Vaginal walls are well lubricated with a thin layer of transparent fluid. This keeps the lining of the vagina thick and stretchy. This moisture is maintained by the hormone estrogen, and a decline in estrogen’s level reduces the amount of fluid keeping the vagina healthy.
Initially, it doesn’t affect you much apart from minor irritation, but then it develops into an extremely uncomfortable condition characterized by itching and burning. Also, if left untreated, vaginal dryness can affect your sex life.
What causes a reduction in vaginal lubrication?
Vaginal dryness is a very common cause of menopause. As almost every other woman goes through menopause, vaginal dryness is also expected. This condition gets recurrent after the menopausal stage.
The vagina gets narrower and less elastic, a condition termed vaginal atrophy.
Other instances in which estrogen levels drop are during childbirth and breastfeeding, chemotherapy, surgical removal of ovaries or anti-estrogen medicines used for endometriosis or uterine fibroids, douching, antidepressants, antiallergic medicines, or Sjogren’s syndrome which is an autoimmune disorder in which your body attacks the moisture producing cells.
How is vaginal dryness diagnosed?
Once a woman is experiencing this uncomfortable situation, it becomes a pressing need to get assessed by a gynecologist. Before providing a treatment plan, the doctor will follow certain steps to diagnose the exact cause.
They will inquire about your medical history and then will proceed towards the present condition by asking about symptoms and possible triggers.
A pelvic examination is also required to examine the vagina for any redness or thinning. This helps rule out vaginal or urinary tract infections. Vaginal atrophy can be indicated if your vagina seems narrowed, there is loss of stretch in the skin, sparsity of pubic hair, dryness, redness, swelling or whitish discoloration of the vagina, dermatoses, vulvar lesions, erythema, bladder sagged into the vagina, urethral lesions, bulge in the back wall of the vagina and minor cuts near the vaginal opening.
Pap tests may also be performed for which the doctor scrapes off some tissues from your vaginal wall or cervix. Other tests that are performed consist of urine samples, ultrasound, serum hormone, and vaginal pH
How is vaginal atrophy treated?
The most common treatment method is to make up for the loss of estrogen through topical estrogen therapy i.e through creams. These help up to some extent but are not as effective as pills used for hormonal therapy.
The most commonly used vaginal estrogen is in ring form, tablet, or cream.
Estring is a soft and flexible ring, inserted into your vagina. There it releases a stream of estrogen directly into the tissues. This ring needs to be replaced after every 3 months.
Vagifem is the tablet form of estrogen. You need a disposable applicator to insert this tablet into your vagina. The dose is repeated once daily for two weeks. It is then increased to twice daily for a week until discontinued.
Estrace and Premarin are the topical forms of estrogen. These creams are also applied through an applicator daily for 1-2 weeks. The dose is dropped to 1-3 times a week as per the consultant’s instructions. Topical estrogen is not suggested in case of a woman having breast cancer, a history of endometrial cancer, vaginal bleeding, or in case of pregnancy or breastfeeding.
Other products to use include vaginal moisturizers available at local pharmacies. Ospemifene, an oral medicine, makes vaginal tissues thicker leading to less pain for women during intercourse, although FDA warns that this drug can thicken the lining of the uterus and can cause blood clots.
Vaginal atrophy is a discomfiting condition that shouldn’t be ignored as it might grow into a more painful situation. Avoid using scented soaps, douches, bubble baths, and lotions around the vaginal area as these might just aggravate the situation.