Are you avoiding intimacy with your partner because sex has become painful? Understanding the causes and treatments available for one of the most common menopausal symptoms can help bring intimacy back to your relationship.
Given the very personal nature of this issue, it’s no wonder that many women don’t openly seek help from their doctor; and, unfortunately, many suffer in silence. However, if you don’t take the initiative and have your symptoms checked, vaginal atrophy can have a serious negative impact on your confidence and put strain on your relationship.
What is vaginal atrophy?
Vaginal atrophy is drying, thinning, and inflammation of the vaginal walls as a result of a woman’s body producing less oestrogen. Oestrogen is the hormone that helps keep the tissues in your vagina lubricated and healthy. It’s also responsible for producing certain acids that maintain the pH balance of the vagina, which protects against infection. Vaginal atrophy mostly happens during menopause, but for many women continues post-menopause.
Before the onset of menopause, your vagina is normally moist, red, and plump; but vaginal atrophy means that the tissue in your vagina becomes frail, and the lining gets thinner, drier, and less elastic. It also causes the folds and ridges to gradually disappear, and the color begins to change to pale pink or bluish.
This is a very common menopausal symptom with research suggesting that it affects 50-70% of women. These symptoms, if left untreated, can have significant impacts on your health, sex life, self-esteem, and overall quality of life. The following are some of the symptoms that should signal you to call your doctor.
- Vaginal dryness (it feels like sandpaper being rubbed when you have sex)
- Itching and/or burning before, during, and/or after sex
- Thrush-like symptoms
- Pain or aches in the vagina or vulva
- Pain during intercourse
- Internal and external irritation
Ongoing pain during sex (known as dyspareunia – “dis-puh-roo-nia” – in medical jargon), if left untreated, can lead to decreased sex drive as well as problems with arousal and orgasms, while the psychological impact can negatively affect your sexual confidence and self-esteem.
Another reason to seek treatment is that you may also encounter problems in your urinary tract. These include infections that lead to irritation, incontinence (peeing when you sneeze), and an increased frequency of urination (because your bladder has shrunk to the size of a walnut). Please see your doctor if you notice any of these symptoms.
The most common cause of vaginal atrophy is a decrease in oestrogen levels during menopause. Before the onset of menopause, the role of oestrogen is to stimulate vaginal secretions, which in turn protect the tissues of the vagina. When oestrogen levels drop, as they do in menopause, the walls of the vagina become thinner, and secretions struggle to get activated.
Vaginal atrophy can also be experienced after childbirth. In this case, the changes are temporary and less severe. The use of hormones or medications for the treatment of endometriosis, infertility, fibroid’s, or breast cancer can also lead to a decrease in oestrogen (and vaginal atrophy).
It can also be caused by treatments to the pelvic area, severe stress, chemotherapy, uncontrolled diabetes, or depression. Younger premenopausal women who have had surgery to remove their ovaries are also at risk for developing vaginal atrophy.
Personalised treatment is key when it comes to vaginal atrophy. Allow your healthcare provider to recommend a solution that takes into account your medical history, symptoms, lifestyle, and treatment goals.
Generally, the available treatments for vaginal atrophy aim to improve the overall quality of a woman’s life (sex life) by alleviating the distressing symptoms of the condition. The following treatments can be either hormonal or non-hormonal.
The first option is to consider over-the-counter lubricants and vaginal moisturisers. These are available without a prescription. While there is no significant evidence that they actually treat vaginal atrophy, they can help to alleviate vaginal dryness and discomfort, at least in the short term.
Some over-the-counter lubricants include punctured Vitamin E gel caps (where the gel is placed in the vagina), Replens (a moisturiser that restores vaginal pH balance), and water-based lubricants that can be used with condoms and diaphragms. A variety of silicone-based lubricants are also available, which normally last longer than water-based products.
You should still be careful when choosing a non-hormonal treatment method, as some women experience sensitivity or allergic reactions to the components of lubricants and moisturizers. It is also recommended that women avoid petroleum-based treatments since they can disrupt the natural vaginal flora and lower the effectiveness of barrier contraceptives.
Topical oestrogen applications
Your doctor can prescribe treatments containing oestrogen, which include vaginal creams, rings, tablets and suppositories. These methods deliver oestrogen only to the vagina and surrounding tissues without giving it to the whole body. Usually, topical oestrogen treatments are applied every day for two weeks then twice a week thereafter.
While topical treatments usually work well, it’s worth noting that the symptoms might return after the course of treatment ends. Also, possible side effects of products with higher estrogen levels include breast tenderness, vaginal bleeding, nausea, and perineal pain.
Menopause Hormone therapy (MHT)
Menopause hormone therapy (MHT) involves using a patch, gel, or tablet that delivers oestrogen to the whole body. MHT is often considered the best treatment for various symptoms of menopause, including vaginal dryness. Even though MHT is very effective, there are advantages and disadvantages to its use, including various side effects. It is important to discuss the benefits and risks of MHT for treating vaginal atrophy with your doctor when considering this option.
There are other options to relieve the discomfort of vaginal atrophy, such as spending more time on foreplay. There are also various sex positions you can try that help minimise friction during sex. Using plenty of quality lubricant during sex also helps with friction. Regular aerobic exercise is also great for this condition, as well as pelvic floor exercise, such as Kegals.
While vaginal dryness can be a painful nuisance, the variety of treatments available means that it does not have to be debilitating. If your quality of life is being impacted by vaginal atrophy or dryness, have a conversation with your healthcare professional as soon as possible. You might feel awkward or embarrassed initially, but your doctor is the best person to help you find a solution that meets your needs, relieves your symptoms, and ultimately restores your quality of life.
IMPORTANT TAKE AWAY
♥Vaginal atrophy is caused by the decrease of oestrogen during/after menopause, ovarian surgery, chemotherapy, and other processes
♥Symptoms of vaginal atrophy include vaginal dryness, itching, burning, discharge, pain or aches in vagina or vulva, pain during intercourse, and urinary tract infections
♥Please see your healthcare provider and do not suffer in silence – it won’t just go away
♥A number of non-hormonal and hormonal treatments are available to relieve vaginal atrophy and improve your quality of life
♥Hormonal treatments for vaginal atrophy need to be discussed with your doctor to discuss advantages and/or risks
So ladies, let’s now talk.
How have you been affected by menopausal symptoms? Share with us what treatment you have tried by commenting below.
With love & gratitude
Michael Krychman, Vaginal Atrophy: The 21st Century Health Issue Affecting Quality of Life.
Vaginal Atrophy, Mayo Clinic.