This is the fourth in a series of articles on menopause titled: Menopause: Not for the Faint of Heart. My last article was about prescription medications that treat the symptoms of menopause.
Now I’m going to tackle a subject that a lot of women find uncomfortable. The topic is vaginal dryness during and after menopause.
Because estrogen levels are lower during menopause, 3 out of 5 women experience vaginal dryness. Before menopause high levels of estrogen keep vaginal tissue healthy by maintaining normal lubrication, acidity and tissue elasticity. When vaginal tissue is healthy it provides a natural defense against vaginal and urinary tract infections. Menopause (and decreased estrogen) leads to a thinner, less elastic vaginal lining, which in turn can lead to dryness, burning, itching and painful intercourse. To make matters worse, many medications have side effects that decrease moisture in your body (including the vagina). Allergy medicines, OTC cold remedies and some antidepressants are just a few of the culprits.
If you’re bothered by vaginal dryness, the first step to take is vaginal moisturizers. Moisturizers such as Replens and Lubrin can be purchased over the counter at pharmacies. They work to relieve dryness for up to 3 days with a single application by imitating normal vaginal moisture. Avoid using vinegar, yogurt or other types of douches, hand lotions, scented soaps and bubble baths because they can irritate the area and make matters worse. To prevent pain and irritation during sex always apply a water based lubricant such as K-Y or Astroglide to both your vaginal opening and your partner’s penis.
If you are still bothered by vaginal dryness the next step is to make an appointment with your doctor. She can prescribe vaginal estrogen therapy. Estrogen applied to the vagina won’t decrease your testosterone levels (essential for sexual function) and is minimally absorbed into the blood stream. Vaginal estrogen therapy comes in several different forms. The most common are creams, such as Estrace and Premarin that you insert into your vagina with an applicator at bedtime. These are used daily for a few weeks and then 2-3 times per week thereafter. You could be prescribed a tablet called Vagifem that is inserted via disposable applicator into the vagina daily for the first 2 weeks and then twice a week thereafter. Finally, there is an estrogen ring called Estring that is a soft, flexible ring inserted into the upper part of the vagina. The ring releases a constant dose of estrogen for 3 months, at which time it is removed and replaced. None of these methods combat hot flashes or any other symptom of menopause. They are only used to treat vaginal dryness.
Sex can be wonderful during this time of life, but it can be painful both during and after if you suffer vaginal dryness. As embarrassing as it is you need to be open and honest with your partner. You don’t need to be celibate — try my suggestions and talk to your doctor so that you can continue to be the vibrant sexual woman you’ve always been.