Vaginal Dryness

Menopause can cause irritation, dryness and itchiness in, and around, the vagina. Uncomfortable and not something many of us talk about. “Burn Baby Burn”, but we’re not talking about the disco inferno envisaged by The Trammps.

Oestrogen makes the lining of the vagina thicker, and more elastic, keeping it moist and healthy. Now depleting levels mean thinner, less elastic, drier vaginal tissue and loss of fatty tissue. Unfair! Weight loss where you’d least expect – or want - it. And yes, your vagina will look different. The soul-sapping medical name for this condition is Vaginal Atrophy but there’s not a trophy in sight. We think vaginal dryness is a more all-purpose description so that’s how we’re describing.
And the good news is…. You’re not alone. There are products, professionals and other women who can help you through this. Taking action should go some way to resolving the problem.

The best ways to deal with vaginal dryness Knowing what personal hygiene products* to use or avoid, taking supplements and making changes to your diet may relieve symptoms.

What to eat to help with vaginal dryness

So what you put in your mouth can benefit your vagina? Clearly food alone isn’t going to sort out vaginal dryness but most foods recommended for menopause have benefits across the board as well as helping to address hormone imbalance. 
Eat foods containing isoflavines (phytoestrogens) to boost your body’s oestrogen production. Eat more: soya products, soybeans, soy milk, soy yogurt, miso soup. Also found in lower quantities in apples, cherries, peas, pulses, beans and multi-grain bread. 
Eat foods containing lignans (phytoestrogens) found in milled linseeds, whole grains, fruit, vegetables and legumes. 
Increase Omega-3 intake by eating more: oily fish; salmon, mackerel, anchovies, sardine, halibut, or herring (remember the SMASH acronym for which fish to choose).

What to avoid to help with vaginal dryness

No scents Avoid all scented soaps, detergents, fabric softeners and lotions. Ordinary scented soaps and shower gels can be astringent. 
Ditch the douche Vaginal douching removes the natural oils and lubricants from the delicate tissues, altering normal vaginal pH balance. These changes may cause thrush and urinary tract infections.

Lifestyle & wellbeing to help with vaginal dryness

Don’t suffer in silence. Dyspareunia, or painful sex, in menopause is reported by almost 40% of women, most of whom don’t seek medical help or talk about it. Research by the Journal of Psychology, in 2017, found that relationships where sex is reported to be good, improved by 20% whereas those relationships with no sex declined by 70%. Women's Health Physiotherapist, Christien Bird, believes that with so many physiological, relationship and physical benefits attached, improving women’s enjoyment of sex by alleviating vaginal dryness, is essential. 
Talking to your partner about the big menopause picture and how vaginal dryness may be impacting on your sex life should help to calm fears that it's them, or your relationship, that’s the problem - rather than physical discomfort.

In our experience and at the events we run, women really enjoy and benefit from these frank, intense and often funny conversations. Look around for a menopause mate who you can share experiences with. Discussing vaginal dryness may also encourage you to get professional help. Although it may feel overwhelming and embarrassing to talk to strangers about your sex life, as health professionals, they’ve heard it all before. Get advice from the GP in your practice that you feel most comfortable with or ask for a referral to an NHS Women's Health Physiotherapist or psychosexual counsellor.

Wash and go! Intimate care products don’t always help. 
Using warm water alone is the best way to wash your intimate areas but sometimes we want to use products to feel fresher. Avoid using normal shower gels and soap. There are specially formulated feminine intimate care products on the market but these are not generally recommended by specialist gynaecological health professionals.

You’ve always known you should use a good moisturiser! 
We know the importance of a good moisturiser on your face but what nobody tells you is that you can use one on your vagina. Yes, really. PH-friendly, products offer long-term relief for vaginal dryness. The 2015 NICE guidelines recommend using moisturisers and lubricants on their own, or in addition to, vaginal oestrogen to treat vaginal dryness. Creams or gels include:
Sylk Natural Intimate Moisturiser’, parabens-free. 
Non-sticky with kiwi fruit extract, YES VM organic, parabens and glycerine-free moisturiser or ‘Replens’, along-lasting vaginal moisturiser. All available on prescription, to buy online or over the counter. Really worth talking to your GP or buying yourself.
To ease the discomfort of any itchiness caused by vaginal dryness try Salcura Topida Intimate Hygiene Spray, 99% natural, instant relief and a gorgeous smell.

There's a laser for that! 
MonaLisa Touch is a new laser treatment for vaginal atrophy. It has been approved by the FDA (the American food and drug regulatory body) and is available through private clinics here. However, it’s expensive (you need up to three treatments six weeks apart) and further controlled studies are required to confirm its effectiveness. 
Put that tablet where? 
(Non-HRT) Tablets or pessaries such as Premeno Duo Vaginal Ovules can be inserted into the vagina. These non-HRT capsules are inserted before bed for an initial 10-day period and then every 3-4 days. The manufacturer says, ‘No-mess, colour or odour’. They may help improve moisture balance and strengthen vaginal walls. 
Vitamin E, an ingredient in many moisturisers, may help. Pop it as a pill, a pessary or apply directly as an oil to help repair damaged skin cells and promote skin cell moisture.
Have more sex to help lubricate the vagina! 
Vaginal dryness may lower the chance that you’re going to feel like sex. However, the more sex you have, the more natural lubrication your body produces. Read our post by Sylk on Sex and the Menopause for some top tips to re-kindle your flames of desire.
Lubricate before sex! 
Because the tissue around your vagina is thinning, friction may make sex painful and could tear the tissue. As the shrinking vagina is less likely to produce moisture when stimulated, extra help may be needed. Lubricants can help relieve vaginal dryness during intercourse. Try using: Sylk Natural Intimate Moisturiser, a water-based personal lubricant or the YES range of water-based and oil based lubricants free from chemicals and irritants, which are particularly suitable for women who are sensitive to the glycerine or glycol in some lubricants.
Note: KY Jelly is often recommended by GPs as a lubricant to ease vaginal dryness but it was developed to help internal examinations rather than as a moisturiser or lubricant. Many women find the chemicals it contains, vagina-unfriendly irritants. So best avoided.
Women's Health Physiotherapist Christien Bird, says that painful sex is too common but not normal, she gave us 4 top tips to prevent painful sex. Watch her talking with Positive Pause about Menopause & The Pain Of Sex.
Read all about it! 
Me & My Menopausal Vagina: Jane Lewis' book urges women to be proactive about vaginal atrophy. You’ll find everything you want to know and more besides. As the review by Menopause Counsellor, Diane Danzebrink says “If you have a vagina, know or love somebody with a vagina, then you need to read this.” 

Supplements worth trying for vaginal dryness

Sea Buckthorn Oil (containing Omega 3, 6 & 7) taken orally in capsules, or as a powder to add to smoothies, may increase vaginal PH and moisture. 
Sage is a natural hormone-mimicking supplement, thought to be a mild phytoestrogen, 
Ginseng a phytoestrogenic herb that mimics the role of oestrogen, may help with dryness and boost your energy
Natural products may impact on other medications. Talk to your doctor about how safe these products will be for you, if you have any existing health condition.

When to see your doctor about vaginal dryness

Ring of fire? Localised HRT to reduce vaginal dryness 
Not the Johnny Cash song but we couldn’t resist. Estring is a soft vaginal ring, worn for three months that slowly releases a small, localised dose of oestrogen straight to the vagina, to reduce dryness. This is an HRT product available with a doctor’s prescription. Reviews seem mixed with some women talking about weight gain and discomfort but others finding it does the job. This would be something to discuss with your doctor.
Other options to manage vaginal dryness:
Include topical vaginal creams or capsules applied directly into the vagina - Ovestin or Vagisan oestrogen-only creams or, or localised HRT oestrogen capsules, such as Vagifem.
Symptoms will return once you stop using the ring, creams or pessaries. (Your doctor can prescribe lubricants. If you're prone to bacterial infections or sensitive to glycerin and glycol ask for a lubricant free from these ingredients.)

And then there’s always HRT 
HRT taken as a tablet, patch or gel can help deal with vaginal dryness by restoring hormone balance. Doctor’s will look at your unique circumstances and whether or not HRT is appropriate for you. The usual caveat here that this is something to be discussed with your doctor. There are pros and cons to taking HRT.

And we can help 
Your Fbl Team x