Breaking the Silence on Vaginal Atrophy

By Dr. Michael Krychman, MD

Founder & Executive Director SoCal Center for Sexual Health and Survivorship Medicine, Clinical Health Professor University of California Irvine

“I’m really suffering here. How do I have that awkward conversation…you know…about dryness…down there…with my healthcare practitioner about getting some help?”

I often hear this complaint from my brave patients who have sought help from several health care providers. Many women falsely believe that if vaginal dryness in menopause or after breast cancer was an important point of discussion, their health care provider would gladly and openly start the discussion.

Patients and providers remain embarrassed and silent. Health care professionals are often poorly trained and embarrassed themselves; all too often in a rush to address a laundry list of medical and psychological issues. Providers feel that if the patient was concerned, she herself would open up the discussion. The silence is often deafening.

And so the topic of vaginal dryness often goes unrecognized and unreported.

Vaginal dryness occurs in many women. Women who breastfeed, those taking certain medications (believe it or not up to 300 medications cause dryness including allergy medications and combined oral contraceptives), and those who suffer from a variety of medical conditions (lupus etc.) may experience vaginal dryness.

With the end of menstrual cycles and the beginning of menopause, a wide variety of symptoms can occur. While most women recognize and associate hot flashes with this stage of life, few make the connection of vaginal dryness with menopause. It is estimated that approximately 50% of menopausal women will experience distressing chronic and progressive symptoms of vaginal dryness and atrophy. If left untreated, the woman will undoubtedly experience a plethora of troublesome effects.

Anyone experiencing vaginal dryness—whether occasionally or regularly—can benefit from a well-formulated personal lubricant. It provides temporary relief by reducing friction and enhancing comfort during intimacy and other activities, such as tampon insertion or pelvic floor physiotherapy exercises. However, not all lubricants are suitable for long-term vaginal health. Choosing the right one is key.

A variety of symptoms signal that women are suffering from vaginal and vulvar atrophy. Some of the more commonly reported symptoms include:

Vaginal pain, discomfort, or irritation
Pain or heat in the vulvar and vaginal area
Burning or stinging
Fear of pelvic and digital examinations
Painful intercourse (dyspareunia)
Paper cut-like tears at the vaginal opening
Bleeding or vaginal spotting with minimal trauma

Besides the troublesome symptoms listed above, a menopausal woman with vaginal dryness and atrophic tissue changes may also experience an increased incidence of urinary tract infections and their associated symptoms such as dysuria (burning when you urinate), bad odour during urination, increased urinary frequency, increased urgency, nocturia (urinating at night) or hematuria (blood in the urine). Other common vaginal infections like bacterial vaginosis and candidiasis may be more common with menopausal atrophic vaginitis.

How impactful are the symptoms? There have been a variety of surveys that ask menopausal women this question. Two popular ones are worth discussing.

The VIVA Study (Vagina Health Insight Views and Attitudes) was an international online survey which assessed the impact of vaginal changes and discomfort on overall quality of life. Some remarkable findings include:

75% reported negative consequences on their sexual lives
68% reported that it made them feel less sexual and sexy
36% reported that it made them feel old
33% reported adverse effects on the marriage or their primary relationship
25% reported lower sexual self-esteem

The REVIVE (Real Women’s Views of Treatment Options for Menopausal Vaginal Changes), is the largest US women survey which surveyed over 3,000 women with symptoms of VVA.

85% of women with a partner indicated it adversely affected intimacy
59% of women said that the symptoms decreased sexual enjoyment
47% said it impacted their relationship
27% reported that their vaginal and vulvar dryness symptoms were directly associated with a negative effect on their general enjoyment of life

The bottom line: Women are suffering in silence from the symptoms of vaginal dryness and they should be proactive in getting help for these bothersome symptoms.

How do we address the conspiracy of SILENCE?

Be prepared for your medical appointments: With pen to paper, write down your concerns in order of importance and bring this to your appointment. You may need to practice and run through some scenarios in your head: What should I say? How should I say it? What are the correct words? Being prepared is half the battle. Some suggest practicing what you will say in front of a mirror
Recruit help: It maybe the nurse or the assistant you are more comfortable with when it comes to talking about vaginal dryness. It’s okay to mention your concerns to the allied health care professionals and encourage them to relay your concerns to the doctor
Be engaged during your appointment: During your visit, you should try to maintain and build professional rapport with your provider. Make eye contact, ask questions and expect answers. Review your list and make sure you’ve addressed your agenda for the visit
Be informed about lubricant choices: Choosing a lubricant for sexual activity can be a bit complicated! Water? Silicone? Hybrid? Colored or Flavored? Here is a quick and easy guide that debunks the lubricant myths. It is important to remember that one lubricant does not always fit all sexual practices. It’s important to have a few choices in your lubricant treasure chest. Consider trying a few. Individual preference of different types can enhance your sexual exploration and sensual playfulness

Oils and Oil-based Lubricant

Most healthcare professionals advocate avoidance of this type of lubricant, as it may alter and upsets the vagina’s natural acid base (pH) balance. Oil-based lubricants may also be associated with an increased risk of vaginal infections and bacterial overgrowth. The strength, efficacy and integrity of latex condoms are also compromised with oil-based lubricants.

Water-Based Lubricant

Often contain deionized water and also may have some glycerin or propylene glycol as part of their listed ingredients. Water-based products are generally safe to use with silicone/latex accessories. They must be reapplied, as they can dry out with extended activity. Some find these products tacky when they dry and some may leave a residue on your body. They are easily cleaned up with mild soap and water.

Silicone-Based Lubricant

Last longer than water-based products with less need to re-apply. They are sleek, slippery and perfect for prolonged sexual interludes. For anal play, silicone lube provides ample lubrication to prevent any micro-tears or abrasions. It is also a must for aqua sex in the shower or swimming pool. Silicone is ideal when menopause and andropause collide. When a man who is on medication that prolongs and intensifies his erection is coupled with a woman who is in menopause and has prolonged time to arousal or climax, silicone lube may be the perfect solution.

Silicone lubricants like überlube are tasteless, odorless and have no stickiness or tackiness. They are anhydrous and do not contain water so they will not adversely influence the vaginal ecosystem. They can also be used as massage lotions since they do not dry out. Use soap and warm water for a quick cleanup.

Keep in mind many silicone toys will not be compatible with silicone lubricant!

Hybrid Lubricants

Are often a combination of both water and silicone characteristics. They have the qualities of each product, last long and have the feel of some water-based lubricants.

Flavored/Warming Enhanced Lubricant

Many men and women will choose lubricants with warming, flavors or other enhancers in them to tantalize and spice up a sexual interlude. For those with sensitive or dry skin, these may cause burning or irritation.

Pantry Solutions

Extra virgin and coconut, vegetable, avocado or peanut oil, may not irritate the vagina. Most healthcare professionals frown upon using food products within the vagina area since they have been linked to increased vaginal infections that may be be persistent and difficult to treat.

Do your homework and be prepared to discuss choices with your healthcare provider. You deserve answers and knowledge that will help you to work through discomfort and enjoy many more years of health and well being.

Dr. Michael Krychman is a clinical health professor at the University of California Irvine, where he maintains a clinical practice of complex gynaecology at the Ann’s Center, a High Risk Breast and Ovarian cancer center. He specializes in cancer survivorship, vulvar disease, and comprehensive care for those with chronic disease and focuses on quality-of-life concerns. He is also the Founder & Executive Director of SoCal Center for Sexual Health and Survivorship Medicine. He is a thought leader, Fem Tech expert, medical and scientific advisor, and executive board member.

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