Dry down there?

Our gy­nae­col­o­gist an­swers your ques­tions about vagi­nal dry­ness so you don’t have to suf­fer in si­lence

Prevention (Australia) - - In This Issue - BY DR LAU­REN STREICHER

Even the most healthy, sat­is­fy­ing sex life can be knocked off course by vagi­nal dry­ness, whether it’s tem­po­rary or long-last­ing. Lack of lu­bri­ca­tion – and the itch­ing, burn­ing, ir­ri­ta­tion and painful in­ter­course that of­ten fol­low – can hap­pen for a va­ri­ety of rea­sons and at var­i­ous life stages.

It’s a par­tic­u­lar prob­lem after menopause, but breast­feed­ing, chemo­ther­apy and ra­di­a­tion can each re­sult in cel­lu­lar dam­age and low oe­stro­gen lev­els, which in turn sab­o­tage the abil­ity of vagi­nal tis­sue to stay lu­bri­cated and elas­tic. And some med­i­ca­tions (an­ti­his­tamines and de­con­ges­tants, for ex­am­ple) can have a neg­a­tive im­pact as well.

Too many women, though, suf­fer silently, not re­al­is­ing that this is a highly fix­able is­sue. And doc­tors of­ten don’t broach the topic or aren’t fa­mil­iar with treat­ment op­tions. So to help you, here are an­swers to some com­mon ques­tions.

My doc­tor sug­gested I try a vagi­nal lu­bri­cant. Which one is best?

Sil­i­cone lu­bri­cants are more slip­pery and last much longer than wa­ter-based ones (so you don’t need to use as much) and don’t ir­ri­tate the area. While wa­ter-based lu­bri­cants are less ex­pen­sive, many are gloopy and sticky, and they may con­tain a propy­lene gly­col preser­va­tive, which can be ir­ri­tat­ing. Ap­ply the lu­bri­cant on your part­ner and on the open­ing of your vagina be­fore in­ter­course.

What are vagi­nal mois­turis­ers, and how are they dif­fer­ent?

Lu­bri­cants don’t al­ter vagi­nal tis­sues; they just make them more slip­pery. A long-act­ing over-the- counter moisturiser, on the other hand, in­creases the wa­ter con­tent of the cells, mak­ing vagi­nal tis­sues thicker, more elas­tic, and bet­ter able to pro­duce lu­bri­ca­tion. They need to be used two to five times a week and should be in­serted in the vagina and ap­plied around the vagi­nal open­ing.

Two with proven clin­i­cal re­sults: poly­car­bophil gel (Re­plens Long-last­ing Vagi­nal Moisturiser) and hyaluronic acid vagi­nal gel (Vag­isil ProHy­drate Plus).

What are the op­tions if I need more help?

Some­times a woman’s vagi­nal walls are so thin and dry that a pre­scrip­tion med is needed. One op­tion: lo­cal vagi­nal oe­stro­gens. Be­fore you think, ‘Oh, no, oe­stro­gens! Breast cancer, blood clots, bad stuff…’, know that there are no proven safety is­sues with th­ese prod­ucts.

There are three types to choose from: vagi­nal creams (in­serted and spread on outer ar­eas); vagi­nal tablets (in­serted twice weekly); and vagi­nal rings (which can last up to three months).

Are there treat­ments for women who want to avoid oe­stro­gen?

There are sev­eral op­tions avail­able. One is a pre­scrip­tion pill, taken orally, that ac­ti­vates oe­stro­gen re­cep­tors in vagi­nal tis­sue to al­le­vi­ate painful in­ter­course in post-menopausal women.

And some clin­ics now of­fer CO2 vagi­nal laser treat­ments to stim­u­late and re­gen­er­ate vagi­nal and vul­var cells. Th­ese treat­ments should be per­formed only by a gy­nae­col­o­gist, not by a plas­tic sur­geon or der­ma­tol­o­gist and you’ll need a re­fer­ral from your GP.

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