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Blog: MenoPause ~ take time to think about it

Menopause and the volatile vagina

by Margery Gass | Sep 27, 2012
Bothersome symptoms of the vagina and vulva occur in women of all ages, but they become much more common around menopause. Loss of estrogen at this time is a major cause of vaginal dryness, itching, burning, discomfort, and pain during intercourse. These symptoms range in severity from mild annoyance to a point where they significantly affect a woman’s quality of life in the following ways:

  • Vaginal atrophy. Tissues of the vulva and the lining of the vagina become thin, dry, and less elastic.
  • Decreased lubrication. Lack of lubrication is due to diminished vaginal secretions.
  • Pain with intercourse. With severe vaginal atrophy, the tissues of the vagina become dry and sometimes fragile and inflamed. As a result, they are more prone to injury, tearing, and bleeding during sexual intercourse or even a pelvic exam. Over time, especially in the absence of regular intercourse, the vagina may also become shorter and narrower. The resulting discomfort can intensify to the point where sexual intercourse is no longer pleasurable or even possible.

Treatment options:
  • Vaginal moisturizers. Available without a prescription, these nonhormonal products help maintain vaginal moisture in peri- and postmenopausal women. Just like moisturizing your face or hands, the vagina should be moisturized on a regular basis, usually twice weekly at bedtime. There are many effective brands, including Replens and K-Y Long-lasting Vaginal Moisturizer.
  • Vaginal lubricants. These products reduce discomfort with sexual activity when the vagina is dry by decreasing friction during intercourse. There are many options and you should find one that works for you and your partner.
  • Regular sexual stimulation. Intercourse promotes blood flow to the genital area, helping to maintain vaginal health.
  • Developing expanded views of sexual pleasure. If vaginal penetration (intercourse) is difficult or uncomfortable, consider so-called “outercourse” options such as extended caressing, mutual masturbation, and massage. More and more women are using vibrators  for sexual pleasure.
  • Local prescription therapy. For vaginal dryness and discomfort that does not respond to over-the-counter lubricants and moisturizers, low doses of local vaginal estrogen therapy are very effective and safe. Local estrogen increases the thickness and elasticity of vaginal tissues, restores a healthy vaginal pH, increases vaginal secretions, and relieves vaginal dryness and discomfort with intercourse. Government-approved products are available as vaginal creams, a vaginal estradiol tablet (used twice weekly), and a vaginal estradiol silastic ring. All are highly effective.
  • Systemic prescription therapy. Low doses of systemic estrogen in the form of a pill or skin patch used to treat hot flashes are also effective for treating vaginal dryness, although some women might benefit from adding local treatment to their systemic treatment to relieve discomfort. If only vaginal symptoms are present, local therapy described above is recommended.
  • Vaginal dilators. After many years of severe vaginal atrophy, especially if sexual intercourse is infrequent, the vagina may become so shortened and narrowed that it cannot accommodate an erect penis. In addition to regular use of vaginal estrogens and moisturizers, some women also may require several months of daily “exercises” with lubricated vaginal dilators to stretch and enlarge the vagina. Once intercourse becomes comfortable again, dilators typically are no longer needed, as the vagina remains healthy with regular intercourse and low-dose local estrogen therapy. Dilators may be purchased from pharmacies, medical supply stores, and online, and should be used under the guidance of a gynecologist, physical therapist, or sex therapist.
With their healthcare provider, women can assess the symptoms, causes, and treatment for vulvovaginal distress and find a comfortable and healthy solution for their distress. For more information, visit the sexual health section of our website.



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MenoPause: the blog!

Posts to our Blog are written by NAMS staff members and Dr. Margery Gass. All posts are reviewed and edited by Dr. Gass. We strive to bring you the most recent and interesting information about various aspect of menopause and midlife health. We accept no advertising for our website. We want you to have accurate, unbiased, evidence-based information. 

Margery L.S. Gass, MD, NCMP
NAMS Executive Director

An internationally recognized leader in the field of menopause, Dr. Gass became Executive Director of The North American Menopause Society in 2010. Dr. Gass has been an investigator on numerous research projects, including serving as a principal investigator for the Women’s Health Initiative, and has published and presented on a wide range of topics related to menopause, including osteoporosis, sexual dysfunction, and hormone therapy.

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