I have an embarrassing problem. I am 52, and have been happily married for 18 years. Lately my vagina seems drier than it used to be and, after sex, I’m having burning and a feeling of raw soreness. Is there something wrong with me, and what can I do about this?
Parched in the Privates
Welcome to Part Two of the Wonderful World of Womanhood. Part One included such treats as bleeding, cramps, and childbirth. Just when you’d gotten a handle on all of that, Part Two comes along bringing with it vaginal dryness, night sweats, and chin hairs. Lucky us.
There is no reason to be embarrassed. You are not alone. Nearly one-half of all women will experience vaginal dryness due to the decline of estrogen that occurs as a result of menopause.1 Vaginal dryness is just one of the symptoms of something called vaginal atrophy (Aack!). Other symptoms of vaginal atrophy are burning, soreness, painful intercourse, and frequent UTIs.2
What is happening is that your plump and pretty little ovaries—which are where your estrogen is produced–are shriveling up and wasting away. Check out this super-scientific illustration that will help you visualize what exactly is happening:
Because of this ovarian atrophy, your vagina, once a verdant garden of pleasure,
can become a dried-up wasteland.
What is a girl to do?
The first step is to see your doctor and tell her what is going on.
Here’s the thing…
Patients expect the doctor to mention stuff like this, but doctors often don’t say anything about vaginal dryness because they wait for the patient to say something. If you don’t say anything then your doctor will assume that you don’t have a problem. Besides, I don’t know about you, but I don’t find a vaginal exam all that stimulating. The doctor can’t really tell during a typical exam that you aren’t lubricating during sex. She’ll just assume that you are, unless you tell her you aren’t.
After a thorough internal exam, your doctor will likely recommend one or more of the following treatments:
There are several good water-based lubricants on the market today, like KY and Astroglide. Lubricants are often a good first step in treating mild vaginal dryness. Avoid the ones with irritating chemicals that promise to give you a “new sensation” because that new sensation might be the feeling like your vagina is on fire.
Replens, is a long-acting, non-hormonal vaginal moisturizer that “contains a bioadhesive that allows it to attach to dry, compacted cells and deliver continuous moisture until those cells are naturally regenerated.” You apply Replens during non-sexy-time every 3-5 days to keep your tender lady parts supple and moist, and ready for action whenever the mood strikes.
Numerous clinical trials have show that Replens is just as effective as vaginal estrogen in treating vaginal dryness, making this a good choice if hormone replacement therapy is not an option for you due to concerns about cancer.3
Vaginal Estrogen Therapy
Estrogen therapy became very controversial after a large longitudinal study called the Women’s Health Initiative found that “synthetic progesterone, when used with synthetic estrogen, increases the risk for breast cancer in some women.” This finding has been repeatedly reported in the media and many women are now afraid to take estrogen for fear of breast cancer.4
This isn’t the time nor the place to explore this complicated issue, but if you are interested in doing research for yourself here’s a couple of links to start.
- Dr. Joseph Mazzei over on The Perimenopause Blog gives an interview on the safety of estrogen.
- Dr. Oz’s expert gynecologist, Dr. Streicher, writes specifically about the safety of vaginal estrogen.
Vaginal estrogen is considered more effective in treating vaginal atrophy than oral estrogen. And, since vaginal estrogen enters the blood stream in very minuscule quantities , they are safer than oral estrogen for women with cancer concerns. Studies show that bioidentical vaginal hormone replacement therapy is just as effective as synthetic hormone replacement.5
Vaginal estrogen therapy comes in creams, rings, and suppositories. Oh my.
- Creams, like Estrace and Premarin, are messy, but can be useful in keeping external vaginal tissue plump and moist.
- The vaginal estrogen ring, Estring, is convenient and not messy.
- Suppositories, like Vagifem, are less convenient than the ring, but not as messy as creams.
Rings and suppositories might not be enough if you are experiencing atrophy of the labia and clitoris (Aack!) This is why some doctors prescribe Vagifem or Estring for internal use and vaginal cream for external use.
There is no scientific evidence that herbs like Black Cohosh help at all. One study done on 350 women showed no benefit when compared to a placebo.6
Some women use natural oils like coconut or olive to moisturize vaginal tissue. I’m not a fan because oils like this are messy, and ruin your underwear.
Use it or Lose it
The truth is that your vagina is a muscle that was made for sex. Women who engage in regular sex have less chance of developing vaginal atrophy. It’s really as simple as that.
Even a good sex life may falter during middle-age. Doing the same things over and over again after so many years together can get boring. Talk to your husband. You may need more foreplay and/or something new to spice things up. Now is the time for adventure and reconnecting with your mate.
Sex not only keeps your vagina healthy, it keeps you healthier overall. People who have active sex lives are happier and live longer.7 Sex is what you do when you aren’t dead. Once you stop having sex, you are on the sure road to dead.
So, see your doctor, find the treatment that is right for you, and, please, keep having sex.
- http://www.ncbi.nlm.nih.gov/pubmed/8293835 (prevalence of vaginal atrophy)
- http://www.nlm.nih.gov/medlineplus/ency/article/004016.htm (Aging changes in the female reproductive system)
- http://www.ncbi.nlm.nih.gov/pubmed/20828948 (Replens as effective as hormonal replacement)
- http://www.ncbi.nlm.nih.gov/pubmed/22942807 (Vaginal Estrogen in post-menopausal breast cancer patients)
- http://www.ncbi.nlm.nih.gov/pubmed/10810960 (Vagifem versus Premarin Vaginal Cream
- http://www.mayoclinic.com/health/vaginal-atrophy/DS00770/DSECTION=alternative-medicine (Black Cohosh ineffective in treating vaginal atrophy)