If you’ve gone through menopause and now intercourse hurts, or your vaginal region itches, you’re not alone. In extreme situations, your vaginal wall can actually rip and possibly lead to infection.
The good news: There’s help available.
Drying up “down there” is called vaginal atrophy, sometimes vulvovaginal atrophy (VVA) or a broader term, genitourinary syndrome (GSM). It happens because less estrogen flows through your body than when you’re younger, and estrogen helps the body self-lubricate. The medical word is “hypoestrogenism.”
More than half of older women have this problem. Only a quarter are treated fully for it. As many as 60 percent “suffer in silence,” according to a study published by the National Institutes of Health. Most women shrug the situation off as an inevitable effect of maturing, or they’re just too embarrassed to mention it during an exam.
How Do I Know If I Have Vaginal Atrophy?
Some women discover they have vaginal atrophy via a pelvic exam, but most have one or more of these symptoms:
- Painful intercourse
- Stinging pain
- Burning during urination
- Changes to the labia, clitoris, vagina or entry to the vaginal canal
Menopause begins a year after your last period ends; the average age is 51. From then on, your body might stop producing enough lubricant for comfort during intercourse or to be comfortable in general. What’s more, your vaginal wall might flatten and become less flexible. During the reproductive years, that area is thick with folds that make it flexible and stretchy, according to The North American Menopause Society. Once you’re past child-bearing age, you might produce less estrogen, and thus the dryness begins. Your labia and clitoris might shrink, too.
How Can I Ease Vaginal Dryness?
Help is easy to find. It falls into three categories:
- Over-the-counter lubrication
- Over-the-counter vaginal moisturizers
- Doctor-prescribed estrogen treatments
For most women, a simple combination of over-the-counter products provides enough lubrication to keep the vagina healthy, whether a woman has intercourse or not.
Lubrication, often called “lube,” is the same array of substances many couples of all ages use during sex. Some are made primarily with water, others with silicone. Choose whatever works best for you.
You might consider cooking oils – vegetable, coconut or olive – which are more natural than other lubricants. If using any of these, or another oil-based lubricant such as Vaseline, with a condom, be sure to test first for sexually transmitted diseases. Oil-based lubricants can weaken condoms, causing them to tear. (Lubricants can also make the spermicide on condoms less effective. However, pregnancy risk shouldn’t be a concern post-menopause.)
Whatever your choice, before penetration dab some lubricant around your vulva (the whole outer area) and inside the vagina, and/or on your partner’s penis.
Moisturizing is a more advanced option. If your dryness is persistent, talk to your doctor about trying a non-irritating, over-the-counter moisturizer that is marketed for assistance with vaginal dryness. They come in several forms. Some are suppositories to insert into your vagina, where they dissolve; others are liquids that you inject via disposable plastic applicators. For best results, you’ll likely need to use the moisturizer every two or three days to attain and maintain a healthy lubrication level.
It’s like rubbing your hands with lotion in the wintertime. In this case, the moisturizer increases the amount of natural lubrication, or “vaginal mucosa.” In some cases, the product sticks to the vaginal lining to “mimic” natural secretions, another study published by the NIH reported. These myriad products also adjust acidity. The active ingredient is almost always water. After that, each version is made with other ingredients designed to be like the secretions women have when younger.
For some women with more advanced dryness issues, products that contain estrogen are the best solution. Those must be prescribed by a doctor. Options are pills, creams, gels, rings and patches.
There’s a fourth “treatment” too: intercourse. Women tend to produce natural lubrication when they have intercourse regularly. The presence of a penis acts as a mechanical dilation; it keeps your vagina open. A vaginal dilator works similarly. Without one of these or the other, some vaginas lose length and width.
Why It’s Important To Maintain a Healthy Vagina
Vaginal dryness happens progressively. A small percentage of women start having symptoms during perimenopause. By three years after menopause, about half of women experience dryness issues. That number rises to an estimated 60 percent.
You’re likely to start lubricating and moisturizing to increase pleasure and avoid pain, yet a vaginal health routine has a third benefit: avoiding harm. By the time they’re in their 70s, especially if they haven’t had intercourse or used vaginal moisturizers or hormones regularly, some women’s vaginal walls become so thin that they might tear when penetrated.
Intercourse results in friction, and that friction can open the vaginal tissue — the same tissue that acts as a defense mechanism against infection. As a result, you might see gray or yellow spots in your underwear, or even blood. In extreme situations, you can get an infection and need antibiotics to treat it.
It’s easy to avoid trouble like that. Just as it’s best for women to eat healthy foods and exercise regularly to keep our hearts, muscles and minds in tip-top shape, we should be proactive about keeping our vaginas healthy. A lube, maybe a moisturizer, and off we go to live our lives.
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