DEAR DOCTOR K: I’ve been bothered by vaginal dryness. Sex is painful. My doctor believes it’s vaginal atrophy due to menopause. Can you tell me more about this condition? How is it treated?
DEAR READER: During a woman’s reproductive years, the lining of the vagina is kept moist and lubricated in part by female hormones made by the ovaries – particularly estrogen. With the start of menopause, estrogen levels decline. This often leads to vaginal atrophy: The lining of the vagina becomes thin and dry.
Natural menopause is not the only reason for estrogen levels to drop and vaginal atrophy to develop. Breastfeeding, surgical removal of the ovaries and certain medical treatments can also do it.
As you’ve experienced, the reduced lubrication of the vagina can lead to painful sexual intercourse. It can also cause vaginal itching or burning.
Vaginal atrophy is best treated with estrogen therapy. This is available in many forms. Some forms apply estrogen directly to the lining of the vagina. For example, estrogen creams or suppositories are inserted into the vagina using an applicator. A vaginal ring can be placed in the vagina for three months. It slowly releases estrogen directly to the vaginal tissues.
Vaginal estrogen preparations produce very low levels of estrogen in the blood. They are the safest way to treat vaginal atrophy with estrogen. But some of my patients prefer something easier.
One alternative some women prefer is an estrogen pill. Another treatment is an estrogen patch that is applied to the skin once or twice a week. The pill and the patch deliver estrogen into the blood.
You may prefer to avoid estrogen altogether. If so, try a water-soluble lubricant. Lubricants relieve vaginal dryness, moisten vaginal tissues and can help make sex less painful. They can be purchased without a prescription at most pharmacies or grocery stores.
Regular sexual activity also can help to prevent symptoms. This is because sexual intercourse improves blood circulation to the vagina. This helps to keep vaginal tissues healthy.
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