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December 15, 2019
 

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Weekend doctor: Is dryness affecting your relationship?

By Lori Thomas, MD
Medical Director, Beyond MedSpa
Many women are affected by vaginal dryness or pain during intercourse, which is a direct result of vaginal dryness. However, many women do not realize that there are treatment options available.

Why is this happening? Once a woman’s ovaries stop producing estrogen naturally due to menopause or induced by chemotherapy or surgery, their bodies will begin to lose the benefits of these hormones. One of the benefits of estrogen is healthy genital tissue. When women no longer have estrogen circulating in their body, they begin to notice changes of the vaginal and vulvar tissue, which may begin to make sexual intercourse uncomfortable.

What should I do first? There are options of moisturizers and lubricants that may be used initially when mild symptoms arise. Vaginal moisturizers may be used on a regular basis and protect the tissue by adhering to it. Replens or K-Y Jelly are two of several options women have for over-the-counter use. These may be obtained from a pharmacy, grocery, chain store or even privately from Amazon. Items to intermittently assist with intercourse fall under the lubricant category. There are a variety of options available such as water-based lubricants like K-Y Jelly and Astroglide, silicone-based options (which may last longer), such as Pjur, or oil-based options.

I’ve tried lubricants, now what? Most women will have already tried these options, so what most physicians will discuss is the use of topical estrogen, which is available in creams, vaginal rings and vaginal tablets. Insurance plans will often dictate what options a client may use rather than the physician.

Estrogen vaginally will correct the pH of the vagina along with the flora, thicken the mucosa and restore natural sections, thereby treating the dryness and dyspareunia (pain during sex). This is not a “quick fix” as this does not happen overnight.

Other options may include the prescribed use of ospemifene or testosterone.

What if I cannot use hormones, but nothing else has worked? Vaginal rejuvenation, known as FemiLift, with a CO2 laser has recently become a popular treatment. Although not FDA approved for this procedure for vaginal dryness, the laser has been used by gynecologists for years to treat various gynecologic conditions. This has given women who cannot use hormones an option that will thicken the vaginal epithelium, restore natural secretions and improve many urinary symptoms.