that you know what causes it, what can YOU do about it?

I will first start with tips which you can do, buy or get for yourself:

 (The vaginal products that contain hormones, such as estrogen and DHEA, are prescription-only and need to be given to you by your medical provider.)

Lifestyle tips:

–          Avoid harsh soaps, chemicals and douching – these change the vaginal pH and cause irritation, discomfort and increased risk of infection.

–          Make dietary changes; increase your intake of omega-3 FA, flaxseed, Vitamin C and Vitamin E and stay well hydrated.  A well-hydrated body makes for a healthier vagina :).

Over-the Counter Products:

Vaginal lubricants – These provide only a slippery barrier during sex to reduce friction and do NOT change or heal the vaginal tissues. There are three different types:  water, oil or silicone-based. Remember that oil-based lubricants can break down latex condoms which help with STD protection.   Some water-based lubricants may cause vaginal dryness due to the high osmolality, pulling water out of the vaginal walls, leading to irritation, infection and tissue damage.  In general, silicone-based lubricants are recommended and coconut oil is a great, natural organic alternative.

Vaginal moisturizers – These products change the water content of the cells, resulting in more elastic, thicker and more plush vaginal tissue.  Moisturizers, unlike lubricants, need to be used consistently, and NOT at the time of sex.  Usually twice a week is sufficient.  The 2 most popular over-the-counter moisturizers are Replens and Revaree – which contain hyaluronic acid.

Hormone-containing products – From Rings to creams to tablets to inserts…

These products require a prescription from your health care provider and contain hormone (s) that act locally on the vaginal walls to restore elasticity and lubrication.  They also alleviate other common symptoms during this time including decreased urinary urgency and prevention of recurrent urinary tract infections.

Estring – vaginal ring releasing small amounts of estradiol which is inserted every 3 months.

Estrace/ Premarin vaginal creams – These come with an applicator and usually ¼ applicator is used twice a week.

Estradiol tablets: Vagifem, Yuvafem and other generic, come in disposable single use applicators used 2x/ week.

Estradiol vaginal inserts: Imvexxy – easy to use and is inserted with your finger without any applicator and is less messy than creams.

DHEA vaginal inserts: Intrarosa, vaginal suppositories that contain DHEA- a building block for both estrogen and testosterone, placed with an applicator every night – yet most patients can use every 2- 3 days. 

Oral Osphena – for those of you who do NOT want to apply anything directly into the vagina, there is an oral FDA- approved alternative, Osphena, which acts as a SERM – selective estrogen receptor modulator, activating estrogen receptors in your vaginal walls for more blood flow, lubrication and elasticity.

What else is available? 

Laser treatments, the most common one is known as Mona Lisa, use a C02 laser to increase vaginal lubrication and elasticity by increasing collagen, fibrin and blood supply.  Most treatments require three treatments spaced 6 weeks apart, with annual maintenance treatments thereafter.

As you can see, there are MANY options and no need for any more pain or “knife-cutting, Saharan deserts”.  Speak to your Gyn. specialist and see which is best for you and start feeling like yourself again!

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