Vaginal dryness affects far too many women in silence, but it is a very treatable condition.
Vaginal dryness, whether it is short-lived or persistent, has the power to derail even the healthiest, most fulfilling sex life. Lack of lubrication—and the painful sex that frequently follows—can occur for a variety of causes and at different stages of life.
Breastfeeding, chemotherapy, and radiation can all cause cellular damage and low estrogen levels, which in turn compromise the ability of vaginal tissue to remain lubricated and elastic. This is a concern particularly after menopause. Additionally, some drugs (such antihistamines and decongestants) may have undesirable side effects.
But far too many women suffer in silence, oblivious to the fact that this is a very solvable problem. Additionally, doctors frequently avoid the subject or are unfamiliar with the available treatments. So allow me to assist with some frequent question and response examples.
My doctor suggested I try a vaginal lubricant. How do you use these, and which one is best?
During sexual contact, lubricants are used to lessen friction. Types of silicone that I advise: They are less irritating to the area, more slippery, and last a lot longer than water-based ones (so you don't need to use as much). Although water-based lubricants are less expensive, many of them are gloppy and sticky and may include the irritant propylene glycol preservative. Before having sex, lubricate your partner and the opening of your vagina.
What are vaginal moisturizers, and how are they different?
Lubricants don’t alter vaginal tissues; they just make them more slippery. A long-acting over-the-counter moisturizer, on the other hand, increases the water content of the cells, making vaginal tissues thicker, more elastic, and better able to produce lubrication. They need to be used two to five times a week and should be inserted in the vagina and applied around the vaginal opening. Two with proven clinical results: polycarbophil gel (Replens Long-Lasting Vaginal Moisturizer) and hyaluronic acid vaginal gel (Hyalofemme).
What about vaginal estrogens?
Sometimes a woman’s vaginal walls are so thin and dry that a prescription medication is needed. One option: local vaginal estrogens. Before you think, Oh, no, estrogens! Breast cancer, blood clots, bad stuff..., know that there are no proven safety issues with these products. There are three types: vaginal creams (inserted and spread on outer areas), vaginal tablets (inserted twice weekly), and vaginal rings (which last three months).
Are there treatments for women who want to avoid estrogen?
One option is ospemifene, a daily pill—taken orally, not vaginally!—that activates estrogen receptors in vaginal tissue to alleviate painful intercourse in post-menopausal women. The FDA recently approved a daily vaginal suppository, prasterone, or DHEA, which also works inside vaginal cells to increase lubrication and elasticity. And finally, many doctors now offer FDA-cleared medical CO2 laser treatments in their offices, to stimulate and regenerate vaginal and vulvar cells. These treatments should be performed only by a gynecologist, not by a plastic surgeon or dermatologist.