The Best Ways to Manage Vaginal Dryness

By Eve Marx

Most of us have experienced it – changes, dramatic or not, to our most private parts. Whether it’s vaginal dryness, painful intercourse, vaginal itching or burning, painful urination, even a drop in our pelvic floor, these conditions are upsetting and may affect your overall feeling of health.

According to Dr. Lauren Streicher, menopause expert, book author and assistant clinical professor at Northwestern University’s Feinberg School of Medicine, at some point every woman will experience vulvar and vaginal changes. In an interview, Streicher, who authored Sex Rx, said very few women between the ages of 45 and 90 find their genitals functioning the same way they did when they were younger. And that is natural. These changes, she said, are caused by a decrease in estrogen.

“Biologically speaking, women aren’t meant to have sex after their reproductive years,” Streicher says. “Women in this age group can [also] have medical problems that get in the way. Heart disease, diabetes, depression, all impact normal sexual function.”   Statistically speaking, she said a woman who’s had a heart attack or has been given a cancer diagnosis is likely to never have sex again.

On the other hand, a healthy 70-year-old woman is capable of having the same sex life as a much younger woman. But if that’s your goal, you’ll have to be proactive. “Don’t count on your specialist,” Streicher says. “Most doctors don’t ask about your sex life unless you ask them.”

Unfortunately, there are many women who aren’t asking. While 75 percent of menopausal or post-hysterectomy women report vaginal atrophy as negatively impacting their lives, only 63 percent recognize the condition as a chronic situation, and even fewer women ask their gynecologist or other medical practitioner for help with the problem.

So what is the solution? Unlike many physicians, Streicher is not a big pusher of hormone replacement therapy or even bio-identical hormones. “I have not prescribed Premarin in years,” she says, referring to the popular HRT drug that uses pregnant mare urine as its primary ingredient.

She acknowledges that a growing number of women object to how the drug is made and how the horses (and their offspring) are treated. “It is a political issue,” she says. “There are other products to use that are plant derived. There are drugs that are not hormones.” While Ospemifine, a daily pill taken orally, is now a popular choice, as is Estring, a soft, flexible vaginal ring clinically proven to relieve moderate to severe pain during sex as well as vaginal itch and dryness, Streicher is an enthusiastic proponent of a new FDA-approved CO2 laser treatment.

“It’s quite extraordinary,” Streicher says. “The Mona Lisa Touch procedure is done in the gynecologist’s office. It involves inserting a laser wand into the vagina.” She says that while the treatment is expensive and is not covered by insurance, the results are extraordinary. The treatment involves three painless five minute sessions spaced six weeks apart. It addresses vaginal dryness, burning, urinary incontinence, and what doctors call atrophic vaginitis by stimulating the production of collagen and restoring proper balance to the mucous membrane of the vagina.

Not ready to try the laser or underwrite the expense? Silicone-based lubricants may be the answer, or at least should be a first step. “Lubricants are not all the same,” Streicher says. She recommends a product called Replens Silky Smooth. “It’s a first step for people just beginning to experience these types of problems.” This writer found relief for vaginal itching and dryness with another product found in the women’s personal products aisle of her local grocery store. K-Y Personal Lubricant applied internally twice daily has been beneficial in relieving internal dryness.

There is also that old business about “use it or lose it,” Streicher says. “Women who have had a long hiatus from regular intercourse are more likely to experience vaginal dryness than women who have regular sex.” She recommends getting creative and being consistent with stimulating blood flow. “Regularly inserting a dildo or a vibrator will maintain vaginal lubrication and elasticity. And just like going to the gym, you’ll probably learn to enjoy it once you get started.”

But, she says, “don’t have sex until you solve the problem. Sex that rubs or tears thinning vaginal tissue will only cause more issues.”

Women who don’t have the interest to pursue sexual relationships or even experience orgasm on their own are still not off the hook, Streicher says. “I have patients who say they no longer care about their sexuality but who are experiencing urinary/genital complaints. These issues are not sexual but they are bothersome. We don’t use that old term vaginal atrophy in my practice. We call it, as do many other doctors, genital urine syndrome of menopause.”

She said women experiencing these problems are often offered antibiotics as a cure. But that’s not a good solution because the problems are caused by the lack of estrogen receptors in the vagina and the urethra. “Just give this woman a little estrogen and she’ll be fine,” Streicher says. “This will treat the dryness and vaginal discomfort and uncomfortable urinary symptoms.”