Vaginal dryness is not a fun or particularly comfortable topic to discuss, but as a gynecologist I hear this complaint from so many women—even from those in their 20s and 30s but especially from women in their mid-40s on up. So let's start having an open conversation about vaginal health! Your body, mind, emotions, and relationship will all thank you.
What's causing the problem?
There are many different causes of vaginal dryness, some of which you may never have considered like medications such as antihistamines, certain antidepressants and anticholinergic medications, stress and anxiety, or douching and irritants such as soaps and perfumes. It can also be caused by estrogen and hormone-disrupting practices such as smoking, being postpartum or breastfeeding, and insufficient arousal. The biggest factor for most women, however, is the natural decline of hormone levels as we age, which result in physical changes to our feminine health. And these changes go well beyond vaginal dryness, hot flashes, and other physical discomforts.
Research has shown that as these hormones decline—and women are faced with the resultant symptoms—it can dramatically affect both our self-esteem and our relationships. Researchers have found that women start to experience many emotional, mood, and confidence issues as vaginal dryness and associated symptoms plague us. As much as we don't want to believe it—it can greatly affect our ability to be happy and positive.
Research also shows that the "sexual distress" many of us are feeling has been associated with a higher incidence of relationship conflicts and depression. And even if sex isn't in the picture, vaginal dryness still may affect how you feel. You may suffer from anxiety relating to worsening symptoms of dryness or discomfort. You may be feeling older than your years (because our spirit is always youthful!), your self-esteem may be dwindling, and you may not be able to do the things you once enjoyed (horseback riding, cycling, jogging, etc.) due to irritation.
Is there anything I can do?
Yes! First, focus on all the simple stuff. Vulvar and vaginal dryness and overall vaginal health can be tackled with various easy (and natural) approaches.
1. Kegel your way to improved pelvic health.
To get the blood flowing to those vaginal tissues (important to keep things from drying and losing elasticity), make sure you are doing your pelvic floor exercises!
2. Minimize toxin exposures to your delicate lady parts.
Many soaps and bubble baths contain irritants, and some even expose you to endocrine-disrupting chemicals. Reading labels and reducing the worst offenders can help.
3. Talk with your doctor.
Don't be embarrassed and do proactively bring up all of your symptoms. Research shows women routinely do not discuss vaginal dryness with their doctor. In one study 42 percent of women experiencing vaginal discomfort didn't realize it had anything to do with their hormones and menopause. And 75 percent of these women had experienced their symptoms—without trying to do anything about them—for at least a year.
4. Educate yourself about your body.
Do you know where your vulva is? Hint, your vulva is where all that dryness is causing you irritation while you're trying to do everyday things. Need a little guidance? Check out my video.
5. Use natural lubricants.
These do not contain additional chemicals that are found in many commercial lubricants. They can help with discomfort during intercourse, but they do not provide long-term relief. Some of my favorites are ghee and organic coconut oil.
6. Fill up on probiotics and essential fats.
Choosing healthy foods including fermented foods—rich in probiotics such as kimchi, kombucha, and pickled veggies—or supplementing with a good probiotic is richly beneficial. Adding in healthy fatty food choices like oysters, salmon, free-range eggs, avocado, olive oil, and butter from free-range cows are also fantastic choices.
What are the hormone-based therapy options?
Next, educate yourself about hormone treatment options. Awareness of locally applied hormone therapies (which are generally healthier) is lower than knowledge about oral tablets (systemic hormone replacement therapy). And the whole topic is confusing. Some 67 percent of women in one study didn't feel they had enough information to make an informed choice about starting ANY kind of hormone-based therapy. But it can really help. So get educated on these options:
1. Hormone replacement therapy
While oral estrogen therapy can be helpful for hot flashes, it really hasn't been found to significantly resolve vaginal dryness issues. So if you are considering this, know that some 40 percent of women receiving oral estrogen therapy continue to have their persistent vaginal symptoms. It also isn't recommended for women who've had breast cancer.
2. Estrogen therapy
Locally applied, estrogen therapy may improve vaginal moisture and irritation but only really addresses the mucosal layer of the vagina—not the muscle.
3. Androgen therapy
Few women know about locally applied androgen hormone alternatives such as DHEA. But I have been prescribing DHEA and other natural hormones—as have some of my peers—for almost two decades, with tremendous results. And the research is substantiating DHEA as a viable and healthy solution all of the time; just this past November the FDA approved the first DHEA vaginal suppository to address pain during intercourse. And research has also shown DHEA can positively affect libido, arousal, and sexual satisfaction.
Why is this an important topic? Well, it's estimated that many women can expect to live almost 40 percent of their lives in this discomfort. Forty percent? That is just not acceptable for something that so greatly affects our quality of life.