Treatments for Vaginal Dryness

Let’s cut to the chase: not a topic most people like to discuss at the dinner table, but can be a problem for many women.  In fact, it’s an unfortunate common side effect in perimenopausal women, menopausal women and in women that have been treated for breast or ovarian cancer.  So what are some options to help with vaginal dryness – aka vaginal atrophy – and pain with intercourse? Breezy Mama’s go-to OB, Dr. Gafori from IGO in La Jolla, CA, gives us the options. From Dr. Gafori:
 

Vaginal atrophy is a result of decrease of estrogen that effects the tissue of the genitourinary system, the vagina, vulva, and tissue surrounding the bladder.  This usually occurs in women in the perimenopause (the year or so before menopause) and worsens as we age.  A lack of estrogen causes a thinning of the tissue of the vagina.   So, women in their 40’s and up can start suffering from the symptoms which include dryness, pain with sex, itching, irritation, and burning of the vagina and frequent urinary tract infections and mild leaking of urine.  Other medical problems including cancer treatments can cause early menopause for women who also can suffer from these symptoms. 

Long term treatment is essential otherwise women will suffer from discomfort that can lead to sexual dysfunction, pain, and bleeding after intercourse  which can also be distressing for their relationships.

The first line treatments are usually only for symptom relief, namely vaginal lubricants or moisturizers.  They help with treating the discomfort but do not treat or reverse the vaginal changes.  Moisturizers like Replens or Vagisil moisturizer can be used 3-4 times per week to help with irritation and lubricants like Astroglide and KY jelly are used during intercourse. 

The main treatment for vaginal atrophy is hormonal.   The treatment therapies restore the normal vaginal acidity and flora (bacteria), cause thickening of the epithelium (lining of the vagina), and restore the natural lubrication of the vagina.   Estrogen is the treatment of choice and comes in many different types of vaginal preparations, pills, creams, suppositories.  They are typically used daily for 2 weeks and then twice weekly for maintenance.  They can be expensive (sometimes insurance does not cover them), and messy and may be contraindicated in certain types of estrogen dependent cancers like Breast Cancers.  Some examples are Premarin or estrace cream, Invexxy (suppository), Vagifem (vaginal pills).
 

Other hormonal treatments like DHEA can also be used, these medications can be converted to small amounts of estrogen so there is no clear indication of safety in certain types of estrogen dependent cancer.  These medications also need to be used daily for true effect.  A new oral medication called osphena has also been developed for treatment of pain with intercourse (also called dyspareunia), it is a type of medication called a SERM and can take up to 8-12 weeks for a noticeable effect and has hot flashes as a side effect.
 

Another interesting treatment option is the Mona Lisa Touch Carbon Dioxide laser.  It is a series of three treatments spaced 6 weeks apart.  The laser delivers controlled energy to the vaginal walls and external tissue of the vulva that promotes the stimulation of natural growth factors that then encourage the generation of new collagen and elastin.  It is quick and painless and patients can notice a difference in their symptoms within a few weeks of their first treatment.   Patients have improvement in the tissue of the vagina and then decreased pain with intercourse, burning, and itching.  I have also been using it to treat itching from Lichen Sclerosus which is a difficult to treat dermatologic condition that causes severe itching, atrophy, and scarring of the vulva.   Unfortunately, the CO2 laser treatments though convenient are not covered by insurance. 

About Dr. Gafori:
Valerie Gafori MD, FACOG is a board certified obstetrician/gynecologist. She completed her undergraduate degree in Physics at MIT, her masters degree in Biology at Stanford University, and medical degree at UMDNJ: New Jersey Medical School. She completed her residency in OB/GYN at George Washington University and joined a private practice in Washington DC for one year before she moved to La Jolla. She is now in private practice in La Jolla, California with IGO Medical Group. She has special interests in minimally invasive surgery and gynecology.

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