Menopause & Vaginal Dryness – Causes and treatments/ solutions

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Vaginal dryness, irritation and burning are common symptoms of menopause which affect different women to varying degrees.
During and after menopause, estrogen levels continue to fall gradually until they stabilize at a new lower level. This means that vaginal dryness is usually not experienced until several years after menopause. The vaginal tissue depends on estrogen to keep it moist and healthy. In the absence of estrogen:

• the vaginal lining (mucosa) becomes thin and easily injured
• the mucus glands which help with lubrication decrease in number leading to slow and poor lubrication when you are sexually excited
• there is reduction in vaginal blood supply and the vagina shrinks (this is called vaginal atrophy). This causes small wounds which occur during intercourse to heal very slowly because of poor supply of nutrients from the blood
• the vagina becomes less acidic so you become more prone to bacterial and yeast infections
• the vulva (the area surrounding the entrance to the vagina) is usually involved in these changes and may become thin, dry and cracked

The result – having sex becomes a nightmare! Your partner may not understand what you’re going through unless you tell him. It will cause less of a strain on your relationship if you explain that that your reluctance to have intercourse is not his fault but because of the vaginal dryness you’re having. So, does this mean you have to give up intercourse? Definitely not! There are various strategies you can use to improve vaginal moisture and lubrication and reduce the discomfort of intercourse.

1. “Use it or lose it!” – As with many other things in life this also applies to your vagina. Having vaginal intercourse once or twice a week will help your vagina stay moist and healthy and reduce the symptoms of vaginal atrophy. You will also lubricate faster when you’re aroused.
2. Use a bioidentical, natural estrogen vaginal cream. This has a direct effect on the tissues of the vulva and vagina and restores moisture over several weeks. Use 1/4 teaspoon of cream inserted into the vagina and applied to the vulva 3-4 times a week. It may take up to 4 weeks for you to notice any improvement in vaginal moisture. If you are applying a bioidentical progesterone cream or progesterone/estrogen combination cream to your skin, you may also notice an improvement in vaginal symptoms.

If you have a past history of breast or uterine cancer, avoid estrogen. You may benefit from a natural progesterone cream, 1/4 teaspoon applied into the vagina 3 times a week and applied to the skin daily.

3. Keep a lubricant handy – A water-based lubricant should be close to your bed in a drawer or night stand. This will make sex more comfortable while you work on naturally increasing vaginal moisture. It will also relieve anxiety about painful intercourse which can kill your urge for sex.Avoid using oily lubricants like baby oil and petroleum jelly which are not healthy for the vagina and are difficult for the body to remove. Some good ones include Astroglide, Wet and K-Y .
4. Can Replens and other vaginal moisturizers cure a dry vagina (vaginal atrophy)? Replens, Astroglide and K-Y are well known vaginal moisturizers with long-lasting effects. A single application can last up to 72 hours. They have also been shown to increase the acidity of the vagina making it less prone to infection and also increases vaginal secretions. They may seem a little bit expensive compared to ordinary lubricants, but you may find that they are worth it.
5. Fish oil for vaginal dryness – Take lots of essential fatty acids (EFA). These include:
   • Omega-3 (fish and flaxseed oil ),
   • Omega-6 (evening primrose oil and borage oil) and
   • Omega-9 (olive oil).

   They help to keep the vagina healthy and also help your body produce hormones. The best source of these fatty acids is oily fish like fresh salmon. Others are tuna, mackerel and halibut. If you can’t eat enough fish to get a good supply of these EFAs take a good supplement with a combination of all these fatty acids .

6. Vitamin E – the natural form of Vitamin E (d-alpha tocopherol) rather than the synthetic form (dl-alpha tocopherol) can be very useful for vaginal dryness. Puncture one capsule and insert it into the vagina. You can do this daily.
7. Avoid using harsh soaps and scrubbing your vulva vigorously. If you must use a mild baby soap and rinse generously, otherwise a soft cloth and water will do.

Sex is an important part of your life. Regular intercourse will make you healthier, happier and you will live longer. Don’t give up on it. Many post-menopausal women enjoy active and pleasurable sex with their partners. With care and perseverance, your sex life may be better now than it ever was.

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