Vaginal dryness, although more common during menopause, is a problem that can affect women at any stage of life (due to the use of contraceptives, breastfeeding, postpartum period, peri- and postmenopause). In fact, more than half of the women who suffer from this condition are under 50 years of age. In these women, it may be associated with secondary irritations caused by the use of soaps and shower gels, detergents and fabric softeners for washing underwear, lotions, and perfumes.

Certain medications or hormones used in the treatment of endometriosis, uterine fibroids, or infertility, as well as others used for the treatment of breast cancer and pelvic radiotherapy or chemotherapy, can cause vaginal dryness, loss of elasticity of the vulva and vagina, and discomfort or pain during sexual intercourse (dyspareunia).

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Causes

The reasons why this condition is more frequent in postmenopause are derived from estrogen deficiency, since the basic causes of this syndrome are twofold:

  • Alterations in the structure and function of the vaginal mucosa
  • Alterations in the vaginal microbiota (microorganisms that normally live in the vagina)

Functions of oestrogen in the vagina:

  1. Lubrication: Due to its stimulus, the vaginal mucosa produces a transparent lubricant fluid which prevents the dehydration and dryness of the mucous membranes; in addition, during sexual intercourse, its increase means that these are more comfortable due to the reduction in friction and micro-traumas.
  2. Regeneration: The vagina is covered by an epithelium that is regenerated due to the stimulation of oestrogens and, when its levels are reduced during the menopause, this proliferation process is decreased meaning that the urovaginal epithelium becomes thinner and, as the nerve endings are found near the surface, sensitivity is increased and this can cause pain.
  3. Alteration in normal microorganisms (vaginal microbiota): Oestrogen influences the pH of the vaginal epithelium which contributes to maintaining the vaginal microbiota in balance, and to lowering oestrogen levels, good bacteria are reduced and this promotes infections.
SintomasSintomasSymptoms

Symptoms

Initially, it was thought that the only problem in postmenopause was vaginal dryness, which is why the term "genital atrophy" was previously used. Today we know that this is only one of the symptoms, as it is a much more complex condition. For this reason, we now refer to it as the urogenital syndrome of menopause (although it can also occur outside menopause in the situations mentioned above).

The range of symptoms can vary from mild discomfort to significant interference with a woman’s personal, social, and professional life.

The most frequent symptoms include:

  • Sensation of burning, irritation, or itching in the genital area, which can cause significant discomfort
  • Burning sensation during urination
  • Abnormal vaginal discharge (in appearance or odor)
  • Appearance of small fissures, especially in the lower part of the vulva (vulvar fourchette) or in the vaginal walls
  • Pain during sexual intercourse due to poor lubrication and lack of elasticity, which makes penetration difficult and intercourse unpleasant or painful
  • Light bleeding, spotting, or excoriations after sexual intercourse
  • Gynecological examination may be uncomfortable or painful
  • The vulva may become so sensitive that sitting, walking, running, or practicing certain sports becomes difficult
  • Vaginal atrophy increases susceptibility to vaginal infections caused by bacteria or fungi (due to imbalance or absence of normal vaginal flora)
  • Chronically, ulcers, fissures, or adhesions may develop in the vaginal walls
  • Significant impact on the relationship with a partner, especially if there is inadequate communication, due to the effects on sexual health
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Treatment

There are several treatment options depending on the severity and frequency of symptoms. Some can be used in a stepwise manner.

  • Lubricants
    Used when extra lubrication is needed during sexual intercourse to minimize friction, irritation, dryness, and pain. Water- or silicone-based lubricants are recommended, as they are easier to remove with washing. They should be applied as often as necessary inside and around the vagina. Lubricants containing fragrances or perfumes should be avoided, as they may be irritating, as well as petroleum jelly, which can adhere to the vaginal mucosa and alter it, favoring fungal growth.

  • Moisturizing creams
    Applied vaginally several times a week. They adhere to the vaginal epithelium, retaining water, maintaining hydration and elasticity. Additionally, they lower vaginal pH, and by increasing acidity, they help control bacterial growth. Some products may also contain substances with epithelial regenerative and antipruritic effects to relieve itching.

  • Local hormonal therapy
    Used to treat moderate to severe symptoms of vaginal atrophy. Low doses of local estrogens are administered directly to the area in the form of vaginal suppositories or tablets, creams, or silicone vaginal rings. Their use helps normalize acidic pH, increase blood flow to the epithelium, and improve vaginal lubrication, reducing vaginal dryness.

  • Non-Hormonal Oral Therapy
    Uses a medication called ospemifene, an oral treatment that does not contain hormones but mimics estrogen effects in certain parts of the body, such as the vulva and vagina. It is indicated for postmenopausal women in whom local estrogen therapy is not appropriate.

  • Hormone Replacement Therapy
    Uses estrogen therapy combined with progesterone in the form of a patch, transdermal spray, or oral pill. The risks and benefits of its use must be carefully considered.

  • Laser Therapy
    A minimally invasive outpatient technique that uses heat to stimulate collagen production in vaginal tissue cells and replace the driest skin layers with new cells, reorganizing and rebalancing the different components of the vaginal mucosa.

  • Hyaluronic Acid Injection
    A minimally invasive treatment consisting of intradermal/intramucosal vaginal injections of a preparation based on cross-linked hyaluronic acid and mannitol to biostimulate, improve elasticity, rehydrate, and retone the female intimate area.
Specialties:
  • Gynecology and Obstetrics