As I have a particular interest in the menopause, many of my female patients are very comfortable talking to be about their hot flushes and night sweats. However, even the ones I have know for many years are often really reserved and not forthcoming when talking about their dry vaginas!
There is no subject that embarrasses me when I'm talking with my patients. I find I need to be increasingly direct when asking very personal questions when determining if a woman has any difficulties having sex and whether she is experiencing any soreness or irritation in her vagina. This is usually because women are embarrassed and do not realise how common vaginal dryness is.
Key facts about vaginal dryness
So what is vaginal dryness? When the amount of oestrogen reduces in our bodies our vaginas become less lubricated and stretchy. This reduction in oestrogen is often due to the menopause but it can also be due to breast-feeding, taking the oral contraceptive pill, or some types of medications (such as anti-depressants, antihistamines or tamoxifen). Using chemical products such as medicated wipes, sprays or even some types of washing powder can lead to vaginal dryness.
Vaginal dryness or atrophy is also called atrophic vaginitis. Some doctors refer to it a genitourinary syndrome of the menopause (GSM), as it is not just your vagina that is affected. The low levels of oestrogen in your body can also lead to thinning and weakening of the tissues around the neck of your bladder, or around the opening, where you pass urine (the urethra). For example, urinary symptoms that may occur include an urgency to get to the toilet and recurring urinary infections or cystitis.
Why women need oestrogen
Oestrogen is important because it acts as a natural lubricant in your vagina and helps to keep this area healthy and moist. Oestrogen also stimulates the cells that line your vagina to produce glycogen. Glycogen is a compound which encourages the presence of helpful germs (bacteria) which protect your vagina from infections.
This lack of oestrogen tends to cause the tissues around your vagina to become thinner, dryer and inflamed. These changes can take months or even years to develop and varies between women.
Your vagina may shrink a little and expand less easily during sex, making sexual intercourse more painful or uncomfortable. Your vulva may become thin, dry and itchy. You may notice that your vulva or vagina has become red and sore. You may also find you have episodes of thrush more frequently. Many women have symptoms of vaginal pain and discomfort throughout the day, so it is often not just a problem to those women who are sexually active.
As the skin around your vagina becomes more sensitive it is then more likely to itch. This can make you prone to scratching, which then makes your skin more likely to itch, and so on.
All these symptoms can be present long after your menopause, even when you do not have any other symptoms. They are very common symptoms that affect the vast majority of women at some time after the menopause. You are also more likely to experience symptoms, as more years pass after your menopause. They occur in at least seven out of 10 women after the menopause and can occur even if you are taking hormone replacement therapy (HRT).
The good news is that there are really effective treatments available. The usual treatment is replacing the oestrogen in your vagina and the surrounding tissues. A cream, vaginal tablet or ring containing oestrogen is often prescribed and they work really well. A vaginal tablet is a very small tablet that you insert into your vagina with a small applicator. The vaginal tablets and creams are usually used every day for two weeks, and then used twice a week thereafter. The ring is a soft, flexible ring with a centre that contains the oestrogen hormone. This ring releases a steady, low dose of oestrogen each day and it lasts for three months.
Using topical oestrogen in this way is not the same as taking hormone replacement therapy (HRT) and therefore does not have the same risks associated with it. This is because these preparations work to restore oestrogen to your vagina and surrounding tissues without giving oestrogen to your whole body. These preparations can be safely used by most women and also can be used on a regular basis over a long period of time (usually indefinitely) as your symptoms will usually return if you stop this treatment.
Vaginal lubricants and moisturisers can be used either with hormones or on their own and are usually also very effective. These are available either from your doctor, or to buy from various chemists. There are many different products available and it is important that you find one that suits you. These can be prescribed by your doctor, obtained from chemists or directly from the manufacturers. Moisturisers are used regularly, whereas lubricants are usually used during sexual intercourse.
Your symptoms should improve after about three weeks of treatment. You should see your doctor if your symptoms do not improve, as sometimes these symptoms can be due to other conditions. It is also very important to see your doctor if you have any unusual bleeding from your vagina if you are receiving hormone treatment.
Dr Louise R. NewsonBSc(Hons) MRChB(Hons) MRCP FRCGP is a GP and menopause expert, based in Solihull, West Midlands, UK.
Follow her on twitter: @mymenopausedr