Vulvavaginal dryness is very common and most women will experience some degree of vulvavaginal dryness in their lifetime - probably up to 70% of post-menopausal women and up to 15% of premenopausal women.
Vulvavaginal dryness is a condition whereby the external genitalia and the vagina become dry, thin, pale, fragile, and actually becomes vulnerable to trauma, infection and even bleeding.
The most common cause of vulvavaginal dryness is low estrogen. At any stage of a woman's life. Estrogen, if you will, is the life force of the vagina and the vulva. It promotes the production of glycogen, which is a substance that the good bacteria, Lactobacilli, thrives on. And which in turn keeps the vagina in a healthy vaginal pH. It also helps promote the production of mucus, the increase blood flow, it makes it elastic. When the estrogen levels are low in a woman -- usually in the postmenopausal stage but it can happen at other stages of life -- all those good things become reverse. And what happens is, you see these nice little ridges here in the vagina, those are called rugae -- they flatten out and the vaginal becomes thin, the blood flow decreases and the vagina becomes pale, the tissues lose the glycogen that I spoke of, and the good bacteria aren't there, the pH goes up and women lose lubrication and moisture.
The same with the vulva. The vulva has estrogen receptors as well. And the estrogen in the vulva keeps the skin -- like skin in your body -- it keeps it very healthy. It increases collagen in the skin, subcutaneous fat. And when the estrogen levels are low, these qualities are diminished so women notice that there is thinning of the tissues, hair loss, and just very ...vulnerable! The tissue becomes very fragile.
The symptoms of vulvavaginal dryness and which eventually, with long-term low estrogen can lead to atrophy are varied but some women present to me just with vaginal itching. Or they're very dry and don't lubricate during sex. And this has a tremendous impact on female sexual function. In fact the leading cause for Female Arousal Disorder is vaginal atrophy. And it can impact one's self image, one's self-esteem and overall quality of life. But vulvovaginal dryness doesn't just affect older women. 15% of premenopausal or reproductive aged-women also suffer with vulvavaginal dryness.
The important thing is that women address this problem. Over 60% of women are afraid to address it and many providers fail to address it as well. I've had patients come in and until someone asks I say, "How are you doing? How's your relationship? Are you sexually active?" And one patient recently said to me. "Oh Doc! I am dry as sand down there!" Which really says it all. Vulvavaginal dryness can make women feel old.
What are other causes for vulvavaginal dryness? It isn't just menopause. Women can have low Estrogen at various stages of their life. They can be breast feeding, they could have just had a baby where all the hormones have gone way down after being pregnant, they can be on anti-breast cancer medications that are anti-estrogens. They can be on Chemotherapy. They could have been exposed to pelvic radiation for pelvic cancers. Certain medications can cause dryness -- even nonspecific antihistamines. There are some birth control pills that are only Progesterone pills or Progesterone birth control and they don't have estrogen and I've noticed over time, that women are on these a long time, they know that they have decreased lubrication and suffer with some vaginal dryness. There are even some lifestyle factors that come into play that can aggravate dryness: Smoking, excess alcohol, lack of sexual activity and even obesity can impact your vulvovaginal area.
I encourage women to speak to their doctors or their gyn providers about vulvavaginal dryness and if long term left unchecked it becomes atrophy.
There are numerous remedies for this. We have are over-the-counter lubricants that can aid women during sexual activity and help with lubrication. There're also moisturizers that they can use externally and then there's also a number of localized estrogen therapies, which work very effectively because if you're lacking estrogen and you give it back locally, in that area, it works wonders to restore vulvovaginal health. And these come in many, many forms. We have rings and creams and tablets...So please, this is not a condition that women should suffer in silence. There are terrific remedies out there to improve your overall quality of life.