Menopause and Vaginal Dryness

For women who are approaching or who have experienced menopause, it can either be considered a grand irony or one of the cruelest tricks that Mother Nature can play. Just when she doesn’t have to worry about birth control or counting the days until the fertile part of her cycle, a menopausal woman may have to deal with physical barriers, mainly vaginal dryness, that can get in the way of her enjoyment of her new “sexual freedom.”

This can rob a woman of an active and enjoyable sex life, and down the road, can have a more significant effect on her life than some of the other more prevalent symptoms. When vaginal dryness happens, it is often one of the more silent symptoms that women experience as they go though menopause. Many times, a woman is too embarrassed to discuss changes that are going on “down there,” so she is left to deal with the consequences of the condition on her own.

Vaginal dryness is caused by reduction of estrogen that is caused when perimenopause (the years leading up to menopause and when most common symptoms occur) begins in a woman. When the ovaries produce fewer and lower quality eggs, levels of estrogen decrease. Estrogen is what helps keep the vagina moist during a woman’s fertile years. Therefore, there is a direct relationship between the amount of estrogen in a woman’s body and the production of vaginal lubrication.

The most direct result of vaginal dryness is painful intercourse. Already, for many women, menopause has robbed them of the desire to have frequent—or even regular—sex. But, knowing that it’s a vital part of any successful relationship, a woman will make the attempt to be an active participant in bed. But, if the vagina is not sufficiently lubricated, sexual activity is very painful, and, obviously, not pleasurable. From there, one of two things usually happens. The first is that the woman says nothing and settles for a painful and unexciting sex life.

The second, and more typical experience, is that her sex drive plummets even further and she withdraws from physical contact. She feels as though she’s lost her femininity and appeal to her partner, while the partner may be feeling confused and rejected. This becomes a breeding ground for miscommunication and problems in a relationship.

Women can already feel alone and isolated as a result of the many symptoms of menopause, so when something like vaginal dryness starts to interfere with the most intimate part of her life, she may feel as though there is no where to turn. It is critical that women overcome any fear or humiliation they may feel when discussing sexual problems. By going to the doctor and being candid about the situation, a woman may find that the solution to her problem is not so difficult.

A woman’s first means of treatment is usually over the counter, water based lubricants or moisturizers. K-Y Jelly ™ and Astroglide ™ are some of the most well known examples of lubricants available. Lubricants are best used only right before sexual intercourse for the most effective results. On the other hand, vaginal moisturizers, such as Replens ™ and Lubrin ™, usually last longer than lubricants—up to one full day.
A doctor may also recommend a woman to have sex more often to help with vaginal dryness. This may seem like a contradiction or that the doctor isn’t sympathetic to a woman’s condition; however, women who are sexually active on a regular basis tend to maintain a higher level of lubrication than those who don’t. Doctors know that once intercourse is painful, it is difficult for some women to even think about trying again. However, doctors will encourage some women to engage in longer foreplay, to increase arousal, and therefore possibly increase the vagina’s moisture level. If the thought of intercourse is just too much to bear, masturbation is another possibility. The key is for a woman to get to the state of sexual arousal on a regular basis.

The bottom line is it doesn’t matter how she gets there, whether it be with or without a partner. When and if vaginal lubrication improves, then a woman can consider taking the next step—intimacy once again with her partner.

However, over the counter remedies and increased sexual activity aren’t enough for many women. This is when doctors may prescribe estrogen therapy for a patient. There are a number of options available for women who are in need of this kind of intervention**:
Vaginal estrogen cream (Premarin, Estrace, others). Cream is inserted into the vagina with an applicator two or three times a week.
Vaginal estrogen rings (Estring). The patient or doctor inserts the soft, plastic ring into the upper part of the vagina. The ring releases estrogen over a period of 90 days.
Vaginal estrogen tablets (Vagifem). A disposable applicator is used to place a tablet in the vagina on a regular basis — every day for the first two weeks and then twice a week.
Skin (transdermal) patches containing estrogen (Estraderm, Climara, others). A patch is applied to the skin and worn for several days to a week at a time, according to the doctor's instructions. This form of estrogen slightly increases the risk of blood clots, and possibly breast cancer.
Oral hormone supplements (Premarin, Menest, others). These pills are taken daily. Low doses of estrogen-only and combined estrogen and progesterone supplements are effective. Risks associated with the use of combination oral hormone supplements include an increased risk of heart disease, breast cancer, stroke and blood clots
A woman does not have to allow the symptoms of menopause control or alter her lifestyle. Physical complications may be difficult, if not impossible, to prevent as the body goes through extraordinary physical and chemical changes. However, with a little trust in her partner and her doctor, oftentimes the physical challenges can b reduced or overcome, leading to a happier, healthier woman.

(**medical information provided by http://www.cnn.com/HEALTH/library/DS/00550.html)

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