Vaginal dryness
Vaginal dryness is a more widespread problem than people think. It is part of a more complex condition, vulvo-vaginal atrophy, and affects not only menopausal women but can affect, even temporarily, women of childbearing age as well. Although there are several therapeutic aids available, it is not always easy to find the most suitable remedy. For this reason, it is essential to consult the specialist who can direct toward the most appropriate treatment protocol, depending on the situation, age, and the possible presence of associated symptoms, such as itching, burning, vulvar pain, cystitis, or recurrent vaginitis
Topical remedies for vaginal dryness
Lubricating and emollient creams and gels
For all women, including those who are young and/or of childbearing age, local remedies such as creams or gels are available, which are safe and without side effects, and have an effective lubricating, moisturizing and emollient action when applied regularly and/or before sexual intercourse.
According to some studies, these preparations are useful in relieving women’s discomfort and pain during sexual intercourse in cases of mild to moderate vaginal dryness and are especially indicated for those who have contraindications to the use of estrogen or choose not to take it. One of the most effective formulations is a gel based on hyaluronic acid and spermidine. Hyaluronic acid is a natural glycosaminoglycan, that is, a compound consisting of a chain of sugars (polysaccharide) that interacts with numerous water molecules to form water-soluble gels capable of giving skin tissues a high degree of hydration. Due to its humectant and cell-matrix balance stimulating properties, it counteracts alterations occurring at the level of the vaginal mucosa, including dryness. Results show significant improvement in parameters related to symptoms of vulvo-vaginal atrophy (dryness, itching, dispareunia, urinary incontinence). Spermidine for its part is effective in the treatment of atrophy because it improves the thickness and elasticity of vaginal tissues with estrogen-like effect. In addition, in the presence of vulvar pain, it can modulate the inflammatory response by reducing the production of pro-inflammatory cytokines
Hormone therapy in creams, ovules or rings
It is preferred to opt for local hormone treatment when, for example, vaginal dryness is the only symptom reported by the menopausal woman and therefore a systemic treatment is not strictly necessary, or if the latter is contraindicated for the reasons already stated. “Treatment consists of local application, vaginally and vulva-wise, of tablets, ova or creams, or insertion of a ring containing the active ingredients prescribed by the doctor,” the gynecologist continues.
“There are several formulations: one of the most recent is based on dehydroepiandrosterone (DHEA) in vaginal ovules, which is effective on the front of both vaginal dryness and vulvo-vaginal pain, acting directly on the tissues with combined effects, both androgenic and estrogenic.” Other remedies for vaginal dryness include a 1 or 2 percent testosterone ointment, to be applied only on the external genitalia. “At the genital level, testosterone stimulates the production of collagen, elastin and mucopolysaccharides by fibroblasts, increases the trophism of vulvar tissue and improves pleasure and sexual response,” the specialist explains. “The ointment should be prepared by the pharmacist on prescription, should be applied to the external genitalia in a very thin layer, and manifests the first benefits after two to three months of continuous use.”
Oral therapies for vaginal dryness
Hormone replacement therapy
In the case of vaginal dryness in menopause (the most common situation), when this disorder is associated with others typical of menopause, such as hot flashes, the first choice is systemic hormone replacement therapy, that is, hormone-based drugs to be taken by mouth or applied to the skin via a patch.
“At the vulvo-vaginal level, taking hormones orally or transdermally (in addition to alleviating all menopause-related symptoms) has a direct action because it helps to restore vaginal pH and increase lubrication, alleviating dryness,” explains Monica Costantini, gynecologist
Oestrogen-like oral therapy
For those who are unwilling or unable to take hormone therapies by mouth (for example, in cases such as suspected estrogen-dependent disease such as breast or uterine cancer, endometrial hyperplasia, heart disease or cerebrovascular disease such as heart attack or stroke, venous thromboembolism, liver disease, hypersensitivity to hormone therapies), one of the most effective actives is ospemifene, a selective estrogen receptor modulator.
“It has estrogen-like activity at the level of the vulva and vagina, but without stimulating endometrial growth and without effects on the breast, because it acts on different receptors,” the expert explains. “It is taken by mouth, once a day, continuously. The oral route of intake and its hormone-like action make it unique in treating vulvo-vaginal atrophy.” According to studies, it acts on the vaginal epithelium, increasing lubrication and mucosal thickness, reducing pH, and improving tissue trophism and elasticity
Treatments with medical devices
Laser
In selected cases, mini-invasive regenerative and physical therapy approaches developed in the field of aesthetic medicine, such as laser or radiofrequency, are also available, using heat to regenerate tissue, improve elasticity and vascularity. “Laser is indicated in cases of persistence of vaginal dryness and pain, despite local hormone therapy, or if this is contraindicated or not desired by the woman,” Costantini specifies. “It has the advantage of acting in a very targeted way, by means of thermal heating that goes to stimulate fibroblasts to produce new collagen, strengthens and thickens vaginal walls, and increases lubrication and hydration of the mucosa. The treatment is neither invasive nor painful: it is performed on an outpatient basis and takes about 30 minutes, without anesthesia (anesthetic cream may be applied), incisions or stitches. Studies show noticeable benefits of three to six months achievable with a course of three or four sessions, at three- to four-week intervals. However, data on long-term efficacy are still lacking.”
Radiofrequency
Like laser, radiofrequency is a noninvasive technique that is effective against vaginal dryness because it uses the action of heat to promote cellular regeneration of tissue. In addition, it can be used to deliver functional ingredients, such as hyaluronic acid, useful for the treatment of vaginal dryness, directly into the vulvar tissues, increasing their absorption and thus their therapeutic effectiveness. The session is quick (about 20 minutes) and painless, requiring no anesthesia and may cause only temporary discomfort. At least four sessions, 15 days apart, are recommended. Contraindications include women with gynecologic and urologic cancers due to the lack of studies in this area.