Vaginal dryness or ‘vaginal atrophy’ as it’s medically known is a very common condition affecting 70% of women post-menopause. A recent study* of 8,000 women found that over half experienced it post-menopause and 41% said it made sex painful, yet British women are 50% less likely to ask for help compared to those in the US and Europe. The study, the first of its kind to clarify the impact of vaginal atrophy, also found that 25% of women had lost confidence in themselves as a sexual partner following menopause and 20% of men felt uncomfortable discussing it with their partners.
“I thought I had a disease when I first experienced it because I didn’t know what it was and nobody tells you about it,” Kathryn Colas, founder of Simply Hormones, said on ITV’s This Morning recently. “I was too embarrassed to talk to my own husband so he felt isolated and we started rowing. Our relationship fell apart and he said it was like sleeping with a stranger.”
“It [vaginal dryness] started earlier on in my mid-40s. I used to use tampons and they became scratchy and itchy and it felt like they were going to fall out so I had a muscular problem there as well. Sex was very painful, like a carpet burn.”
How the vagina lubricates
Moisture is produced by the cervix and over the course of the day it moves through the vagina coming out as a whitish discharge. On average we produce 2-3g moisture per day but this varies according to where we are in our menstrual cycle. Lubrication is governed by oestrogen levels, which protect the vagina and labia, keeping it healthy, moist and plump. The fluid is also slightly acidic so protects the vagina against bacterial and urinary infections.
During sexual arousal and foreplay the two gland inside the vagina (Bartholin’s glands) produce extra fluid, which is slippery to enable comfortable penetration. The musky smell is irresistible to men to ensure survival of the species!
Causes of vaginal dryness
Menopause is the most common cause of vaginal dryness due to declining oestrogen levels, but the following can also have an effect:
- Medical conditions like diabetes, side effects of chemotherapy, full hysterectomy or immune disorders
- Medications – contraceptive pill, anti-depressant and allergy medications
- Overusing chemical products – washing powders, harsh soaps, feminine sprays and douching, perfumed toilet roll
- Childbirth and breastfeeding
- Lack of foreplay – women need more than men…
- Stress, anxiety and relationship issues
- Hot tubs and chlorinated swimming pools
Low oestrogen causes vaginal changes – a thinner, shorter, drier lining which isn’t as elasticated. It may itch, burn or produce a watery discharge and can lead to urinary problems because the vaginal pH is less acidic so less capable of fighting infections.
Using sexual lubricants can reduce the incidence of cystitis and urinary tract infections during the menopause. Having frequent or vigorous sexual intercourse can cause the bladder to become inflamed or infected. Lack of vaginal lubrication can irritate the delicate tissues of the vagina, vulva and around the entrance to the urethra, the hole where you pee out of, leading to what is commonly known as“honeymoon cystitis” but this can affect any woman of any age. It is called this as couples on their honeymoon have lots of sex!
Fortunately vaginal dryness is easy to treat and GPs can offer several different treatments on prescription. If you feel a little embarrassed about discussing it write down your symptoms/questions or ask for a female GP.
Topical (vaginal) oestrogen has had good results. It keeps the lining of the vagina plump and elastic and encourages it to produce glycogen, a compound that helps bacteria to fight infections. It comes as a cream (Premarin) used nightly, a ring (Estring) worn for three months before replacing, and tablets (Vagifem) inserted into the vagina via an applicator. These are a good alternative to HRT in tablet form.
Falling testosterone levels can also be a problem and testosterone therapy can help (0.5-1mg a day). Dr Nick Panay is the leadinghormone expert in the UK, advocating the use of testosterone.
Water-based lubes are condom compatible and great to use before sex to moisturise the vagina and labia. Several brands are recommended – YES available on-line or over the counter. Be aware that some lubricants available on prescription contain chemicals that are not beneficial to vagina health such as parabens and glycerin, which can cause thrush as it is a sugar. Therefore choose a product that is natural such as YES which is similar to your body’s natural lubrication.
To increase natural lubrication whatever your age it helps to masturbate regularly, do pelvic toning exercises (check out our jiggle balls, which you can wear during the day to encourage lubrication and sensitivity – they tone as you walk! Also, slow sex down and make time for plenty of foreplay. Women take longer to become fully aroused and while studies show younger women can be ready for sex in as little as five seconds, the process is longer (five minutes or more) for older women due to changing hormone levels. Lots of foreplay gives the Bartholin’s glands time to produce the maximum amount of natural lubrication.
Complementary therapies can also help – a 1987 study found black cohosh has a similar effect to oestrogen on the body. It’s used in Germany and other countries to help treat menopausal symptoms but further research is needed into its safety and efficacy. Wild yam extract and soy isoflavones can also help. Speak to a qualified medical herbalist.
Acupuncture can also help relieve pain and excessive heat in the body caused by hormonal fluctuations.
Given that we are living longer and have 1/3 of our lives left after menopause, there’s no need to put up with a condition that reduces your quality of life and is simple to rectify. Talk to other women about it and you’ll be surprised at how common it is. “The challenge remains that vaginal health in older women is still a taboo subject, and even doctors find it difficult to talk to their patients about it,” says Dr Heather Currie, gynaecologist and secretary of the British Menopause Society.
*Data taken from information given by 8,000 women as part of the CLOSER study: Clarifying Vaginal Atrophy’s Impact on Sex and Relationships.