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Vaginal dryness
Introduction
When your vagina isn't properly lubricated, it can feel itchy and irritated. Vaginal dryness may make some daily activities uncomfortable, and it can make sexual intercourse less pleasurable. In fact, during menopause, vaginal dryness is a common cause of discomfort or pain during sex (dyspareunia).
Vaginal dryness is a common condition. It can affect women of all ages, though vaginal dryness most often occurs during and after the menopausal transition. An estimated 10 percent to 40 percent of women who've reached menopause have signs and symptoms related to vaginal dryness.
A number of self-care measures and medical treatments can help you reduce vaginal dryness.
Signs and symptoms
Aside from dryness, some of the signs and symptoms include:
Itching
Burning
A feeling of pressure
Pain or light bleeding with sex
Urinary frequency or urgency
Causes
A variety of conditions can cause vaginal dryness. Determining the cause is key to helping you find an appropriate solution. Potential causes include:
Decreased estrogen levels
Reduced estrogen levels are the main cause of vaginal dryness. Estrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining.
Estrogen levels can fall for a number of reasons:
Menopause or perimenopause
Childbirth
Breast-feeding
Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy
Surgical removal of your ovaries
Immune disorders
Cigarette smoking
Medications
Allergy and cold medications, as well as some antidepressants, can lead to dryness of mucous membranes, including those of your vagina.
Sjogren's syndrome
In this autoimmune disease, your immune system attacks healthy tissue. In addition to causing symptoms of dry eyes and dry mouth, Sjogren's syndrome can also cause vaginal dryness.
Douching
The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated.
Screening and diagnosis
A pelvic exam is one way your doctor evaluates and diagnoses vaginal dryness. He or she may take a sample of cervical cells or vaginal secretions for examination under the microscope or to send to the laboratory for other testing. You may also be asked for a urine sample for testing if you have associated urinary symptoms.
Treatment
Vaginal estrogen therapy
If vaginal dryness is due to a lack of adequate estrogen and if self-care measures don't correct the problem, vaginal estrogen therapy may be helpful. Vaginal estrogen therapy comes in several forms:
Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it, generally two or three times a week.
Vaginal estrogen tablet (Vagifem).You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet, usually twice a week.
If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches, gel or a higher dose estrogen ring. Talk to your doctor to decide if estrogen treatment is an option and, if so, which type is best for you.
Self-care
If you're uncomfortable from vaginal dryness, self-care measures can help:
Lubricants and moisturizers
If vaginal dryness makes sexual intercourse uncomfortable, try an over-the-counter product such as:
Lubricants, VGel Personal Lubricant Water-based lubricants like this lubricate your vagina for several hours.
Before intercourse, spread the lubricant on the head of your partner's penis. Also put some around and inside the entrance of your vagina. Many couples treat this as a part of foreplay. If intercourse lasts more than a few minutes, you may need to stop briefly and smooth on some extra lubricant. You can also use a vaginal moisturizer at regular intervals, as mentioned above. With vaginal moisturizers, you can still use gel lubricant around the vulva or on the penis if needed.
Symptoms of Premature Menopause
If you have gone through premature menopause because of cancer treatment, you may be bothered by frequent hot flashes, especially at night. Some women also feel grumpy and less interested in sex, though these symptoms may be linked more to stress and poor sleep than to a shortage of hormones. Pre-menopausal women who have had surgery that removed their ovaries are more likely to report problems with low sexual desire. If you think this has happened to you, talk with your doctor about whether you may be helped by small doses of androgens.
Replacement female hormones in a pill, shot, or vaginal cream may help with vaginal dryness and hot flashes. If your doctor does not advise the use of hormones for you, hot flashes can also be treated by other methods, such as taking medicines that control the nervous system's reactions to a lack of estrogen (clonidine or serotonin reuptake inhibitors), using relaxation techniques, or avoiding caffeine. There are many new ways to treat hot flashes--both medically and with minor changes in your environment. Ask your doctor or nurse about ways to help reduce your hot flashes.
Replacement estrogens may promote cancer of the uterus if taken for more than 2 years. Adding progesterone reduces this small risk. In fact, women who take a low dose of estrogen with progesterone have fewer cancers of the uterus than women who do not take hormones after their menopause. If you have questions or concerns about hormone replacement therapy, talk with your doctor or health care provider.
If your cancer is sensitive to estrogens, as are some tumors of the breast, uterus, and possibly melanoma, your doctor will probably not prescribe replacement hormones. Estrogens could make any remaining cancer cells grow. Each woman must discuss the benefits and risks of replacement hormones with her doctor. The safety of taking hormones will depend on the woman's own unique medical history.
Vaginal moisturizers help moisturize your vagina and last longer than lubricants do; they may decrease dryness for up to three days with a single application.
Occasional vaginal dryness during intercourse may mean that you aren't sufficiently aroused. Make time to be intimate with your partner and allow your body to become adequately aroused and lubricated. It may help to talk with your partner about what feels good. Having intercourse regularly also may help promote better vaginal lubrication.
Avoid certain products
Though you may be willing to try just about anything to relieve your discomfort, avoid using the following products to treat vaginal dryness, because they may irritate your vagina:
Vinegar, yogurt or other douches
Hand lotions
Soaps
Bubble baths
Complementary and alternative medicine
Some alternative therapies that have been suggested for treating vaginal dryness include isoflavones, black cohosh and wild yam. However, there's no convincing evidence that any of these therapies are effective. More research is necessary to determine the safety and effectiveness of these approaches for treating vaginal dryness.
Always check with your doctor before using alternative therapies, especially if you're already taking other medications or are pregnant or nursing.
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