Vaginal dryness can occur at any age, but it is more common as we begin to lose our estrogen in the years leading up to menopause and post-menopause. It can also be present post-partum while breastfeeding and while someone is on the birth control pill.
The cervix has glands that produces mucus in response to estrogen. The vaginal tract also secretes fluid and is responsive to hormone levels. The good bacteria that live in our vagina and the cells that line the tract (as well as our musculature) is responsive to estrogen.
The amount of fluid you produce is a product of many factors: where in your menstrual cycle you are, age, genetics, menstrual history, hormone levels, medication use, vaginal bacterial levels, etc. What this means is that some people make a lot of fluid while others don’t.
Genitourinary syndrome of menopause (GSM)
If you’re in perimenopause — this is almost all of you if you’re in your 40s, but can also include those of you in your late 30s — or have reached menopause, vaginal dryness can show up. This is categorized under GSM (genitourinary syndrome of menopause), which includes:
- low lubrication and associated symptoms like irritation, itching, pain, burning in the vaginal tract and vulva
- high incidence of urinary tract infections
- thinning of the cells in the vaginal tract and associated symptoms like pain with penetrative intercourse, irritation, itching, and spotting
- pelvic floor issues and prolapse
Low lubrication during intercourse
There is nothing wrong with using lubrication during penetrative intercourse even though there is some shame and embarrassment that can come along with this.
If you find that you’re not producing enough fluid for a pleasurable experience, then using lube can be extremely helpful. There are a lot of reasons why someone might not be lubricated enough. It’s typically not something that is depicted in the media or porn, however, the use of lube is more widespread than you think!
The choice of lube is personal — pick one that feels good to you and one that is appropriate for your situation. For e.g., if you use physical barrier protection like condoms, then use condom-safe lube.
What to do about vaginal dryness and GSM
An assessment of the tissue through an internal exam can be really helpful. This can be done with your GP or gynaecologist, but also with a pelvic physiotherapist.
Vaginal moisturizers with hyaluronic acid, seabuckthorn oil, aloe, and other nourishing ingredients can be really helpful. This is usually a good place to start for many people.
Vaginal estrogen, especially vaginal estriol (which isn’t particularly absorbed systemically and doesn’t carry the same risks as transdermal or oral hormone therapy) can be a game-changer for a lot of people. Talk to your gynaecologist, naturopathic doctor, or family doctor.
I prescribe this often to my patients who are peri/post menopausal and it is extremely effective for GSM.
Working on hormonal health, obviously, is also important, as is avoiding using soaps and irritants to the vaginal and vulvar areas so that you’re not disturbing the pH or bacteria that are protective (plain ‘ole water works best).
If you’re struggling with vaginal dryness and/or GSM and in need of some support, feel free to book in an appointment.