We recently hosted our second Instagram Live on the topic of vaginal dryness experienced during menopause, featuring Bonafide Chief Medical Officer, Dr. Alyssa Dweck. During the conversation we covered a variety of topics including what causes vaginal dryness, what are some associated symptoms and how do you address it. In case you missed it, we’ve included a recording of this second session here along with a full transcript of the video.
Stay tuned for more Instagram Live sessions, which are planned for the near future!
TRANSCRIPTION
Sarah: Hi, everyone. Thanks for joining. I just want to make sure everyone can hear us okay, so if you can just drop an emoji in the comments or send a “yes”, that'd be great!
It looks like we’re good to go! Alright, let's just wait a few minutes for everyone to join. How are you doing tonight, Dr. Dweck?
Dr. Dweck: I'm great. How are you? Sarah?
Sarah: Good. It’s good to be here at our second Instagram Live! And probably the most popular topic of all?
Dr. Dweck: Yes, yes, definitely.
Sarah: Alright, great! I think we'll, kick it off. So, welcome, everyone to our second Instagram Live from Bonafide Health. My name is Sarah and I'm on the product team here at Bonafide. I'm excited to be here again with Dr. Alyssa Dweck, who's our Chief Medical Officer. She's also a practicing gynecologist with 25 years of experience in the field and is an amazing person to work with.
I’m so happy to be here with you! Do you want to do a little introduction?
Dr. Dweck: Yeah, sure! So, as Sarah said, my name is Alyssa Dweck. I am a gynecologist here in New York and I have been in practice for a long time, more than 25 years. I take care of patients like you every, single, day.
And what I find, is that people really want to know what's normal, what's not, and what they can expect during their menopause journey. And I'm really excited to talk today about a very popular topic, which is vaginal dryness.
The Basics of Vaginal Dryness
Sarah: Yes, exactly! Thank you again for being here. So, for today's topic, we're going to focus on vaginal dryness and associated symptoms.
Just a few reminders, we will be recording this session, and it'll be available on Instagram and Facebook, as well as our blog afterwards, if you want to view it later on.
And the format of this is that we're going to go through the basics of vaginal dryness, what it is, the symptoms and how to treat it. We’ll then open it up for a live Q&A at the end. You can drop comments in the comment section below; there's also a Q&A button where you can drop in a question.
So, we're ready to get started. I feel like we should just start by talking about, what are the vaginal changes that occur during menopause. So, you know, what is dryness, vaginal dryness?
Dr. Dweck: Sure, so vaginal dryness is one of those symptoms that occurs during menopause as a result of lower estrogen levels. And what I really find is that vaginal dryness is kind of this “catch all” term used to really explain so many different symptoms that people complain about.
For example, real dryness is where people say that they feel like there's no moisture in their vaginas, but also things like itching, irritation, a change in the amount of drainage that might come from the vagina, changes in sexual health as it relates to vaginal changes, can all be experienced.
So maybe pain, urinary complaints and changes in urinary habits can be a result of less estrogen and dryness. And overall, there can be a greater sense of awareness of one's vagina, and that may not be a good thing.
So, that's this all-encompassing term of dryness. In the medical world, we call this vaginal atrophy. And we also call it genitourinary syndrome of menopause, a real word salad used to kind of explain every vaginal or urinary symptom that might be affected by these low estrogen levels.
What Causes Vaginal Dryness?
Sarah: Okay, got it. That's a really helpful overall definition. And I like that you brought in the medical term because I'm sure people are hearing that [from their healthcare providers].
So, next I wanted to ask you what causes vaginal dryness?
Dr. Dweck: Yeah. So, most of the time, this vaginal dryness, and all the other symptoms we'll speak about, are caused by low estrogen. The hormone estrogen is typically made in abundance by our ovaries, but during menopause, this production of estrogen really declines significantly. And what happens from that, from a general standpoint, is that less estrogen translates into less blood flow to the vaginal and genital tissues. And that means less natural lubrication that's being formed. And this is what leads to all the symptoms that people might complain about [as they relate to dryness].
Sarah: Got it. And how many people are experiencing about this? Meaning, what do you see in your office? How common is it?
Dr. Dweck: Yeah, I'm so glad you asked that. Because so many people come to my office complaining of this symptom and they feel like they might be the only person suffering, that maybe this is their own unique symptom.
In fact, probably more than 70% of people with vaginas will complain about dryness or these other symptoms that are encompassed in vaginal dryness. And the sad part, is that most people don't get any management help with this, because they might be embarrassed to bring it up, or their healthcare providers may not ask about it.
Sarah: Do you have any suggestions for someone who maybe is uncomfortable talking to their healthcare provider? Rather, how can they approach their doctor about this?
Dr. Dweck: Absolutely. I think being direct is most important. I also think that, you know, these days, people are doing so much research on their own and are likely finding information, whether it's on the web, from a reputable book, or some sort of a community forum that they might be speaking in, or even from their friends or from their family, that this is a very common symptom. And so hopefully, people are getting much more comfortable bringing it up to their healthcare providers.
And frankly, healthcare providers have to also be proactive about this. You know, the days of being afraid to ask people about their vaginal health are kind of over. And whether it's a gynecologist, an internist, a menopause specialist – these are all wonderful resources who to want to help.
Sarah: Yeah, I’m sure that it helps to have a two-way conversation where you can proactively talk to your doctor about it, and also that the doctor can approach you and meet you halfway.
So, now that we've covered how common vaginal dryness is, and its symptoms, I want to kind of dig in a little bit more into the associated symptoms, because I know you mentioned there are a few, so, there's vaginal dryness, but you mentioned itching and odor, irritation, and other symptoms, too?
Dr. Dweck: Yeah, so you know, first and foremost, what usually comes to somebody's mind, whether it's a practitioner, or a patient, when they're having itching or irritation, maybe a slight change in scent, or burning, is maybe they have an infection. So, certainly, it's reasonable to get checked for infection, to make sure there's no yeast, make sure there isn't an imbalance of bacteria, because these things may be treated in a in a different way. But oftentimes, there is no infection found, and the symptoms can be blamed on menopause and the low estrogen levels occurring due to menopause.
Sarah: Okay. I also hear that a lot of women struggle with having pain during intercourse because of that. So, is that also something you see a lot in your office, and is it common?
Dr. Dweck: Yes, incredibly common! And this is something that's also becoming a little bit more comfortable for people to talk about.
Pain during intercourse can occur for various reasons. But vaginal dryness, and changes related to menopause are probably the most common cause, other than infection, which we've already talked about.
There are so many ways to manage this. So, it's not necessary for people to suffer or suffer in silence about it. But one thing I do want to bring up is that oftentimes, people's partners, sexual partners, are not aware of all of the symptoms that somebody may be having, either because they've never experienced it themselves, or because they just aren't aware that somebody might be suffering with symptoms. So, it's very important to have direct communication with your partner about what you're going through so that these things can be navigated.
Sarah: And as we mentioned earlier, more women like Google symptoms and learn about this stuff online, too. So, you know, maybe partners also are able to do that, and it can kind of be like a joint effort, for sure.
Are there other symptoms that we can touch on? I've heard some women have uncomfortable urination because of dryness. Is that also something you see?
Dr. Dweck: Oh, no question! So, remember, the genital tissue is all estrogen related. So, this includes the vulva and the tissue around where you urinate from the urogenital tissue.
This can become very delicate during menopause; it can also cause burning with urination from time to time. Some people are even more prone to urinary tract infections as a result of less estrogen and vaginal dryness. And some people suffer with frequency of urination that isn't related to an infection.
So, for example, we often refer to something called overactive bladder, where the bladder just you know, doesn't listen to what your brain is instructing it to do all the time. And you'll have symptoms like frequent urination or the urgency to have to go. And it can be really disruptive to one's day to day life. So, this too, can have some relation to menopause and to low estrogen, but also to age in general.
Sarah: Okay, so I feel like we've covered the major symptoms that are associated vaginal dryness and atrophy. We talked about how dryness can be associated with menopause and lower estrogen levels, but I know there are some other causes of dryness aside from these. Can you touch on those?
Dr. Dweck: Absolutely. So, you know that vaginal dryness is one of those later symptoms, as people are traversing the menopause journey. And it's something that's not going to get better on its own. It's a chronic and kind of a progressive thing. But it is gradual over the years, okay.
There are certain special populations that are going to traverse these vaginal changes very quickly and abruptly, and they can be much more severe. So, the populations that I'm speaking about might be the breast cancer population. People who have gone through breast cancer treatment can be placed in an instant menopause. Because of that, they might have instantaneous symptoms that can be really uncomfortable, without a gradual lead up to trying to navigate them.
Another population that might be really at risk for more significant symptoms of dryness would include those who have to have their ovaries removed, for various reasons. So, removal of the ovaries when they're still functioning and still producing estrogen instantly gets rid of that supply and production of estrogen. And so, these people may have a more severe and more sudden onset of symptoms.
The last population that is not really in menopause, but I thought was worth bringing up, would be people who are lactating, especially long term, because they may not have returned to ovulation, and therefore their estrogen levels are also still low. And that can cause the similar vaginal changes to those traversing menopause.
How to Treat Vaginal Dryness
Sarah: So, there are a bunch of different groups of people who are affected by this, okay, and at different ages and different points, interesting. Now that we've covered what is vaginal dryness, the symptoms and some causes of it, I want to get to the treatments, which is why I know a lot of people are here to learn about. So, maybe you can just talk about what you use in your practice, what you've seen success with.
Dr. Dweck: Sure, remember, there are nuances to treatment paradigms based on individual medical histories and patient desires, as well as thoughts and values.
So, there will be some people who unfortunately don't get symptom management for this because they don't bring it up to their providers or their partners. Most important – is education [on the subject], recognizing that this is a typical symptom that can occur during the menopause journey, and that there are management strategies.
Hydration – hydration is super important. Remember, we rehydrate our skin cells in order to hydrate our skin, and that includes the intimate tissue. The first step is usually starting use of a really good vaginal moisturizer, and maybe even adding a lubricant.
Let me explain the difference between these because they're often confused. A moisturizer is something used on a regular basis; this could come in the form of an insert, it could come in the form of a cream with an applicator, it can be something that's applied digitally. But this is something used regularly, like two to three times a week, like we would use face cream, to replenish moisture and keep it there; it does need to be used regularly.
A lubricant, on the other hand, is used more on demand. So, usually, we recommend a lubricant during intimacy as a way to alleviate friction or even enhance pleasure. So, these are two different things. But this is where we normally start for vaginal dryness and for some of the symptoms that it can cause.
A second option would be vaginal estrogen. So, a minimally absorbed, vaginal estrogen comes in various forms. This can either be in the form of a ring, a tablet that gets inserted into the vagina, or a cream, but not everybody can tolerate vaginal estrogen, and many, many people don't want to take estrogen due to medical reasons. So, that's the caveat I just wanted to provide.
There are other pharmacologic options for vaginal dryness, two FDA approved medications. One is oral, one is vaginal. And some people do turn to these as secondary items.
Some people even benefit from dilating their vagina mechanically, with vaginal dilators. So, this happens to be a vaginal dilator that I brought just to show people. Essentially, they come in a set that get larger in diameter. They are used not only to mechanically stretch the opening of the vagina, but they also to help stretch the width and the length a little, because after all, vaginal dryness and lack of estrogen, and these changes, can lead to a narrowing and the shortening of the vagina over time, and a tightening of the opening. So, dilators can be helpful for those uses, usually [when used] in conjunction with another treatment.
Dilators really need to be used with a moisturizer, and with a lubricant. And there are exercises that are performed over time, after which a maintenance program is started. So, dilators aren't necessary for everybody. But they are an option, particularly for people who don't want to use medications.
Sarah: And I just wanted to jump back in, since we were talking about the difference between moisturizers and lubricants. I know there are a lot of over-the-counter lubricants and things like that. And some of them have a lot of ingredients. So, I was wondering kind of what advice you give your patients on what to avoid and what to look for. In those types of over-the-counter products.
Dr. Dweck: Look, we are already dealing with some very sensitive tissue, and for somebody who is looking to use a moisturizer and or a lubricant – I'm just going to mainly talk about moisturizers since they’re used so regularly.
Ingredients that we really try to avoid would include things like parabens; these are preservatives, but they can be endocrine disruptors, they also can cause irritation. So, we typically inform people that they may want to avoid that.
Number two would be an ingredient called propylene glycol. Again, this is a common ingredient [in OTC products]. It is an approved ingredient, but it can be very irritating for people, particularly those who have very sensitive skin.
And fragrance! Fragrance can be a real pH disruptor and disrupt some of the natural ecosystem in the vagina. So, we typically advise people who with such sensitive skin and already having sensitivity to avoid that.
It's very important to look at the ingredients list in your moisturizer. One ingredient that is super moisturizing, that is really all the rage right now, is hyaluronic acid. This is a natural ingredient. It is usually naturally made by the body to moisturize all over. However, with age, production of hyaluronic acid in the system declines. So, we often turn to it in our face moisturizers and in fact, Bonafide, obviously makes Revaree, which is a vaginal insert, made predominantly with hyaluronic acid [designed to provide moisture to dry, vaginal tissues]. And it's just a little teeny insert that gets inserted comfortably into the vagina two to three times a week, again, mostly hyaluronic acid.
Sarah: Great, thank you! Alright, so, I think we've covered all the basics. And more than just the basics, we’ve expanded on a lot of these different areas. Did you have anything else you wanted to cover? Before we open it up for more questions?
Dr. Dweck: No, I'm hoping there are a lot of questions and that this is really opening up a good dialogue where people can feel like this is a safe space to talk about these changes. Because after all, it is incredibly common. I don't want to call it normal, but it is a very, very typical symptom that people present to in my office with.
Common Questions About Vaginal Dryness
Sarah: Alright, we're going to open it up to questions now, for our live Q&A portion. You can put a question in the comments section, or you can drop one in the Q&A section.
Someone is asking why the vaginal opening can be painful, or why does it hurt? And she said she's in menopause.
Dr. Dweck: Of course, yeah. Well, the vaginal opening can narrow during menopause due to lack of estrogen exposure. Also, a vicious cycle can sometimes occur where, if somebody is anticipating pain, because they feel their opening is a little narrow, they then avoid any penetrative intimacy, which further you know, fosters more narrowing. So, a great moisturizer, used regularly, a lubricant, particularly a really slick one, like maybe one with silicone use during intimacy, can be real game changers.
In addition, the vaginal opening being narrowed might be solved by using vaginal dilators because this not only mechanically stretches the vaginal opening, but it also tends to train the brain that it doesn't have to hurt to put something in the vagina, because it's done on your own terms.
Sarah: Okay, thank you. We have questions asking about what's the difference between non-hormonal and hormonal solutions [for vaginal dryness].
Dr. Dweck: Sure. Essentially, hormonal solutions contain estrogen. Usually, there are a couple of options that are hormonal solutions. For example, something called Intrarosa, which is a brand name for a vaginal insert, that's acts like a pre-hormone, meaning it turns into estrogen and testosterone once inserted in the vagina. But estrogen is a hormone that some people do need to avoid or do prefer to avoid. So, we also have non-hormonal options that basically are moisturizers for the most part.
Sarah: Okay. Yeah, that makes sense. Someone has asked if estrogen is the only thing that can stop or slow down vaginal atrophy. I know we talked about some other solutions.
Dr. Dweck: Yeah, estrogen does a great job. However, we have clinical studies that compare the hyaluronic acid containing Revaree inserts with estrogen, in fact, with various forms of vaginal estrogen. And actually, the studies really show very similar results in terms of improvement in the cellular nature of the vaginal tissue. So yes, estrogen can deal with these changes, but so can something like hyaluronic acid in Revaree.
I'm just going to make one more note. This is really all about blood flow. You know, we want to increase blood flow to the vaginal tissue. Sometimes, if this is comfortable for you, you need to dust off your vibrator and use it, because vibrators bring blood flow to the vaginal and intimate tissue. So, for those of you who are faint of heart when it comes to vibrator use, we will often write a prescription, “please use your vibrator once or twice a week,” to help massage the tissue and enhance blood flow. So, this is something that you can do in addition to a moisturizer, lubricant, and estrogen treatments.
Sarah: Okay. I like the idea of writing a prescription.
Dr. Dweck: Yes, sometimes we have to!
Sarah: Yeah, that's good. So, there's another question about if it's actually possible for the vagina to close because of dryness? Is that something that is possible?
Dr. Dweck: I guess the short answer is yes, the vagina is a canal, the less that it's used, the less estrogen that's exposed to and the more delicate the tissue becomes, the vagina will narrow it will shorten and the opening will also narrow. So, technically speaking, the tissues can fuse and make the opening much narrower and the depth of the vagina much shorter. This is where dilators can come in and be very, very helpful in an effort not only to prevent that from happening, but also in the treatment paradigm as well.
Sarah: Do you have any questions that come commonly into your office that you want to bring up?
Dr. Dweck: You know, often times I'll get questions regarding surgical management – meaning some of these procedures that people may hear about for vaginal dryness and for painful intercourse; particularly laser therapy or other energy procedures that use radiofrequency energy in order to help manage the symptoms.
In fact, these procedures are supposedly used to increase collagen in the vagina and therefore make them less dry. I think the jury is still out in regard to how effective they are and whether the side effects that could occur with any procedure are worth taking that chance. And usually, these procedures are not covered by insurance, which can be a deterrent for lots of people. They also have to be repeated. Nonetheless, I certainly have patients who have undergone some of these procedures and have found them to be very helpful.
Sarah: So, a few people were asking about the Mona Lisa procedure?
Dr. Dweck: Yeah, that was what I was speaking of. So, the Mona Lisa is a particular brand of machinery that uses a laser to help promote collagen production in the vagina. These are quick, outpatient procedures, typically done in a urologist, gynecologist, or surgical center-type setting. There are other procedures with different machine names that uses radiofrequency and other forms of energy to try to promote collagen production as well.
For some people they've been helpful, however there are always potential side effects with any sort of procedure, like infection or bleeding or scar tissue formation or further pain – but you know, some people have found them successful.
Sarah: When people do these treatments, typically afterwards, is there some sort of [outpatient] treatment regimen?
Dr. Dweck: I don't believe so. Most people basically get up, walk out, and are maybe placed on, you know, pelvic rest, nothing in the vagina for a couple of days. Some people may be given a moisturizer to be used afterwards or even some receive vaginal estrogen afterwards. But for the most part, it's an outpatient procedure.
Sarah: Okay, that's good, I know a lot of people had questions about that. Someone is now asking what can Revaree actually do to make a difference in dryness and atrophy.
Dr. Dweck: Yeah, so we know that Revaree works on a cellular level. We have clinical studies to suggest that tissue not exposed to estrogen but is exposed to hyaluronic acid – which is touted to retain like 1000 times its weight in water – will start to show signs of repair and cellular change. Similar to that of a weak vaginal estrogen or even Premarin cream, we do have one study to that compares them head-to-head. So, it [Revaree] works on a cellular level to help maintain moisture. The theory is that there's likely little, teeny blood vessels being formed called angiogenesis. And that's likely the real mechanism of action.
Sarah: Interesting, thank you! So, a few people are asking about where to get dilators? Do you have any recommendations?
Dr. Dweck: I sure do. So, there are various kinds of dilators. They come in all shapes, sizes, and materials. The ones that I am showing are silicone dilator – they come in a set, usually getting progressively thicker, so that you can work with them on a sequential basis to slowly stretch the vagina.
Silicone dilators come from various brands, you can find them online, for sure. And then there are also plastic or rigid dilators. Also, you can even buy them on Amazon. I'm not going to go into any brands specifically, but there are multiple brands that are available.
Dilators do need to be used with a lubricant and the type of lubricant you choose to use with dilators depends on the material of the dilator. So, for example, you don't want to use a silicone lubricant with a silicone dilator because it may disrupt the material. So, a water-based lubricant would be best in that case; there are also dilators that vibrate. So, that goes to the blood flow issue that we spoke about. Therefore, it's like a combination. You can get really fancy with this or keep it pretty simple, but they do work a little tediously, but if you stick with the program it can work!
Sarah: Got it. Okay, thanks. Yeah, that's helpful. Someone was asking about using a moisturizer, with Revaree or with a lubricant, so, do you have any advice about that – using Revaree with maybe a lubricant or anything like that?
Dr. Dweck: I think it's very individual preference when it comes to that. I have some people who combine vaginal estrogen and Revaree together, and then also use a lubricant when they are intimate. So really, it's what works for a particular person and what they tolerate.
In general, we recommend Revaree to be used two to three times a week, every two to three days, at night. And before going to sleep. I would say, just [use Revaree] so that it has time when you're laying down to [melt and] dissolve. And people seem to tolerate that regimen very well. And it's easily, very easily inserted.
Sarah: Okay, great. You just answered another question about how many times you need to use Revaree. Let's see what else we have.
Dr. Dweck: I will say one of the other benefits of an insert is that it's a little less messy. So, some people like the feeling of a gel, but I find, in my practice, a lot of people don't like the feeling of the gel seeping out and leaking out. So, that's the other reason that an insert has been become very popular with some people.
Also, just because we have a little time, I think the non-hormonal options for the person who asked about the difference between hormonal versus non hormonal, you know, please consider the population of people who are maybe breast cancer survivors, and really are trying to deplete every molecule of estrogen out of their systems in an effort to prevent any sort of cancer recurrence.
Even though for some of these people, vaginal estrogen might be appropriate – it may not be for many of them. It's more particularly those who are on certain adjuvant medical treatments, where a recent study suggested that there might be a higher chance of recurrence with estrogen use. So, the non-hormonal options are really very, very important for that type of population.
Sarah: Is it also important for people who want to use something more long term or not really?
Dr. Dweck: No, I think, you know, the use of vaginal moisturizers, estrogen or not, is sort of chronic and indefinite, because this is not an issue that's going to resolve on its own. Once the management options stop, the symptoms will likely return.
Unlike hot flashes, or night sweats, which usually have a defined period of time they're going to last, vaginal dryness and some of the symptoms that it leads to, will be chronic and progressive, if they're not managed, meaning they will only get worse with time. And so being proactive is important.
Sarah: Okay. Yeah, that makes sense. We just had a listener asking about a hysterectomy. And what products do you use specifically, after that procedure, or if you’re actually having it?
Dr. Dweck: I'm so glad somebody asked this. There is a difference between having a hysterectomy, meaning the removal of the uterus, with or without the cervix, and then removal of the ovaries.
Often times this is all done together. But sometimes they are done separately.
So, for example, somebody may have a hysterectomy, let's say for a reason of fibroids or reason of abnormal bleeding, but their ovaries may remain in place and continue functioning by producing estrogen until natural menopause would set in. So that person isn't necessarily in menopause, but they're just not bleeding because they don't have their uterus any longer. They still, however, have ovaries that are producing estrogen versus the person who has had their ovaries removed.
That's the definition of surgical menopause, removal in the ovaries.
And so that's the person that may have a sudden onset of symptoms, rather than the gradual onset. And, so for the answer to the question, for both of those groups of people, [those who have had a] hysterectomy with or without ovaries – who’ve had them removed, may benefit from you know, management of vaginal dryness depending on age and need.
Sarah: Interesting, someone said they had a hysterectomy, a total hysterectomy, 10 years ago and never has had a problem with dryness until now.
Dr. Dweck: Again, not knowing your individual circumstances – I don't know how old you were when you had this. But my thought is maybe your ovaries continued to function for a long period of time, you know, but then still natural menopause took hold. I will say that there is information to suggest that those who do undergo a hysterectomy, even with the ovaries left in place, probably go through a slightly earlier menopause than those who's who don't have a hysterectomy. Maybe this has to do with what blood flow is like to the surrounding tissues, but that does seem to be the case.
Sarah: We also had another listener asking about Lichen Sclerosus and how that impacts dryness and how to treat it.
Dr. Dweck: Yeah, good question as well. So, Lichen Sclerosus or “LS,” for people who haven't heard of it, is basically a skin condition that is kind of poorly understood – it tends to really affect the vulva.
It can affect all the tissues around the vaginal opening, so, the labia, the clitoral area, the perineum, which is the tissue in between the vaginal opening and the anal opening. And this skin condition causes the tissue to be unbelievably itchy. It comes and goes sometimes with no rhyme or reason, and it also causes the tissue to be super delicate, very thin, almost with minimal pigmentation to it, and again, it waxes and wanes.
The issue arises that many women in menopause who have Lichen Sclerosus also have vaginal changes, due to menopause and low estrogen. So, they kind of get a double whammy of symptoms with dryness both on the inside, delicate tissue and then this Lichen Sclerosus [externally] on top of it.
Lichen Sclerosus is treated with a steroid cream, a potent steroid cream, used regularly. [In contrast] vaginal atrophy is treated either with a moisturizer or with estrogen. And these two treatment options can be used together for somebody suffering from both symptoms. The big thing with Lichen Sclerosus is that it does need to be formally diagnosed, usually with a skin biopsy, but it also needs to be monitored, because there's a small association with vulvar cancer/skin cancer in the vulva, and Lichen Sclerosus.
Sarah: That's very helpful. Alright, I think I'll do one more question. Somebody just asked if Revaree can be used with some other products such as Premarin or Intrarosa. We talked a little bit about this before.
Dr. Dweck: Yeah. As I said before, I do have patients who use both Revaree and estrogen, and vaginal estrogen, and they alternate them. And these are people who just have found that this is a good regimen for their needs. Intrarosa, which is also called prasterone with the brand name, is an every single night application. So, I think it would be difficult to use a moisturizing insert plus that insert which is recommended to be used every day.
Sarah: Got it!
Dr. Dweck: Great questions! Very appropriate. I feel like I’m back in office hours!
Sarah: Any other questions that you think we should answer? We covered a lot of them – including postpartum [dryness], we spoke about cancer patients and dryness, talked through itching and burning as well as lubricants and moisturizers.
Dr. Dweck: I think the biggest take home message here is, don't suffer. This is something that can be managed, and it might be tedious, and it might be frustrating. But there are options, and plenty of them. So, please use your healthcare practitioner to assist!
Sarah: Alright, well, that's it for tonight. Thank you all so much for joining. And as I mentioned at the beginning, this is being recorded, so you can view this on Instagram and Facebook later on. And we appreciate everyone attending and hopefully, you learned, and this was helpful.
Thank you again, Dr. Dweck for being here.
Dr. Dweck: It's my pleasure. Thanks, Sarah!
