I’ve noticed a real disconnect lately in the world of vaginal health. Seems most women associate menopause with one obvious symptom…hot flashes. These pesky flushes, accompanied by irregular bleeding habits, are often the first clues that something is up hormonally and change is coming.
 
In fact, while hot flashes and wonky menses are iconic menopausal symptoms, another super common complaint often takes women by surprise. You guessed it… it’s “vaginal dryness” or in medical terms, vaginal atrophy, which encompasses a collection of uncomfortable symptoms. There’s often a disconnect with menopause because symptoms of an atrophic vagina are often vague but broad, while still being both chronic and progressive.
 

What’s happening?

Less estrogen during menopause means less blood flow to the vagina. Less blood means less natural lubrication. Intimate tissues become thinner, less elastic, more delicate and more prone to injury, especially during intercourse. The vagina may even shrink in length and width over time due to less estrogen.
 

Why is it so important to address this? 

There are clear and impactful physical and emotional consequences of vaginal dryness.
 
First, women complain of pain or even bleeding during intimacy due to dryness. This impacts self-confidence and a woman’s sense of femininity. Effects on intimacy and relationships over time can be significant. 
 
Vaginal infection including yeast and bacterial vaginosis (BV) might result from dryness. Itching, irritation and a change in scent may also occur. Keep in mind, optimal vaginal health is directly related to a delicate balance of organisms, making up the natural microbiome. Lactobacilli are responsible for maintaining a healthy acidic vaginal pH. Less estrogen can lead to a pH change.  Symptoms of infection can soon follow.

Vaginal atrophy also often leads to urinary complaints, including urgency, frequency and proclivity to urinary tract infection (UTI).   
 
In fact, 1 in 2 menopausal women display symptoms of vaginal atrophy. Shockingly, one study suggests only 50% of women with symptoms receive treatment.¹ Why? Oftentimes, women don’t bring up the issue with their health care providers and vice versa. In addition, many women are unaware treatment is available or perhaps they aren’t happy with treatment options offered.  
 

What else causes vaginal dryness?

Vaginal dryness isn’t limited to the menopause crowd. 
 
Smoking is not vagina friendly; it causes blood vessels to constrict. The result is diminished blood flow, yes even “down there.” Birth control pills, which work by suppressing ovulation and the hormone surges associated with it, can lead to dryness in some women. 
 
Antihistamines may dry up more than just nasal passages; vaginal tissue might become dryer as well.  
 
Surgery including removal of ovaries or total hysterectomy may influence the vagina leading to dryness and physical changes.
 
Certain Medications for example, can potentially interrupt natural vaginal lubrication and lead to symptoms of “dryness”.
 

What’s a woman to do?

Whether it’s an as needed, over the counter lubricant for sex, a regularly used moisturizer, such as Revaree^® with hyaluronic acid, to maintain comfort, vaginal estrogen replacement or other pharmaceutical solutions, a little TLC goes a long way to maintaining a healthy vagina.
 
Remember, non-hormonal treatment options can be used to address your symptoms safely over the long-term. Being both proactive and consistent with your treatment will help maintain your overall vaginal health, long-term.
 
 Resources

1. Kingsberg SA, Krychman M, Graham S, Bernick B, Mirkin S. The Women’s EMPOWER Survey: Identifying women’s perceptions on vulvar and vaginal atrophy and its treatment. J Sex Med. 2017;14:413-424.