Thank you for asking about vaginal dryness, pain, irritation and sexual discomfort. This is a VERY common condition, especially in menopause. You are not alone! This sometimes occurs with low dose birth control pills or during breastfeeding. Symptoms occur because of atrophy – low amounts of estrogen – and, unfortunately, it tends to get worse over time unless you actively use a regular regimen to maintain healthy, soft, supple, well-functioning normal tissue. First, it is important to have an exam to make sure that there are no other issues at hand such as a yeast infection, allergic reaction, sexually transmitted disease, abnormal tissue growth, etc. Then, if we determine the cause of the symptoms to be simply thin, dry, delicate, atrophic tissue, there are various treatment regimens that can be used to keep that area feeling better.

Lots of women need a personal LUBRICANT for sexual relations. Choose the one that you and your partner enjoy the most. Some readily available (grocery or natural food store) options:

  • Water Based: KY Jelly needs reapplication due to evaporation
  • Glycerin Based: Replens, Astroglide tends to get sticky
  • Natural:       Zestra – lubes & arousal oils       Sustain – (aloe)
  •              Good Clean Lovewater, aloe, Yoni Creamorganic oils, beeswax, glycerin
  • Oils: Coconut, Vitamin E, Hemp, Almond, Olive, Grapeseed, etc. (use small amount)

Avena Botanical Vaginal Dryness Oil (calendula, st. johns, plaintain, comfrey)

  • Silicone: excellent lubrication, many brands (few drops last long time)      
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Most all menopausal women need some HEALING & MOISTURIZING with topical salves on a regular basis, ranging from 3 – 5 or more nights per week, per their symptoms. Most women get the best results from massaging in their choice of topical product with a firm pressure into and around the vaginal opening every night until things feel normal. Then it’s fine to cut back a little to 2 – 3 nights per week if things still feel normal. Some women also need to use a vaginal dilator or also use salves during the day.

Over-the-counter:

  • Indian Meadow Herbal Vaginal Balm (chamomile, oat flower, calendula, oils)
  • Femmesil (silver oxide designed to calm skin, treat infections and heal tearing)
  • Vitamin E Cream (choose all natural brands with no chemicals or preservatives)
  • Replens (apply as needed, gives immediate wet feeling, but no real ‘healing’ properties)

Prescription:

Hormone creams are a low dose, topical form used 3 – 5 or more nights per week. This does not get absorbed or have the risks of systemic hormone replacements. Individualized therapy is needed based on each woman’s personal history and goals. Most women do not need intravaginal treatments.

  • Topical Estrogen Creams to outer vagina: Estrace, Premarin, Compounded Estrogens
  • Intra-Vaginal: *NEW* Intrarosa: DHEA suppository (non-estrogen, nightly use)

Estrogen: Ring: Estring (3 months); Tablet: Vagifem (intravaginal tablet 2 x’s per week)

  • Topical Steroid: Clobetazole for other conditions related to dryness such as itching, eczema, psoriasis, allergic reactions, Lichen Sclerosis, Lichen Simplex, Lichen Planus

We hope this handout helps you with understanding and treating your condition. Please call with any questions.    

   * It’s important to come in for an exam if you are doing all this regularly, and still have discomfort issues.*