You Might Be In For a Dry Spell

One of the many joys of menopause is dealing with the fallout from the estrogen drop. In addition to stopping our periods, the lack of estrogen has direct effects on our lady parts. It causes these already delicate tissues to become thinner, drier, and even more sensitive to any physical, sexual, or chemical activity going on down there. It can lead to some uncomfortable symptoms like pain and bleeding following sex, UTIs, and lots of general unpleasantness.

It’s called vaginal atrophy, and about half of women going through menopause will have symptoms, usually in the postmenopausal years. And it’s not just menopause; many things that lead to a drop in estrogen can cause vaginal atrophy.

Unfortunately, whether from embarrassment, cultural or religious reasons, or lack of awareness, most women don’t seek treatment for this condition.

Treatment and management options exist, and that’s important to know because unlike other symptoms of menopause, this one isn’t going away on its own or over time. Vaginal atrophy symptoms will remain if untreated.

That’s not good if you planned on using those parts again. So, what can you do to prevent or improve vaginal atrophy?

What is vaginal atrophy?

If you’re googling symptoms of this condition, you might find it under a variety of names–vaginal atrophy, atrophic vaginitis, urogenital (or urinogenital) symptoms, vulvovaginal atrophy (VVA), and more. But more than likely, you’ll find those terms after googling the condition’s chief symptom: vaginal dryness.

Vaginal atrophy might start with dryness, but it can quickly become more than that. Here’s the full gamut of symptoms:

  • Vaginal dryness
  • Vaginal burning
  • Genital itching
  • Pain during sex
  • Spotting/bleeding following intercourse
  • UTIs or symptoms of them including:
    • Pain when urinating
    • Urinary incontinence
    • Urinary urgency

There are also changes to the structure of the vagina–it tends to get shorter and narrower– which can lead to dyspareunia, aka painful intercourse. Even uterine prolapse–a condition in which the pelvic floor muscles and ligaments weaken, causing the uterus to sag into the vagina–can occur. In addition, estrogen changes have shown to increase rates of UTIs in menopausal and perimenopausal women.

To be more inclusive of all the symptoms that fall into the category of those affecting our nether regions, the term genitourinary syndrome of menopause (GSM) is now used.

What causes these symptoms?

To add to the nomenclature confusion, vaginal atrophy is now included in the term genitourinary syndrome of menopause (GSM). Officially, GSM includes all the symptoms listed above and explains the root cause: a drop in estrogen causes the tissues of the vagina, urethra, and surrounding areas to become thinner and more fragile. Lack of estrogen also leads to a decrease in the normal fluids of the vagina.

How it’s diagnosed

Vaginal atrophy or GSM, like many symptoms of menopause, isn’t something you can test for–instead, doctors rely on clinical diagnoses, i.e., identifying common symptoms. Still, GSM can cause changes in the appearance of the vaginal mucosa (the mucous membranes that line the vagina) as well as the structure and appearance of the vaginal canal itself, so doctors often do a comprehensive exam to see what’s going on.

While you can’t diagnose GSM based on pH alone, a quick pH test can provide clues.

Risk factors

Other things can cause vaginal dryness besides just menopause. In general, anything that can cause a drop in estrogen can cause symptoms of GSM. The following things have been shown to contribute to or exacerbate symptoms:

  • Lack of sex
  • Immune disorders
  • Noncirculating hormones/other hormonal issues
  • Some medications
  • Smoking
  • Breastfeeding

Who gets it?

About 50% of those who go through menopause will show symptoms of GSM, but only 15% experience them during perimenopause; GSM is more likely to occur postmenopause. Sadly, 70% of women who have symptoms don’t seek care. Many aren’t even aware treatment is possible, while others may avoid telling their doctors due to embarrassment. As a result, less than 25% of women with symptoms of GSM receive treatment.

How sex can hurt

The symptoms of vaginal atrophy can certainly complicate intimacy. By looking closer at what’s happening, we see why: plummeting estrogen means less blood flow to the vagina and surrounding areas, which impacts the integrity of already sensitive tissues. “The top layer of the epithelium (the cells lining the vagina) may be entirely lost, leaving the layer below vulnerable to inflammation, infection, or trauma when it’s exposed to any pressure,” says Harvard Health.

Unfortunately, “pressure” pretty much includes some things one would normally do with a vagina, such as have sex or get a pap smear. In fact, “minor cuts or lacerations” around the vaginal opening can be part of the diagnostic criteria for GSM.

So, your lady bits have turned to tissue paper, what else? Oh, there’s the fact that sex without good lubrication hurts, and can lead to more damage. Pain, burning, and spotting are common after sex.

Ouch! It probably sounds like enough to put you off sex altogether. But you probably don’t want to stop now; there’s evidence sex can actually prevent or improve vaginal atrophy. There are ways to avoid the sandpaper, Sahara Desert situation and it’s worth treating.

How sex can help

While it’s true sexual activity can be rough on sensitive tissues, if precautions are taken, it can actually help. Huh? Subjecting sensitive parts to “rigorous activity” can actually help? That’s right–the lining of the vagina became stronger after more activity, according to Harvard.

The definition of “atrophy” says it all. If you google the word “atrophy”, the second definition is “to waste away from underuse or neglect”… you don’t want your lady bits to literally dry up and waste away from underuse or neglect, do you?

In fact, sexual activity can potentially improve symptoms in a number of ways. The activity helps increase blood flow to the area, helps to maintain the elasticity of vaginal tissues, and improves natural lubrication through arousal. Sex has even been shown to help maintain vaginal pH, which can help safeguard against infections. No partner? Don’t worry–the aforementioned Harvard article notes that you can still reap the benefits by taking things into your own hands.

The underlying message here is clear… use it or (potentially) lose it!

How to find treatments for GSM

Of course, if you’re already struggling with symptoms, sex is probably the last thing on your mind. Luckily, there are ways to make you more comfortable so you don’t have to sacrifice your love life.

Lubricants

One of the easiest ways to treat GSM is to use a product that adds moisture, such as a water-based lubricant. Treating the dryness helps avoid the friction that can cause damage to happen.

There are lots of options to choose from, including natural remedies. Just be careful–there are lots of products and treatments that can help, but there are also quite a few things to avoid, including glycerin, petroleum jelly, or anything with perfumes or other possible irritants. Stick to water- or silicone-based products such as KY Jelly or Astroglide.

What if lubricants don’t help?

Sometimes, OTC treatments aren’t enough. If that’s the case for you, your doctor might recommend various types of hormone therapy. Using hormones to control vaginal atrophy may be effective, but there can also be risks.

You don’t have to take hormones systemically; in this case, local estrogen can treat symptoms using a vaginal cream with a low dose of estrogen. If OTC or natural therapies don’t help your symptoms, it’s worth talking about the options with your doctor.

The bottom line

If you have to deal with vaginal atrophy, remember treatments are available. Sometimes a tube of KY is the only thing you need to feel relief. But if not, don’t suffer in silence! It’s worth the effort to figure out what helps you get back to feeling more like you.

 

References

Bleibel, B., & Nguyen, H. (2021). Vaginal Atrophy. Treasure Island, FL: StatPearls Publishing.

Holland, K. (2021, February 21). Ways to Reverse Vaginal Atrophy. Retrieved February 24, 2021, from https://www.healthline.com/health/womens-health/can-vaginal-atrophy-be-reversed

Mac Bride, M. B., Rhodes, D. J., & Shuster, L. T. (2010). Vulvovaginal atrophy. Mayo Clinic Proceedings,85(1), 87-94. doi:10.4065/mcp.2009.0413

Publishing, H. (n.d.). Managing postmenopausal vaginal atrophy. Retrieved February 25, 2021, from https://www.health.harvard.edu/womens-health/managing-postmenopausal-vaginal-atrophy

Santoro, N., Epperson, C. N., & Mathews, S. B. (2015). Menopausal symptoms and their management. Endocrinology and Metabolism Clinics of North America,44(3), 497-515. doi:10.1016/j.ecl.2015.05.001

Vaginal atrophy (ATROPHIC Vaginitis): Symptoms & treatment. (n.d.). Retrieved March 02, 2021, from https://my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy

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Introduction

If you’re reading this, you’re probably experiencing some phase of menopause, or you’re one of our moms. Either way, welcome.