“If this blog helped you out, don’t keep it to yourself—share the link on your socials!” 👍 “Like what you read? Spread the love and share this blog on your social media.” 👍 “Found this useful? Hit share and let your friends know too!” 👍 “If you enjoyed this post, please share the URL with your friends online.” 👍 “Sharing is caring—drop this link on your social media if it helped you.”

Sunday, August 17, 2025

Vaginal dryness


Introduction

Vaginal dryness is a common gynecological symptom characterized by reduced vaginal lubrication. While it can occur at any age, it is most frequently reported during and after menopause due to estrogen deficiency. It can lead to discomfort, burning, itching, pain during intercourse (dyspareunia), recurrent urinary tract infections, and reduced quality of life.

Vaginal lubrication is normally maintained by secretions from the cervix, vaginal transudation, and Bartholin’s glands. Adequate estrogen levels maintain vaginal epithelial thickness, elasticity, and natural moisture. When hormonal or non-hormonal factors disrupt this balance, dryness occurs.

Causes of Vaginal Dryness

1. Hormonal Causes

  • Menopause (most common cause): Reduced estrogen leads to atrophic changes.

  • Perimenopause: Fluctuating hormone levels.

  • Postpartum period and breastfeeding: Prolactin suppresses estrogen.

  • Oophorectomy or chemotherapy-induced menopause.

  • Hormonal contraceptives (low-estrogen formulations).

2. Medical Conditions

  • Autoimmune disorders: Sjögren’s syndrome (reduced secretions).

  • Diabetes mellitus (affects circulation and nerve supply).

  • Chronic infections or pelvic inflammatory disease.

3. Medications

  • Antihistamines, decongestants, some antidepressants (SSRIs), and antihypertensives reduce secretions.

  • Cancer therapies: anti-estrogens (tamoxifen, aromatase inhibitors).

4. Lifestyle and Psychosocial Factors

  • Smoking (reduces blood flow and estrogen effect).

  • Stress, anxiety, depression.

  • Insufficient arousal or foreplay during intercourse.

Clinical Presentation

  • Vaginal discomfort, itching, burning.

  • Pain during intercourse (dyspareunia).

  • Thin, fragile vaginal mucosa.

  • Increased susceptibility to infections.

  • Urinary symptoms: frequency, urgency, dysuria (part of genitourinary syndrome of menopause).

Diagnosis

Diagnosis is usually clinical, based on history and examination.

  • History: Menstrual and menopausal status, medications, systemic illnesses.

  • Examination: Thin, pale vaginal mucosa, loss of rugae, dryness, sometimes petechiae.

  • Additional tests (if needed): Vaginal pH (often >5 in atrophic vaginitis), Pap smear, or infection screening if indicated.

Treatment and Management

1. Lifestyle and Non-Pharmacological Measures

  • Regular sexual activity (maintains vaginal blood flow and elasticity).

  • Smoking cessation.

  • Adequate hydration and balanced diet (rich in phytoestrogens, e.g., soy).

  • Avoiding perfumed soaps, douches, and irritants.

2. Vaginal Lubricants and Moisturizers

  • Lubricants: Used during sexual activity to reduce friction and pain.

    • Water-based (safe with condoms, e.g., KY Jelly).

    • Silicone-based (longer-lasting).

    • Oil-based (not safe with latex condoms).

  • Moisturizers: Provide longer-term hydration (used 2–3 times weekly, e.g., Replens®).

3. Hormonal Therapy

Local (Preferred for Isolated Vaginal Symptoms)

  • Estradiol vaginal cream (0.01%): 0.5 g intravaginally daily for 2 weeks, then 2–3 times per week.

  • Estradiol vaginal tablet (10 µg): Insert one tablet daily for 2 weeks, then twice weekly.

  • Estradiol vaginal ring (7.5 µg/day): Inserted into the vagina, replaced every 90 days.

Local estrogen therapy is very effective, with minimal systemic absorption.

Systemic

  • Hormone Replacement Therapy (HRT): Indicated if vaginal dryness occurs with other menopausal symptoms (hot flushes, night sweats).

    • Examples: Oral estradiol 1–2 mg daily or conjugated estrogens 0.3–0.625 mg daily, usually combined with progesterone if uterus intact.

4. Non-Hormonal Pharmacological Options

  • Ospemifene (oral SERM): 60 mg orally once daily, improves vaginal epithelium and lubrication.

  • Prasterone (DHEA vaginal inserts 6.5 mg nightly): Converted locally to estrogens and androgens, improves dryness and dyspareunia.

Precautions

  • Local estrogen therapy is generally safe but should be avoided in women with active breast cancer unless supervised by an oncologist.

  • Systemic HRT carries risks of breast cancer, thromboembolism, and stroke, and should be individualized.

  • Lubricants should be chosen carefully: oil-based agents degrade latex condoms, increasing risk of pregnancy or infection.

  • Phytoestrogen supplements (soy, red clover) have weak effects and variable safety evidence.

Drug Interactions

  • Local estrogens: Minimal systemic absorption, so interactions are rare.

  • Systemic estrogens (HRT):

    • Interact with enzyme inducers (rifampicin, carbamazepine, phenytoin) → reduced effect.

    • Increase risk of clotting when combined with oral contraceptives or anticoagulants.

  • Ospemifene: Metabolized via CYP3A4; interactions with ketoconazole, rifampicin, clarithromycin.

  • Prasterone: May theoretically interact with other hormone therapies but usually well tolerated.

Red-Flag Symptoms (Require Specialist Review)

  • Vaginal bleeding after menopause.

  • Persistent pain, discharge, or ulceration.

  • Suspicion of malignancy.

  • Severe recurrent urinary tract infections.




on

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)