Vaginal Dryness ~ Everything You Wanted To Know But Were Afraid To Ask

I’m an “older” nurse who has worked since before many of you were even born. So, trust me when I say, I have heard and seen just about anything and everything medical related. Nothing surprises, shocks or embarrasses me. Just ask my family!

Plus, I grew up in a family of nurses, including several aunts and both of my sisters. Let me just say this…family gatherings are never dull!

So when I was asked if I would be interested in interviewing Dr. Marla Shapiro on the topic of vaginal dryness, I didn’t hesitate for even a second.

If you’re a woman, the chances are good, vaginal dryness will affect you at some point in your life.  However, I am very aware this is a topic that many would consider being taboo or off-limits and may not even speak to their family physician about.  And, that is exactly why I want to discuss it. I want to take this opportunity to remove the secrecy and get the answers for those of you who are too embarrassed or shy to ask.

Did you know that average life expectancy for a Canadian woman is 84 years, so most can expect to live over one-third of their lives in a menopausal state? Due to this increase in life expectancy, the effects that menopausal symptoms are having on a woman’s quality of life are becoming more apparent.

All woman experience menopause symptoms differently, though almost half (47 percent), including me, have experienced vaginal dryness. And while it’s not uncommon for women to open up about symptoms like hot flashes and insomnia, one-third are just too embarrassed to talk about vaginal dryness and leave their symptoms untreated. This can not only cause strain on intimate relationships, it impacts a woman’s day-to-day life and that is no way to live.

Below I have posted the vaginal dryness interview with Dr. Shapiro. I strongly urge you to read it and use it as a launching pad to openly discuss vaginal dryness with your health care provider.  Try not to feel embarrassed or shy.

Vaginal dryness

Marla Shapiro C.M.‎ ,MDCM, CCFP, MHSC, FRCPC, FCFP, NCMP

BIOGRAPHY

Dr. Shapiro completed medical school at McGill University and trained at the University of Toronto for her Masters of Health Science. She concluded her specialty training in Community Medicine, receiving her Fellowship in Preventive Medicine and Public Health from the Royal College of Physicians and Surgeons of Canada. She also holds a Fellowship in Family Medicine and is now a Professor in the Department of Family and Community Medicine at the University of Toronto.
Dr. Shapiro is the author of the bestselling book, Life in the Balance: My Journey with Breast Cancer.
Dr. Shapiro is a member of several advisory boards, including Research Canada and the Board of Trustees of the North American Menopause Society. She is currently the President of the North American Menopause Society.

She received an Award of Excellence from the College of Family Physicians of Canada, and was awarded the Excellence in Creative Professional Activity by the University of Toronto. She is also the winner of the 2010 May Cohen Award, the 2010 Peter R. Newman Humanitarian Award was honored as a Woman of Action by the Israeli Cancer Research Foundation. In 2015, Dr. Shapiro was also chosen in the top 10 of the 50 most powerful doctors in Canada by the Medical Post.

In 2015 Dr. Shapiro was named a Member of the Order of Canada for her contributions as a family physician and trusted source of health information. One of this country’s highest civilian honours, the Order of Canada recognizes outstanding achievement, dedication to the community, and service to the nation.

INTERVIEW

Monica – Explain to me a little bit about the physiology of a normal vagina, like how is it normally lubricated?

Dr. Shapiro – This is a great question! Very nice to speak to a nurse. This is all about estrogen and this is all about the vagina in terms of what we call the overall vaginal maturation index. When we are looking at a healthy vagina there’s a ration of what we call your superficial cells, your intermediate cells, and your basal cells, there is their PH and a normal PH frame is about 3.5 – 4.5 or so. There is the thickness of the collagen and the tissues and the natural folds that sit in the vagina. All of this is maintained by estrogen. The one thing that women don’t understand is that unlike hot flashes and night sweats which are driven by the loss of estrogen as well, they typically will get better over time for most women but not all women. Vaginal atrophy is estrogen depletion and menopause is all about a continually estrogen depletion state. The further along in menopause you are, and as you know you don’t go through menopause and you are done menopause, your living in menopause. That this is all about estrogen depletion this does not get better this does not get refractory this gets progressively worse. Where we see thinning of the tissue, loss of the natural folds, pale tissue, petechiae of the tissue the dryness the PH is driven upwards to a more alkaline environment, the normal bacterial flora is lost. There are estrogen receptors in and around the genital urinary area as well which is why the likelihood of having more bladder infection increases in menopause for many women. So, this is a state of estrogen depletion, all women not some women will experience this but only about half of them will experience distress with it and of that half that experience distress we know that maybe 7% of them get treated. We know that there is huge void in the landscape in terms of symptomatic women with distress versus women who are not symptomatic with distress who are not getting advice, treatment, help, direction, or empowered to speak about this.

Monica – Wow, that’s shocking that so many people are affected and it’s a lifelong thing and they aren’t seeking any type of treatment for it. Are women affected by vaginal dryness before menopause sometimes?

Dr. Shapiro – Any type of situation that’s going to give you estrogen loss, is going to give you those symptoms. For example, we have women that are lactating and nursing you know you don’t get your period for many months, many of these women are nursing and they many experience distress. Some women on birth control pills notice that they got a change in their regular area of lubrication. So, the concept of moisturizers putting moisture back, essentially while the focus on most women is perimenopausal transition even when you still having periods in that time leading up to the transition of menopause many women are already beginning to experience some vagina dryness. For many women, they think this is a so-called process of ageing and therefore they don’t necessary recognize that there are other symptoms not just painful intercourse but all the other things dryness, irritation, there can be burning there can be increase in discharge that they mistake for yeast infection but it’s related to the change in the PH. There’s a plethora of symptoms that women may not necessarily recognize that are related to the loss of estrogen in the vaginal area and the general urinary area. We no longer just focus on the volva vaginal atrophy we now focus on the general urinary syndrome of menopause often called GSM. Which stands for the Genital Urinary Syndrome of Menopause. Recognizing that it is not just the vagina and labia but in fact the general urinary system itself. So, it’s now called GSM.

Monica – Wow that is interesting. I wasn’t even aware of that, in that detail. What do people say? I suspect many women first notice vaginal dryness during intercourse maybe a pap test.

Dr. Shapiro – The answer is that most women say nothing, which is terrible in terms of not empowering women to talk about the way that they are feeling. So, you are right that the most common thing that will drive women in, in terms of symptomologies is painful intercourse or loss of intimacy impacting on their relationships. We have lots of excellent data, there is a large study called VIVA Study which looks at intimacy in partners and how vaginal atrophy untreated in women, can have a mirror reflection in terms of symptoms with partners, partners feel the same as the women who is experiencing it. That’s having an impact on their intimacy that it impacts on the way they see themselves as well. Yet women aren’t empowered to speak about this the way that men do speak about issues. And I think part of it is that you don’t see it, you just don’t see it. It is important for women to understand that there are a lot of safe options both prescription and over the counter that they should be aware of to treat the symptoms that they have and also to even be aware of what the symptoms are that their most bothersome symptom may not be painful intercourse particularly women that are not being sexually active but in fact they might still be bothered by troublesome of dryness and irritation and intercourse in discharge and urinary infections and any of the symptoms but because they are not necessarily being intimate there’s that bias that these women aren’t having issues but in fact many of these women are. I think it’s important first to understand what the symptoms are, first to understand that this effects all women, some with distress, some not. And if you are a woman who is experiencing distress then you need to be informed and get education. That education can come from your pharmacist, from you physician, health care providers, nurse practitioner. Your PH and whoever it is that is providing your point of information contact and as well I certainly endorse our website at the North American Menopause Society which is Menopause.org which has a wonderful consumer arm that has dedicated literature that’s not pharma based not funded by Pharma scientific literature on what it is that is important to know about in terms of vaginal moisturizers and vaginal lubricants. To understand that such as you want a moisturizer that’s going to be PH neutral, if it’s too acidic it’s going to damage the vagina. You want something in most cases I believe that should be fragrance free, you don’t need fragrance and fragrance is a potential irritant. Things that are excipients that may be the preservative for example glycol or glycerin that these may fuel candidiasis, it’s not going to add the moisture back it’s an excipient that maybe irritating. You want something that’s going to be bio adhesive meaning that the moisture that you’re putting in is going to be PH neutral, user friendly and bio adhesive meaning that it will stick to the cells stay on the cells moisture the cell for at least a couple of days so you are using this every three days or so and unlike any other moisturizer it’s different that a lubricant. A moisturizer you use on an ongoing basis a lubricant you use as is needed.

Monica – Dr. Shapiro, what’s a women’s first line of defense against vaginal dryness? Would you say just to have the moisturizers?

Dr. Shapiro – I think for many women firstly knowing what the issue is, is their first line of defense. Knowledge is power and then empowering yourself with what your options are. We know that vaginal estrogen in a form of tablets, rings and in creams dosed appropriately is very safe and very effective and is not the same as menopausal systemic therapy which may care more of a concern in terms of long term side effects. That these are products that are very safe and have lost of science and data behind them. That the use of add on moisturizer either with a local estrogen or without a local estrogen is something that women can use on an ongoing basis to put the moisture that their losing back in place. We have a lot of scientific literature that looks at both the polycarbophil that is in this particular moisturizer as a delivery route and other moisturizers that use hyaluronic acid for example as well that is excellent in terms of moisturizing locally. I think you need to know what’s out there that’s safe. You need to get information from either your physician or from a vetted website like Menopause.org where women can read about what the options are and take the time to get educated and empowered. Which sometimes is the first step even before you speak to your health care provider so you come armed with your questions. I think the beauty of writing a blog is that it is very user friendly, you want to keep it scientific and evidence based in language that women understand and make them feel like “I’m not the only one who has this going on.”

Monica – Exactly that way people don’t feel and alone and are willing to talk about it and it removes some of the taboo around the subject.

Dr. Shapiro – Yes because there still is quite a bit of taboo.

Monica – Yeah that’s true, unfortunately. Do you have any tips about how to speak to their doctor about vaginal dryness? Should we make a list?

Dr. Shapiro – I think that for women who feel uncomfortable or who may feel embarrassed, having a list is very empowering. Because having a list means you don’t’ lose your words or get tongue tied. Many women will start the conversation saying that “this is so awkward” or “I’m so embarrassed” and I’ll immediately interrupt them as say this is not a place that you should ever feel embarrassed or uncomfortable. This is a place to bring any question, the only dumb question is the question that you do not ask. If you have a question and you do not ask it that’s a problem. You need to be asking the questions.

Dr. Shapiro was so knowledgeable and such a pleasure to speak with. Although this is a fairly lengthy interview, I could have easily spent hours picking her brain! But then this post would have turned into a novel!

During the interview, Dr. Shapiro mentioned the use of add-on moisturizer, either with a local estrogen or without a local estrogen, as something that women can use on an ongoing basis to put the moisture that they’re losing back in place.

A couple of products I trust and have used are:

vaginal drynessREPLENS™Vaginal Moisturizer (Provides relief of menopausal vaginal dryness symptoms)

How it works:
– Provides soothing moisture to vaginal cells for long-lasting hydration

– Continues to deliver moisture for up to 3 days

– As the cells of the vaginal wall are regenerated, dry cells are cleared and REPLENS™ Vaginal Moisturizer is absorbed

– Regular moisturizing will help prevent dryness from recurring

How to use it:
– Can be used any time of day, but works best when used on a regular schedule

– Recommended that women use the moisturizer at least two hours prior to intercourse to allow proper moisturizing

– It is safe to use REPLENS™ Vaginal Moisturizer when menstruating, however, some women may experience discharge

Product benefits:
Goes to work immediately to relieve vaginal dryness

vaginal drynessREPLENS™ Silky Smooth Personal Lubricant (For enhanced, natural feeling intimacy)

How it works:
– A premium silicone lubricant that moisturizes and lubricates to enhance the ease and comfort of intimate sexual activity

– Supplements the body’s natural lubrication and leaves the skin feeling soft and smooth

How to use it:
– Apply a small amount of REPLENS™ Silky Smooth where additional lubrication is desired prior to or during sex

– Compatible with natural rubber latex, polyisoprene, and polyurethane condoms

– Not recommended for use with silicone adult toys

Product benefits:
– Premium silicone based and contains no preservatives

– Less irritating than most water based lubricants

– Can help alleviate vaginal dryness and make intimacy more enjoyable

– Does not dry out easily

Replens products are available for sale at Shoppers Drug Mart, Walmart, and other retailers nationally
Visit http://www.replens.ca/ for more information.

Remember you are not alone in your vaginal dryness so try not to feel embarrassed or too shy to speak to your health care provider.  Trust me, you will not be the first person to bring up this topic with your doctor.

This is a sponsored post, however, as always, all opinions are our own. 

 

Comments

  1. I honestly never knew that vaginal dryness was so common amongst women. I agree that educating ourselves on the issue and talking openly about it is a great way to raise awareness and support from others. Thank you for going in depth I would have never thought of asking the questions you did.
    Laura recently posted…The Allergy Friendly Dyson V8 AbsoluteMy Profile

  2. robin rue says:

    That is an awesome interview. I use lube fairly often when I have sex because if I am too dry, I will get a yeast infection and that is the WORST!

  3. You’re completely right, we shouldn’t be afraid to talk about what is a normal bodily experience. Just like men should be open about prostates, women should be discussing what changes to expect from our bodies. Thanks for the advice out the replens. I will have to keep this in mind when it’s my time
    Claire recently posted…Danik in the Riga Marathon 2014-2017My Profile

  4. I do find it difficult to talk about “feminine” problems as I get super embarrassed. You are right though, we shouldn’t feel embarrassed and education is key! Thank you!!

  5. Blair villanueva says:

    Thanks for sharing this. And yes vaginal dryness is real! I had encountered it and sometimes it is the effect of my diet. So i eat lots of veggies and fruits and drink more water and fruit juices, thus having a healthy non-dry vagina.

    It is a nightmare to have dryness *wink wink

  6. I knew about numerous side effects that come along with menopause, but not this one. Thank you for shedding light on such a sensitive yet important subject.
    Marcie W. recently posted…Wonder Woman Official Trailer #WonderWomanMy Profile

  7. That was crazy informative. Thank you. I was avoiding reading the post at first and was like why do I feel that way about a post. Anyways I learned a lot and never even heard of this lubricant. Thanks to Dr Shapiro for empowering women to ask or talk about vaginal issues and atrophy. I had no idea at all that I could live 1/3rd of my life in a menopausal state. I had a hysterectomy early due to cysts and endometriosis so that length is likely even longer so this is an issue I should know more about. We really should be better at asking these questions if we don’t know. When I had my hysterectomy for instance nobody mentioned that any of that could happen.
    paula schuck recently posted…Budget Friendly Backyard Cleanup #ChurchandDwightMy Profile

  8. I find it easier to talk to my dr and pharmacist as I get older. Hopefully more people feel comfortable enough so they do not have to have discomfort. Personally, I know hormones play a big part for me.

  9. I have a male doctor and would feel too uncomfortable talking to him about it. Yes, I know intellectually it’s nothing to be embarrassed about, but it does feel awkward, so I appreciate having info like this online.

  10. Oh this sounds so uncomfortable, I hope I never have to experience this!!

  11. I think it’s pretty cool that you grew up in a family of nurses. I did not know that vaginal dryness is a symptom that can come with menopause. I had no clue.
    Yona Williams recently posted…With Love…is a Special Kind of Restaurant in Syracuse, NYMy Profile

  12. Michelle Waller says:

    Thank you for sharing this. I experience this, and it sucks really bad.

  13. There’s definitely so much to be learned from this interview especially if you’re about to go through these stages as a woman. I think it’s really nice to know what our options are.

  14. Bellezakisses says:

    I learned so much reading this thank you for sharing!

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