Vaginal dryness – no one talks about it but it’s common

I was at the National Women’s Show (NWS) in Toronto this weekend raising awareness about vaginal dryness.

Between 10% and 40% of menopausal women have at least one of these signs and symptoms – vaginal dryness, itching, burning, and discomfort or pain during sex. And even though this is a common problem, very few women talk about it and get relief for it.

At the NWS I would approach women and ask them if I could ask them a question about the health of their vaginas; sometimes I would ask them if they have discomfort, dryness, or itching, sometimes I would show them a card with this question:

TRUE OR FALSE
Vaginal dryness affects millions of women worldwide?

About 10% of the women ignored me, 20% quickly moved away from me as if I had a contagious disease, 20% said they didn’t have any problems, and 50% of women engaged in conversation to varying degrees (some of them mainly wanted a drink of water from the fountain we offered at our booth!).

Testimonial wall about vaginal dryness at the Replens booth, National Women’s Show, Nov 2019

Here’s some of what I heard:

Some women who’d had breast cancer had been told by their oncologists to use hormone-free lubricants during sex.

Some women were seniors and had vulvar (the fleshy parts that touch your clothes) dryness and itch, and needed some relief externally.

Some women shocked the female friends they were with when they told me that sex had become uncomfortable and they had tried lubricant—it was obvious women aren’t sharing these intimate issues with their friends!

When we started talking about how important it is for us to talk about these issues all agreed and some shared that they were going through similar experiences. It goes to show the importance of awareness and how many women are affected and yet so few speak up and seek help.

I also spoke to women who confided to me that they had stopped having sex because it was painful but they would love to be intimate with their partners again. How could I help them? My motto on the weekend was, SAY NO TO PAIN, NOT TO SEX!, added to my usual motto, There’s help. I can help you!

There are several products that can help restore moisture to the vagina, decrease discomfort and pain, and increase pleasure during sexual activity. There’s no need to suffer alone and in silence and jeopardize your relationships.

Let’s get into causes and relief.

CAUSES

One of the most common causes of vaginal dryness is menopause. Menopause is the natural transition that all women experience – it is the end of ovarian function, ovulation, menstruation, and fertility. As a result of menopause, estrogen levels decline, and because estrogen is the predominant female hormone and acts in so many tissues and organs of the body, many women experience physical, emotional, and cognitive changes during the menopause transition, like hot flashes and night sweats, sleep disturbances, mood swings, and vaginal dryness.

Most women experience menopause as a transition that occurs over the course of many years. There are three stages of menopause:

Peri-Menopause

5 to 10 years prior to actual menopause when physical signs of menopause begin due to hormone fluctuations.

Menopause

Confirmed when a woman hasn’t had any bleeding for 12 consecutive months. In North America the average age of menopause is 51 years. Menopause can also be caused by the surgical removal of the ovaries, or by certain medications that damage ovarian function, like chemo and radiation to treat certain cancers.

Post-Menopause

The years after menopause. Because Canadian women are expected to live until 84, many of us will spend one-third of our lives in post-menopause.

During the menopause transition most symptoms, like hot flashes and night sweats, get better with time, but vaginal dryness tends to get worse. Estrogen helps keep vaginal tissues healthy by maintaining normal vaginal lubrication, tissue elasticity, and acidity, and low estrogen levels can affect the vagina and urinary tract during menopause.

Over time, the vaginal lining can get thinner, dryer, and less elastic.

Women may feel vaginal burning and itching, more frequent vaginal and urinary tract infections, and frequent urination and decreased lubrication during sex which can lead to painful intercourse.

When a woman is sexually stimulated her vaginal tissues produce lubrication that aids with sexual penetration. In menopause, due to lack of estrogen, the vaginal cells do not produce as much moisture and sexual penetration may become uncomfortable and even painful. Vaginal dryness worsens 5 to 10 years following menopause because of this lack of estrogen on the vaginal tissues.

RELIEF

Several treatment options are available over the counter, without a prescription, and some can be prescribed by your family physician or gynecologist.

Treatment options available over-the-counter:

Vaginal moisturizers and lubricants

Moisturizers and lubricants can help relieve vaginal dryness and painful sexual intercourse. Moisturizers are used on an ongoing basis and lubricants are used during penetration.

These products offer relief but do not treat the problem – the thinning of the tissues that line the walls of the vagina and the shrinking of the external features of the vulva (labia minora, labia majora, and the clitoris).

Treatment options available on prescription:

Vaginal Hormone therapy

Some women experience narrowing of the vaginal opening which can make penetration painful. In this case the best treatment is local, low-dose topical hormone therapy (HT), available by prescription.

These products are available as ovules (estradiol) and cream (conjugated estrogens) that are inserted in the vagina. Because they are used locally in the vagina, studies show that the hormones are not absorbed systemically (do not cause any effects on other parts of the body) and have fewer adverse effects than HT used in pill form or patch.

A new medication recently approved in Canada for the treatment of post-menopausal vaginal atrophy contains prasterone (DHEA), a natural steroid.

Another prescription product to treat vaginal dryness may be available in Canada soon and it is a hormone-free tablet, taken by mouth.

If your doctor doesn’t ask you about the health of your vagina and how it may be affecting your quality of life, self-esteem, and relationships—unfortunately the majority of doctors do not give women an opportunity to discuss these topics—I hope you have read enough here to encourage you to approach your family doctor, gynecologist, or me to discuss what’s going on with your vagina and how to improve your symptoms, sex, and quality of life.

Let’s break the menopause taboo. Let’s talk about menopause.

Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.

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