“Vaginal dryness”- Often underreported and undertreated


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“ It feels very dry, itchy, sometimes burning, uncomfortable down there.”

This feeling every woman must have experienced in her life, maybe once or frequently. Some may suffer in long term. But honestly, how many of us come out to find a solution or at least talk about it. When things become unbearable then only we seek options.

One of the misconceptions is that vaginal dryness occurs only during menopause. No, it can happen in premenopause as well, at any age. Generally, the reason considered is decreased level or lack of female hormone named estrogen. But there are other reasons too. However, vaginal dryness( VD) is a suboptimal health condition that carries a multi-factorial character. Thereby, some of the contributing factors are clearly preventable and, therefore, if treated properly, have the potential to milden the VD. Individual patient profile, pre or postmenopausal determines specific symptoms and reasons for it.



Let's see different causes of vaginal dryness

Hormonal regulation changes

Hormonal regulation, changes in peri and postmenopausal women and it is part of the aging process. There is a decreased level of estrogen hormone and thus causes atrophy and thinning of the vulva and vagina. Vulvovaginal atrophy can be particularly extreme when a menstruating person enters menopause abruptly. Abrupt or “iatrogenic” menopause occurs when a menstruating woman has her ovaries removed, undergoes chemotherapy or radiation to the ovaries, or uses anti-hormonal treatment as is common for some breast cancer types. In some cancer patients due to chemotherapy or radiation ovaries stop functioning and premature menopause is attained. Premature ovarian insufficiency due to cancer treatment can happen in adolescents and teenagers also.


Sexually transmitted infections

Fungal and bacterial infections mainly cause abnormal vaginal discharge and itching. Dryness is not that evident in these infections.


Use of feminine hygiene products

The shiny and mucosal surface of the vagina and vulva have their self-cleansing system. Use of any products like scented or perfumed soap, feminine hygiene products with fun scents or colors, bubble bath, douches, baby wipes, lotions, powders can cause dryness, irritation, or infection. Panty liners trap the moisture from the vulvovaginal area that is helpful for comfort and lubrication.

Dehydration

Sufficient liquid intake is essential for proper vaginal lubrication. The whole body dehydration may strongly contribute to the VD.


Decreased blood flow in the vaginal area

cancer treatment, aging, abnormal metabolism-related pathologies such as diabetes, and changes in vaginal innervation result in vasoconstriction and thus promote vaginal dryness.


Psychologic factors and stress overloads

Psychologic factors play an important role in VD development and further complications. For example, it is evident that not enough foreplay before sex frequently causes VD in both—pre- and postmenopausal women. Further, significant stress overload and anxiety negatively impact both libido and vaginal lubrication. Specific psychological aspects are characteristic, such as a meticulous personality with a particular tendency to perfectionism that can result in significant stress overload demonstrated as a strong contributor to the VD development.

Symptoms

The usual symptoms of the VD are skin irritation, burning, itching, and/or simply discomfort in the area. In postmenopausal women, there is thinning of the vaginal tissues and flattening of naturally occurring “rugae,” or the folds along the walls of the vagina that allow that the vagina to stretch and expand for things like childbirth, vaginal exams, and sexual intercourse. This dryness, irritation, and thinning can make sex uncomfortable or painful. Many women with these symptoms suffer in painful silence because either they do not report their symptoms to a doctor or the doctor doesn’t ask.

Treatment

In a woman with vulvovaginal atrophy, estrogen products inserted into the vagina are a common and effective treatment. But many women want to avoid estrogen or advised not to take it due to cancer diagnosis.

So many women at any age group, find over-the-counter vaginal lubricants and moisturizers helpful. There are different types of lubricants. They help in relieving dyspareunia (painful sexual intercourse) They are short-acting, to be used immediately before intercourse. Moisturizers to be used as maintenance therapy instead of during intercourse, 2-3 times a week.

Avoid using scented soaps, perfumes, douches, baby wipes, lotion, body wash in the vaginal area. Avoid panty liners. While cleaning down there wipe from front to back.


Lubricant and moisturizer

Nowadays it seems that everyone and their neighbor has an opinion on healthy living and self-care strategies. From meditation to crystals and green juice cleanses. So we should be aware of harmful practices too. Vaginal dryness is a very common condition which we ignore most of the times. I remember one of my patient around 50 years old had VD and burning for a very long term .But due to shyness and fear didn’t seek help for all those years. By the time she came to me it was so severe that her vaginal area became so constricted , she was passing urine drop by drop. Due to chronic irritation vaginal and vulvar area became sclerosed. So take home message here is to come out and seek doctor’s help if the condition is bothering you.It may not be severe every time but definitely we can prevent worsening it further.


Thank you.

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