You Are Here:Vaginal dryness by Dr David Edwards

Vaginal dryness

Writes: Dr David Edwards GP, Past President British Society for Sexual Medicine / Specialist in Men’s and Women’s Sexual Problems. Chipping Norton, Oxfordshire.

Vaginal dryness can be a troublesome problem that is under diagnosed and under treated.[i] Educating doctors and nurses as well as patients is essential to encourage women to ask for help and get the treatment they need, so I welcome EveryWoman Day for raising awareness of it.

Vaginal dryness is one of several things that can occur as a result of what we clinicians call ‘Genitourinary Symptoms of the Menopause (GSM)’. As the name suggests this condition affects not just the urinary system but also the vulval and vaginal area as well……that is, all the delicate bits down below.

Science has shown that about 15% of pre-menopausal and 57% of post-menopausal women [ii] experience dryness in and around their vagina. As one patient told me, “It’s like crunching tissue paper between your legs when you walk”. And yet, research has shown that only 1 in 4 have sought professional help[iii].

If the woman (or her partner) thinks that she has symptoms of vaginal dryness and GSM then she should ask for help from her doctor. As the old saying goes, ‘A stitch in time saves nine’. There are simple, effective treatments available for vaginal dryness and a whole range of options for other symptoms of GSM, so there is no need to ‘just put up with it’.

During sex, women are expected to produce some vaginal lubrication. However, expectations can vary from country to country and between cultures [iv].  Women themselves say that they prefer vaginal intercourse to feel wetter. They can reach orgasm more easily when sex is wetter, and believe their partner prefers sex to be more wet than dry[v]. So, it’s not surprising that lack of natural lubrication[vi] is one of the more commonly seen female sexual problems that doctors are presented with – what’s perhaps more surprising is that more women don’t come forward to ask for help.

There are many causes of decreased vaginal lubrication. These include advancing age; hormonal changes; breastfeeding, menopause and some contraceptive pills; stress; conditions such as diabetes, inflammatory bowel disease, multiple sclerosis, thyroid problems and chronic heart failure[viii]. Medical treatment including radiation and chemotherapy, and medications including antidepressants[ix] can also cause vaginal dryness.

Personal lubricants and moisturisers are very effective in relieving pain and discomfort during intercourse for women with vaginal dryness. They can also help women who are not sexually active in many ways, including a reduction of urinary tract infections. Women who are not suitable for local hormone therapy using vaginal oestrogen, or who do not wish to use it, can find vaginal moisturisers particularly useful. Both lubricants and moisturisers reduce that ‘sandpaper feeling’ that comes with vaginal atrophy which can cause thin, dry skin.

The World Health Organization (WHO) recommends that lubricants are used with condoms for women in the menopause and post-menopause as well as in other groups, such as female sex workers and men who have sex with men [x] (World Health Organization, 2012). This is important, because social norms are changing, and there is a rise in Sexually Transmitted Infections (STIs) among people in their 40s and older11.

Many different types of vaginal products are available from pharmacies and on prescription and I recommend that women choose one that matches their normal secretions, so called ‘body identical replacement’. Ideally and importantly they should avoid preparations with ‘those chemicals in small print’ such as parabens and microbicides that have been found to have a variety of proven or potential side effects.

I personally feel that Health care professionals (nurses, GPs, sexual health specialists and gynaecologists) owe it to their female patients to be educated in this topic, sensitively engage in conversation with them about these problems and know how to manage their symptoms.[xi]

From my own experience and from what other GPs tell me, women don’t come forward with other sexual problems either. I wish they would. The oldest couple I saw was a 93-year-old man with erection problems and an 89-year-old woman, who I gave lubricants to. They felt guilty for ‘wasting my time’ but I congratulated them and encouraged them! In the spirit of EveryWoman Day and with the inspiration of this couple, I encourage anyone to ask for help, even if they feel the topic is difficult to discuss.

[i] EDWARDS D & PANAY N 2016 Climacteric  19: 151–61
[ii] PALACIOS, S. 2009. Managing urogenital atrophy. Maturitas, 63, 315-8
[iii] Sturdee DW, Panay N; International Menopause Society Writing Group.
Recommendations for the management of postmenopausal vaginal atrophy. Climacteric
2010;13:509–22.
[iv] BRAUNSTEIN, S. & VAN DE WIJGERT, J. 2005. Preferences and practices related to vaginal lubrication: implications for microbicide acceptability and clinical testing. J Womens Health (Larchmt), 14, 424-33.
[v] JOZKOWSKI, K. N., HERBENICK, D., SCHICK, V., REECE, M., SANDERS, S. A. & FORTENBERRY, J. D. 2013. Women's perceptions about lubricant use and vaginal wetness during sexual activities. J Sex Med, 10, 484-92.
[vi] ANDELLOUX, M. 2011. Products for sexual lubrication: understanding and addressing options with your patients. Nurs Womens Health, 15, 253-7.
[viii] CORDEAU, D. & COURTOIS, F. 2014. Sexual disorders in women with MS: assessment and management. Ann Phys Rehabil Med, 57, 337-47.
[ix] ANDELLOUX, M. 2011. Products for sexual lubrication: understanding and addressing options with your patients. Nurs Womens Health, 15, 253-7.
10 EDWARDS D & PANAY N 2016 Climacteric  19: 151–61
11 PUBLIC HEALTH ENGLAND,
Chlamydia Testing Activity Dataset (CTAD)
Genito-Urinary Medicine Clinic Activity Dataset v2 (GUMCADv2)

 

Leave a Reply

Your email address will not be published. Required fields are marked *

Top