We have many patients who come to us because they’re experiencing vaginal dryness and/or lack of self-lubrication. This is an issue often related to menopause, but there are a lot of other times during a women’s life that she may run into vaginal dryness and irritation, and it’s our goal to find the cause and propose a holistic solution.
What is Vaginal Lubrication?
Vaginal lubrication is naturally produced near ovulation and during sexual arousal. Since the vaginal lining does not have glands, it has to use other sources of lubrication. Plasma from vaginal walls due to vascular engorgement is the chief lubrication source, with Bartholin’s glands (lower part of vaginal opening) coming in second to secrete mucus that augments these vaginal wall secretions. As a woman approaches ovulation, cervical mucous provides additional lubrication.
Aside from vaginal lubrication during intercourse, the vaginal walls stay lubricated with a thin layer of clear fluid. Estrogen helps to maintain that fluid and keep the lining of the vagina healthy, thick, and elastic.
What are some causes of vaginal dryness?
During menopause, estrogen levels drop and therefore reduce the amount of moisture available. This will in turn make the vagina thinner and less elastic. There are other reasons why estrogen levels drop; these include breastfeeding, post cancer treatment/surgery, as well as the use of birth control. Let’s explore these a bit more:
Right after giving birth, estrogen and progesterone levels drop drastically. This is to allow prolactin (the hormone that maintains milk production) to be released. When the baby latches on to the breast, oxytocin is released to help the milk letdown reflex. Prolactin remains elevated as you continue to breastfeed regularly and will suppress ovulation.
One of the treatments for breast and uterine cancer is hormone therapy, which starves the cancer cells of the hormones needed to grow. Layered on top of that are 2 kinds of drugs: the first is Tamoxifen, which keeps breast cancer cells from using estrogen. Then we have exemestane, anastrozole, and letrozole, which prevent testosterone from being changed into estrogen. Some women may also have their ovaries removed, which is another way to get rid of the hormones that cancer needs to grow.
Birth control pills
Birth control pills work by lowering the amount of testosterone produced by the ovaries while increasing a protein secreted by the liver known as sex-hormone binding globulin (SHBG). SHBG binds to testosterone and makes the molecule inactive. Since both estrogen and testosterone receptors in the vagina contribute to lubrication, it makes sense that low testosterone will make things drier. Synthetic progesterone also found in birth control pills will actually poison the testosterone receptor if given in high doses.
Treatment Options for Vaginal Dryness
The first step is to meet with your gynecologist or OB to discuss options. The doctors will often prescribe a low-dose vaginal estrogen or estrogen cream. To help with the deeper tissues, this will come in the form of a suppository. If dryness at the vaginal opening is the issue, topical application will work best. An estrogen ring can also be inserted into the vaginal canal and will slowly release estrogen into the vaginal canal .
Here are some other natural brands of vaginal moisturizers:
- Oasis Silk Lubricant: A natural lubricant and moisturizer that is vegan, paraben free, gluten free. Recommended by a Woman’s Touch website
- Sutil: Hyaluronic acid with natural ingredients. Per website notes that all additives are botanical
- Hyalogyn: Hyaluronic acid, with a few additives. Works similar to Hyauluronic acid.
- Replens is is a bioadhesive, polycarbophil based vaginal gel as read per the website.
- Olive/Coconut oil: Natural oils can also be helpful, but limited research on how effective they are. Coconut oil tends to be more firm at room temperature an easier to use. Olive oil can be bit runny and harder to apply.
So now we know why vaginal dryness occurs and some good treatment options. Every person is different, so you may have to try a few different things before finding something that works. If you have questions, please talk to your doctor and/or pelvic floor PT.