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"A" for Atrophy

By Laura Corio, MD

Vaginal atrophy will affect every women as she ages, so this is a very important topic to cover. But why  is it that no one ever talks about it — not your mother, not your friends… why does it stay so hush hush? I am not embarrassed to speak about it. It can affect our relationship with our partner, our quality of life, our self image, our sexuality.

So what is vaginal atrophy? As a woman goes through perimenopause and into menopause, estrogen levels decline, leading to thinning of the vaginal tissues as well as the bladder lining and the vulvar skin. The opening to the vagina involutes, which makes it become smaller and tighter. There is a decrease in vaginal secretions and therefore, dryness. Painful intercourse occurs, as well as loss of pleasure when a woman is touched in the clitoral, vulvar and vaginal area. Many women then will avoid sex due to discomfort. Why would we want to have sex if it is only going to hurt?

How does a woman approach this problem? First of all, women need to be able to speak freely about sex to their gynecologists and not be embarrassed. The prevalence of vulvovaginal atrophy is about 75% to 90% among postmenopausal women and therefore, all of us are affected. Besides problems with sex, urinary tract infections (UTI), vaginal infections, and having pelvic exams by the gynecologist are other problems that can occur from having vaginal atrophy.

So, I recommend a trial of vaginal lubricants and moisturizers to help vaginal dryness, and painful sex. Replens, a nonhormonal moisturizer for the vagina can be very helpful for vaginal symptoms and can be safely used by women before hormones are tried. Olive oil is also another great choice. These are used to preserve the vagina, but we still need a lubricant during sex. Astroglide, KY silk and Slippery Stuff all are helpful aids during intercourse.If all this does not work, prescription vaginal estrogen must be tried.

I feel comfortable giving my patients vaginal creams, suppositories, rings all containing low dose estrogen. They will alleviate symptoms of vaginal atrophy.

They will increase vaginal lubrication, vaginal blood flow and decrease pain on intercourse. They are absorbed only in the vaginal and bladder tissues. They are safe; however, if a woman ever has vaginal bleeding, she must let her gyn know.

This is not considered hormone replacement therapy (HRT).

Continuing to have sex is also very important because these women will experience less vaginal atrophy. It improves blood flow, lubrication and helps keep the vaginal opening from narrowing.

When a woman is given estrogen, she must treat not only the inner deep vaginal skin but also the opening and lips (labia majora, minora) of her vagina.

I am big on giving an estrogen ring or suppositories or cream for the inner vagina and estrogen cream for the external vulva and opening to the vagina.There may even be some success using testosterone cream along with estrogen for the vulvar area and opening to the vagina.

Lastly, if all fails, some women may need to go on bioidentical hormone replacement therapy. It may make a big difference in the vaginal area. However, what is interesting is that 10% to 40% of women on HRT may still have symptoms of vaginal atrophy and need vaginal estrogen.

I hope this has helped women and has been very informative. As we age, we need to feel good about ourselves and our sexuality. Sexual enjoyment is valuable to any woman at any age and will add to her quality of life. At the first sign of painful sex, please get to your doctor and talk about it, because the sooner it is treated, the less likely this will become a problem for you in the future.

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