When simple things become VERY, VERY AWFUL

It may be due to Vulvar and Vaginal Atrophy (VVA), a chronic and progressive medical condition that affects many menopausal women.

Approximately 1 in 2 menopausal women in the United States experience VVA. VVA is caused by decreased estrogen production. Women may spend an average of one-third of their lives in this hypoestrogenic state. The most common physical symptoms of VVA include dyspareunia (painful sex), vaginal dryness, burning and irritation, and soreness. Urinary symptoms such as dysuria (painful urination) and recurrent urinary tract infections are also associated with VVA.  These symptoms may negatively impact a women’s sense of self, relationships and enjoyment of life.

Unlike night sweats and hot flashes, VVA may not resolve without appropriate treatment.

Treatment of VVA:

1. Vaginal moisturizers like Replens, and Hyalo help to restore moisture in the vaginal tissue. These moisturizers are applied every 2-3 days. The beneficial effects of moisturizers generally last a little longer than vaginal lubricants.
2. Water based lubricants (glycerin free versions of Astroglide, K-Y, and others) help to decrease discomfort during intercourse. Glycerin free is recommended because many women are sensitive to glycerin and the glycerin can cause burning and irritation. Petroleum jelly or Petroleum-based products should also be avoided as petroleum can break down the latex in a condom.

Bothersome symptoms that do not improve with over the counter products may be helped by low dose estrogen products:

1. Topical (vaginal estrogen) – has the advantage of being effective at lower doses and does limit the overall exposure to estrogen as only a small amount is absorbed by the blood symptom. Oral estrogen’s are absorbed into the blood system in much greater quantities than topical estrogen.

Topical estrogen comes in several forms:

1. Vaginal estrogen cream – This cream is inserted into the vagina with an applicator, usually at bed time.
2. The amount and frequency of vaginal estrogen is determined by a health care provider.
3. Vaginal estrogen ring – A small flexible ring is inserted into the upper vaginal area. The ring releases a consistent dose of estrogen while in place. The estrogen ring needs to be replaced every three months.
4. Vaginal estrogen tablet- A disposable applicator is used to release a small vaginal estrogen tablet into the vagina.

Other Therapies:

1. Oral estrogen- Oral estrogen is absorbed into the blood stream. Oral estrogen can alleviate vaginal dryness and combat hot flashes and night sweats. It is important to note that if a woman has an intact uterus either cyclic progesterone or daily progesterone is needed to help prevent endometrial hyperplasia and endometrial cancer. Oral estrogen is generally contraindicated in women with a history of breast cancer.
2. MonaLisa Touch– This is a CO2 laser that works by restoring collagen into the vaginal mucosa to help with vaginal dryness and atrophy. Mona Lisa touch involves a series of five minute treatments six weeks apart. The CO2 laser works quite well in patients with a history of breast cancer where any hormonal treatment is contraindicated.

Natural Remedies usually involve life style changes:

1. Give up smoking – Smoking decreases estrogen and increases the risk of vaginal atrophy and osteoporosis
2. Stay sexually active – Sex increases blood flow to the genitals, which in turn promotes less atrophic changes. Leave enough time to get and maintain arousal.
3. Avoid perfumed products such as powders, soaps and deodorants
4. Get regular exercise and physical activity to help decrease hormonal imbalances
5. Keep well hydrated

Natura Lubricants:

1. Jojoba
2. Coconut Oil
3. Aloe Vera
4. Vitamin E suppository-helps to stimulate natural moisture in the vaginal walls and help protect against infection

Rethink the full impact of VVA