Most women practise a ritualistic skincare regime that involves moisturizing everything from the delicate skin around the eyes to the cracks on the soles of the feet. But what about vaginas? Don’t they deserve a little TLC, too?
Now before you roll your eyes and say, “Not another thing to add to my to-do list!” please note this isn’t about pressuring women to keep another part of the aging body ‘young.’ Vaginal dryness is a health issue that can surface at any age, but in particular among menopausal and post-menopausal women, making everything from sex to exercise, sitting and even wearing your favourite jeans uncomfortable or downright painful.
Vaginal dryness goes part and parcel with vaginal atrophy, a common condition where vaginal tissues become thinner, less elastic and more easily irritated due, in part, to a decline in estrogen levels. When estrogen falls during menopause so too does the amount and consistency of your vaginal moisture.
While 100 per cent of women experience vaginal atrophy as they age, very few seek medical advice.
Dryness is a health issue
Dr. Marla Shapiro, who specializes in women’s health and is a member of several advisory boards, including Research Canada and the North American Menopause Society, wants to empower women, encourage them to ask their physicians questions and know they have treatment options.
“It’s a medical situation and women need to understand that, although we know why it happens, it doesn’t mean that it’s just a natural part of aging,” she explains. “Wrinkles are a natural part of aging, too. Women fight that. [Dryness] is related to estrogen deficiency and that happens to all women, but it doesn’t mean we should be tolerating it.”
Bothersome symptoms vary from woman to woman. When it comes to dryness, many people assume distress only means one thing – painful sexual intercourse.
“For women who are not sexually active, there’s a complete bias against these women that you can’t really have a significant complaint because that’s the most important complaint there could be,” says Dr. Shapiro. “In fact, I have patients who are marathon runners, swimmers and cyclists that complain they’ve got terrible irritation and discomfort because of vaginal dryness.”
Don’t be shy, if your vag is dry
Dr. Shapiro sees a disconnect between how women, especially Boomer women, tend to be proactive in the larger sense about their health and wellbeing, but as far as vaginal health is concerned, it’s a taboo subject as she points out: “It’s really interesting because many women are all about, ‘I feel young; I want to look young.’ They’re seeing their dermatologist about all types of things, whether it be laser or peels or Botox or fillers. They’re seeing evidence-based dermatologists or plastic surgeons and having these discussions about what can I do that’s safe and effective, but who are they talking to about vaginal moisturizing?”
“Vaginal dryness, for 100 per cent of women, will get progressively worse as they continue in their menopause.”
While most women have that initial ‘talk’ with their mothers about changing bodies during puberty, there’s rarely a follow-up conversation at the other end when the hormones are waning and menstruation stops.
“In their mid-40s, most women begin to notice changes. Changes in their cycles, maybe how frequent they are, how heavy they are, and they may begin to notice occasionally they get a hot flash or night sweats or start to experience vaginal dryness,” says Dr. Shapiro. “Over a six-year period, plus or minus, most women will get rid of their hot flashes and night sweats. Vaginal dryness, for 100 per cent of women, will get progressively worse as they continue in their menopause.
“Menopause is not a doorway. You don’t walk through it and you’re done. Menopause is that next transition phase of life, and the further you are in your menopause, the more estrogen-depleted you are, the thinner and more atrophic (your vagina).”
Having ‘the talk’ with healthcare providers
It’s not just women who are loathe to have the second big ‘talk’ – your doctor might check your blood pressure and prescribe treatment for aches and pains – but when was the last time he or she asked, “How’s your vagina? Dry? Moist?”
“If your healthcare provider doesn’t bring it up, then often that reinforces that this is normal. There’s nothing that can or should be done,” says Dr. Shapiro, who, in her capacity as exiting president of the North American Menopause Society, is a strong proponent of getting healthcare professionals to broach the subject of vaginal dryness and have other such conversations with women.
“I think that we’ve got make sure that we’re empowering women with the right information, and that women feel comfortable and safe in their medical environment to ask questions. If your healthcare provider is not meeting that challenge, then you’ve got to find someone who will.”
Medical treatment options
Studies show that only 7 per cent of women receive medical treatment for vaginal dryness. And, that’s unfortunate because there are fairly straightforward treatments.
Local use of estrogen in the dose prescribed is absorbed locally and demonstrates blood levels comparable to women not on any local vaginal estrogen.
Local means it’s applied directly to the vaginal area, usually in the form of a cream, or inserts, including tablets and rings. This is not to be confused with systemic hormone replacement therapy, which helps manage other menopause symptoms.
“It’s totally different – very low dose,” says Dr. Shapiro, who acknowledges that many women don’t know about this option or aren’t comfortable with the idea of estrogen a variety of reasons. “That drives them to over-the-counter products, which is fine, but you need to understand what’s available.”
Many will reach for a lubricant (choose a water-based one) to help pave the way, but that’s a one-off fix and it’s very much addresses issues related to sexual intercourse. It doesn’t help with the day-to-day discomfort.
“If you feel that you need a lubricant, use lubricant on an as-you-need-it basis. It can be used with estrogen, without estrogen. It’s an add-on,” suggests Dr. Shapiro. “For vaginal dryness and its persistent symptoms, what you really need is a moisturizer. And, just like you wouldn’t just moisturize your face just once a month, you’d use it every day, even twice a day.”
We tend to use ‘vagina’ as a catchall term, but moisturizing is also relevant to the vulva and the labia, the external lips. Products shouldn’t upset the bladder or interfere with overall pH levels – a healthy pH is 3.8 to 4.5 and upsetting that delicate balance can disrupt a healthy vaginal biome and lead to further irritation or infection.
“You want to use a product that doesn’t have fragrance, that doesn’t have excipients in it, that doesn’t have the wrong pH associated with it,” Dr. Shapiro recommends. “You want a moisturizer that actually is going to be adhere to the walls of the vagina, giving you back moisture. It won’t thicken the walls of the vagina the way estrogen will. It won’t improve collagen. But, it will moisturize without damaging the tissue and we know that products have hyaluronic acid are going to work best.”
Understanding the science behind treatments
Dr. Shapiro stresses that she does not endorse products per se, however she promotes the evidence-based science behind a product, if that helps empower women to make healthy choices.
“I want to get rid of the myth that dry vaginas are a natural part of aging, and you just have to accept it.”
She agrees the science behind Replens Long-Lasting Moisturizer makes it an excellent estrogen-free option for treating vaginal dryness: “This product is all about using ingredients that are not toxic, that are not fragranced, that are not going to give you a dermatitis-type reaction.”
Replens is inserted inside the vagina with a preloaded applicator (sort of like a tampon) and can be reapplied every few days depending on level of dryness.
A complementary product, Replens Moisture Restore External Comfort Gel specifically soothes discomfort and irritation on the outer skin, namely the labia, and designed to be rubbed on much like any other moisturizer (never inserted, although it’s safe and non-irritating should some slip in).
“There’s a difference between the two areas. If we’re talking about vaginal dryness, that usually is every three days that we’re moisturizing, but on an ongoing basis. Whereas, for our external labia, we usually moisturize daily,” says Dr. Shapiro, adding she likens the multi-faceted approach to women applying a moisturizer over a serum for optimum results.
“I want to get rid of the myth that dry vaginas are a natural part of aging, and you just have to accept it,” says Dr. Shapiro. “I’m all about empowering women to understand that they can use a low dose vaginal estrogen to help medicate against some of these changes or try a moisturizer. What’s happening to the body is physiological, but that doesn’t mean that there aren’t approaches to dealing with it.”