The best option for what you describe is a regular routine of vaginal moisturizer use; use it consistently at least two times a week. Add a lubricant at the time of intercourse to assure your comfort.
Posts Tagged ‘vaginal dryness’
When women in my practice have vaginal dryness or atrophy, I typically start by recommending a vaginal moisturizer. The key is to be faithful, using the moisturizer at least two times each week. Yes is the most popular vaginal moisturizer at MiddlesexMD; the fact that it’s available in pre-filled applicators is definitely a plus for women who don’t like the mess of other options!
I should also mention that a new oral medication for vaginal dryness or pain was approved by the FDA this summer. Non-hormonal, it’s called Osphena and is available by prescription. Because it’s oral, there’s no mess! But you do need to make the consistent commitment, again, to regular use.
Like a number of my patients, you’d like to avoid the disposable applicator that often comes with vaginal moisturizers—whether for environmental or cost reasons (or both!). I know many women prefer to use an applicator: no muss, no fuss. I can’t help but encourage women to reconsider the simplest approach: Wash your hands, apply moisturizer to your finger, and insert it in your vagina. This has a number of advantages—you’re experienced in washing your hands, your finger is warm and able to curve with your vagina, and you’ll know your body better. If you’ve used tampons without applicators or menstrual sponges or cups, you may be entirely comfortable with this method.
But I know our instinctive preferences are hard to retrain. Another alternative that’s worked for patients is to go to the drugstore and check out the syringes for one of appropriate size and cleanability. Note that these are typically designed for single use, so you’ll need to develop your own approach for washing and storing the syringe between uses.
Find a method that works for you! Vaginal moisturizer makes a difference with regular use.
The pain that you describe sounds like vulvovaginal atrophy, and possibly vulvodynia (vestibulodynia). These conditions can both be treated, but need the attention of a physician for an accurate diagnosis and treatment plan. Estriol and progesterone, which you say you’re trying, aren’t likely to be of great benefit to you, but localized estradiol is likely to help.
It’s sad at any age to put this important aspect of a marriage aside. And, because, unfortunately, the longer it goes on, the worse these conditions get, I’d recommend a visit to your physician sooner than later. If you’re unsure of your physician’s ability to adequately manage this part of your health, find a Certified Menopausal Provider in your area.
In the meantime, make sure you are using a good lubricant; a silicone lube like Pink is probably going to be most effective for this condition. It’s also important to use a vaginal moisturizer like Emerita.
I’m sure you feel discouraged. Know that I have had patients who have regained the sex lives they wanted! They’ve felt it was worth the effort. Good luck!
Whether you were already menopausal or were abruptly deposited into menopause after treatment for your cancer, you’re probably familiar with what happens to your vagina when you lose estrogen.
You may experience the burning, itching pain of thin, dry vaginal walls and fragile skin on your genitals. You don’t lubricate like you used to, so sex can be difficult or painful. Or, if you’re experiencing the muscle spasms of vaginismus, sex may be impossible. Less estrogen is a good thing for some cancer treatments, but it’s darned tough on the vagina and, by extension, on your sex life as well.
So, while vaginal health is important for all women during menopause, it’s critical for those undergoing cancer treatment. Your vagina and pelvic floor need a lot of TLC right now to stay comfortable and responsive. Fortunately, compared to the other things going on in your life, taking care of your bottom is usually straightforward and inexpensive. Besides, keeping your vagina in good shape might eliminate one problem area and allow you to stay in touch with your sexual self, too.
Consider this four-part approach to caring for your vagina and pelvic floor.
First, use vaginal moisturizers and lubricants.
Moisturizers are your first line of defense. These are non-hormonal, over-the-counter products that are intended to keep your vagina hydrated and to restore a more natural pH balance. They should be used two or three times a week, just as you’d moisturize any other part of your body. Replens, Yes, and Emerita are examples of moisturizers.
Using moisturizers is important whether or not you’re having intercourse. It should just be part of a regular health maintenance regimen.
Use lubricants liberally before intercourse, on sex toys such as vibrators, and any time you touch the delicate tissue on your genitalia. Also apply lubricant to your partner’s penis.
At this point, keep your lubricants plain and simple—no scents or flavors; avoid warming lubes. Don’t use any product with glycerin, which can create an environment conducive to yeast infections, and don’t use petroleum-based lubricants.
Second, keep your pelvic floor toned. “The pelvic floor is really important in keeping your internal organs in place, preventing incontinence, and enhancing sexual pleasure,” says Maureen Ryan, nurse practitioner and sex therapist.
Plus, knowing how to relax your pelvic floor muscles is helpful if you’re experiencing the involuntarily spasms of vaginismus.
Kegel exercises, in which you flex and relax the muscles around your vagina, will tone the pelvic floor. Or, you can purchase exercise tools to tone your pelvic floor muscles. This is a great way to make sure you’re exercising the right muscles.
Third, use dilators if your vaginal capacity is compromised. Dilators are cylinders that come in sets with various sizes. They’re meant to gradually increase the size and capacity of the vaginal opening, which can be important, especially after some cancer surgeries and treatments that constrict the vaginal opening or create scars and adhesions.
To some extent, dilators are helpful just to reassure you that you can tolerate something in your vagina again.
Start with the smallest size dilator, lubricate it, and gently insert it as far in as you can tolerate. Try doing kegel exercises, tensing and relaxing your pelvic floor muscles. Can you feel your muscles close around the dilator? Keep it in for maybe ten minutes and repeat this exercise several times a week. Move on to the next largest size when you can tolerate it.
Fourth, use a vibrator (lubricated, of course). Self-stimulation increases blood flow to your genitals and helps reacquaint you with the feelings and sensations of your body. The more stimulation you can bring to the area, the healthier it will be.
The point is to keep the vulvo-vaginal area moist and flexible, to increase blood flow, to stay responsive, to maintain capacity, so that when you and your honey are ready to start your engines, you’ll both enjoy a smooth ride.
There really are no special considerations specific to your diabetes. While I can’t confidently diagnose the cause of your pain with intercourse, I can’t think of a diagnosis or treatment option that would be eliminated because of your diabetes.
If you or your physician are considering systemic estrogen/progesterone, cardiovascular disease risks are taken into consideration. On the other hand, if localized (vaginal) estrogen could be part of the solution, cardiovascular disease risks are really not pertinent: The estrogen isn’t absorbed systemically to any significant extent. (Don’t interpret this to mean diabetics shouldn’t be on hormone therapy. May of our new studies suggest that starting hormone therapy at a younger age–closer to menopause–may actually be cardio-protective.)
I’m so glad you’re taking the initiative to investigate your health and your options!
In the last post, we talked about how pH levels affect the vagina. The second part of good vaginal health has to do with moisture. As we say at MiddlesexMD, moist tissues are strong tissues.
Normally, your vagina moisturizes and cleanses itself by secreting a clear fluid that seeps from blood vessels in the vaginal wall. When you become sexually aroused, blood flow increases, and so does the lubrication. Unfortunately, this process is regulated by estrogen, and we all know what’s been happening to that hormone lately.
With decreasing estrogen levels and circulation, vaginal tissue becomes thin and dry. Maybe you’ve noticed that you don’t lubricate as easily during sex so that penetration is difficult or painful, or maybe you’ve experienced vaginal dryness and discomfort at other times as well.
The good news is that this condition is easy to fix. You moisturize your skin regularly; you should do the same with the vagina.
First, a little refresher on the difference between vaginal moisturizers and lubricants. Lubricants may be used in the vagina and on the penis or toys during intercourse to help with penetration and to make sex more pleasurable. Lubricants come in water- or silicone-based varieties or a hybrid of the two, and in various viscosities (thick to thin). Choice of lubricant is a highly personal preference and may depend on the activity you have in mind. Because it’s helpful to try different kinds, we’ve compiled a sampler kit of our favorites.
Lubricants last several hours, and the only rule of thumb related to vaginal health is that no oil-based product, including petroleum jelly, should be used in the vagina. They’re hard for the vagina to flush out; they tend to disrupt pH balance; and they also tend to deteriorate condoms. Lubricants can be used in addition to a moisturizer.
The sole purpose of vaginal moisturizers, on the other hand, is to keep vaginal tissue moist and healthy. Moisturizers last two or three days and should be used regularly, just like facial products. And just like anything you use on your body, you want your vaginal moisturizer to contain natural, high-quality ingredients.
A few common ingredients in vaginal moisturizers (that are also present in lubricants) bear some examination:
- Glycerin. Widely used in moisturizers and lubricants, glycerin is a colorless, sweet-tasting substance that can exacerbate a yeast infection by giving the organisms sugars to feed on. If you’re susceptible to yeast infections, find a glycerin-free moisturizer.
- Parabens. In all their hyphenated mutations (methyl-, ethyl-, butyl, and propyl-) parabens are a widely used preservative and anti-microbial agent. While some contamination-fighting ingredient is a good idea in these personal products, a few recent studies have found very slight health issues that may be linked to parabens. A bigger problem is the potential for an allergic reaction that could be related to parabens or other ingredients in moisturizers.
- Propylene glycol. Used as a fragrance and to control viscosity, propylene glycol has also been linked to skin irritations and allergies.
While none of these substances present major health risks, it’s a good idea to make an informed decision about your personal care products. Read the ingredient list in your moisturizer; the fewer unpronounceable names, the better. If you can find a product that uses natural ingredients and that works for you, wouldn’t that be your first choice?
When you think about it, the vagina is a pretty undemanding organ. It’s cooperated through childbirth and nights of passion; it’s soldiered on uncomplainingly throughout years of menses and the occasional “oops”—such as the patient of mine who applied Retin-A skin cream instead of Vagisil, or the friend who used Ben-Gay. Her vagina did a little complaining then, but soon returned to its cheerful self.
Because the vagina has rarely been the squeaky wheel, we’ve tended to tend to take it for granted. As we age, however, vaginal tissue thins, loses elasticity, and becomes dry, so, like other parts of our bodies, that wheel tends to squeak a little louder.
Often, vaginal troubles can be addressed—or avoided altogether—with some TLC. While few of us think about how to maintain optimal vaginal health, maybe it’s time to give that longsuffering organ some extra attention. The two major factors in maintaining a healthy, uncomplaining vagina are a good bacterial balance and moisture.
First, a science lesson: pH is a measure of how acidic or alkaline (basic) a substance is. The pH scale ranges from 0 (very acidic) to 14 (highly alkaline) with seven being neutral. A healthy vagina is slightly acidic, in the range of 4.5 to 5. This acidity is maintained by a delicate balance of organisms, notably the bacteria lactobacillus that produces lactic acid. This slightly acid environment helps to ward off infection.
When the pH level in our vagina is out of whack, unwanted bacteria and other organisms can flourish—Candida albicans, for example, which is the fungus causing yeast infections. Sometimes it doesn’t take much to upset the balance. A surgary diet, some kinds of soap, a round of antibiotics, or even one of those nights of passion can upset the flora in the vagina. Sperm, for example, is alkaline with a pH of 7 to 8, and so is blood with a pH of 7.4, which is why hygiene is especially important if you’re still menstruating.
Here are some suggestions for maintaining a good pH balance and for overall vaginal hygiene.
- Don’t douche. Douching actually increases the risk of bacterial infection and reduces the “good” lactobacilli in the vagina. The vaginal walls produce a clear fluid to flush out foreign substances (more on this in the next post), so douching is both unnecessary and harmful.
- Maintain good air flow. Wear cotton panties and loose clothing—at least some of the time! Avoid relying on silks and synthetics that trap moisture on the vulva. Don’t wear thongs. Change out of wet bathing suits or clothing promptly.
- Avoid scented products: feminine sprays, soaps, bubble bath, scented pads or tampons. They can be irritating, allergenic, or alkaline.
- Wash your bottom with warm water. Soap is drying to the delicate vulva and inner labia, and some soaps are alkaline.
- Use tampons rather than pads and change them regularly.
- Keep bacteria where they belong. Wipe from front to rear.
- Avoid sugars and refined carbohydrates. They can create an environment that feeds fungi.
- Talk to your doctor about maintaining good vaginal health if you’re prescribed antibiotics. He or she may suggest eating yogurt, for example, or taking Lactobacillus acidophilus tablets.
- Wash underwear with mild soap, such as Woolite. Rinse well. Avoid scented fabric softeners.
At the end of the day, all our parts are interconnected, so it’s not possible to maintain good vaginal health if the rest of your body is unhealthy. Smoking, obesity, and diabetes are all conditions that compromise health, including vaginal health. Good general habits, such as a healthy diet and exercise to maintain good muscle tone, are probably the most critical elements to a healthy vagina.
But you knew that.
You may have heard about the Centers for Disease Control and Prevention’s prediction that by 2050, one in three Americans could have diabetes. One in ten already do, although many of them haven’t yet been diagnosed. A noticeable increase in thirst is one of the first, best-known signs of diabetes. I’m thinking about another, less-well-known symptom: a decrease in sexual enjoyment.
A recent University of Chicago study found that while women and men with diabetes had sex about as often as their non-diabetic counterparts, both women and men enjoyed it less. Women reported having more difficulty in achieving satisfying orgasms. And, worse, women were less likely to talk about it with a doctor.
It’s difficult, I know, for many women to talk to their doctors about sex to begin with. They might feel more comfortable bringing it up if they understand the connection to diabetes.
It’s a hormone, again, that’s causing the disruption; just not the usual ones we talk about with mid-life sex. This time it’s insulin, which regulates blood sugars. With diabetes, the body is unable to make or respond to insulin. Without treatment, sugar builds up in the blood and a number of functions don’t work normally.
High blood sugar levels can lead to vaginal dryness and painful intercourse. Even if it’s not painful, there’s a good chance that intercourse will be less pleasurable. Eventually, the extra blood sugar damages blood vessels that supply nerves; as those nerve endings become less sensitive, sex becomes more ho-hum. (A similar thing happens to blood vessels in the penis, which can lead to erectile dysfunction for diabetic men.) The more time goes by without treatment, the more damage is done.
If you already know you have diabetes, make sure you’re following your doctor’s advice on controlling your blood sugar through a combination of diet and medication. If you’re experiencing changes in your sexual response, take the initiative to discuss it with your health care provider.
If any of this sounds familiar and you haven’t been diagnosed with diabetes, ask your health care provider about being tested. The sooner you start treatment, the more damage you can delay or avert.
And if you aren’t diabetic, do everything you can to stay that way, especially if you have risk factors like obesity, diabetes in pregnancy, or a family history of diabetes. Eat a healthy diet that’s low in cholesterol, exercise for 30 minutes five days a week, and maintain a healthy weight (a body mass index of under 25). Finally, if you smoke, quit.
If nothing else motivates you to stay healthy—or make healthy changes in your lifestyle—perhaps the thought of better sex will!