Vaginal dryness

With the hormonal changes that occur during the period preceding menopause and once it has set in, it is normal for our vaginal health to be affected. When your body produces fewer estrogens, there is a reduction in blood circulation to the vagina, the vulva, and even the clitoris, which causes natural lubrication to be altered.

Vaginal atrophy is a condition in which the tissues lining the inside of the vagina thin, dry out, and become inflamed; as a result, these tissues become thinner, less elastic, and less moist. In addition, the vaginal pH changes and the flora can be altered, making infections more frequent. All of this can cause discomfort, such as itching and soreness, which can be especially pronounced during sexual intercourse.

The prevalence and severity of symptoms will vary depending on the time elapsed since menopause. After the first year, about 65% of women will experience vaginal dryness and atrophy, and six years after menopause, up to 84% will suffer from these symptoms. Sometimes, patients normalize certain symptoms and do not seek medical advice for them. Today, it remains an underdiagnosed and undertreated condition. It is of special interest to emphasize the importance of asking patients about these types of symptoms during consultations in order to treat them as soon as possible and avoid an impact on their quality of life.

Thanks to Regenerative Gynecology, we have different solutions for all these problems. Treatments that will make it possible for you to recover your comfort and confidence. The action plan must be tailored to each patient, individualized, and must not be static, but rather must change throughout the patient's life to adapt to the needs and clinical characteristics present at any given moment.

But… what do women know about genitourinary syndrome of menopause (GSM)?

The term genitourinary syndrome of menopause (GSM) is a medically more precise, comprehensive, and acceptable term than vulvovaginal atrophy. It was first introduced in 2014. Thus, this is how we refer to this type of condition more professionally.

It is a chronic and progressive condition that affects sexuality and quality of life. It is preventable and treatable. It will require long-term, and often sequential, treatment that consists of achieving symptom relief. The best-known treatments among women are lubricants, followed by local estrogens. And, surprisingly, there are studies that suggest up to 20% of women are not aware of any treatment.

NON-HORMONAL TREATMENTS

Among non-hormonal treatments are vaginal moisturizers, which help keep the vagina moist and flexible. The recommendation is to apply them daily, morning and night; they provide immediate relief, but they do not treat the underlying problem and do not repair the tissues.

On the other hand, there are vaginal lubricants, water-based ones are recommended and are indicated for use during all sexual intercourse to reduce pain and friction.

We must keep in mind that the skin is a highly sophisticated biological structure that contains, among other things, water from perspiration and lipids from natural sebaceous secretion. The presence of water and lipids in the skin is vital for its proper function and its ability to maintain homeostasis in the body. It is very important to select a texture and active ingredients with specific characteristics to achieve greater satisfaction and adherence to the prescribed treatment, relieving symptoms and promoting the proper recovery of vulvar skin.

The benefits of maintaining sexual activity to prevent vaginal atrophy are also well known. Maintaining an active sex life, as well as vibration therapy, will also help us, as it increases blood flow, lubrication, elasticity, and sensitivity in our intimate area, in addition to strengthening the pelvic floor muscles. All of this will contribute to better sexual function and overall well-being.

Exercises to strengthen the pelvic floor muscles will also help increase blood flow to the vagina, improving its elasticity as well as urinary function.

On the other hand, we have specific probiotics that act on the vaginal microbiota and, by improving the vaginal environment, they alleviate these symptoms and prevent infections, compensating for the decrease in estrogens.

In the group of non-hormonal treatments are regenerative treatments; among these, perhaps those with the greatest prominence are gynecological laser and vaginal radiofrequency.

Gynecological laser acts on the vaginal mucosa by stimulating collagen production and improving blood circulation, whereby the vagina becomes more elastic, hydrated, and healthy.

Radiofrequency is a non-surgical procedure that uses radiofrequency energy to stimulate collagen production and improve the laxity and tone of the skin in the genital area, thereby successfully improving vaginal dryness and even improving urinary incontinence, pain during sexual intercourse, as well as vaginal laxity caused by aging.

We also have hyaluronic acid therapy. Its infiltration is used to treat vaginal dryness and dyspareunia due to low estrogen levels.

LOCAL HORMONAL THERAPY

Local hormonal therapy for the treatment of vaginal atrophy due to estrogen deficiency in postmenopausal women should be the first choice and, according to the criteria established by the Spanish Menopause Society (AEEM) for eligibility for Menopausal Hormone Therapy (MHT), it would be category 1. This category implies that there are no restrictions or that the benefits outweigh the risks.

The efficacy and safety of using local estrogens for the treatment of GSM is more than proven, even in patients with a history of breast cancer, since systemic absorption is minimal.

Local estrogens have shown improvement in urogenital symptoms between two and four weeks after the start of treatment.

In conclusion, it should be said that, for various physiological, preventative, and efficacy reasons, treatments that act on estrogen receptors should be considered as first-line therapy. Second-line, and at any time and/or as a complement, moisturizers and/or vaginal lubricants should be considered, as they are effective for symptoms but do not prevent or improve the underlying pathology. And in another branch would be regenerative treatments, among which are laser, vulvovaginal radiofrequency, and hyaluronic acid, among others.

Menopause and sexual health are no longer experienced the same as before!

At Beldon Medical, we are very committed to women's health and well-being, and we are very aware that vulvovaginal atrophy can be associated with severe symptoms and a significant deterioration in quality of life, which is why we promote proper clinical evaluation and early therapeutic intervention.