US Pharm. 2018;43(9):15-16.
Associated With Low Estrogen
The medical term for the thinning, drying, and inflammation of the vaginal tissue that is commonly called vaginal dryness is atrophic vaginitis. For women experiencing the disorder, the symptoms can be very uncomfortable. Vaginal dryness, with or without inflammation, most often results from lower than usual estrogen levels. Estrogen is the hormone that keeps the vagina moist, elastic, and acidic. While vaginal dryness can occur in women of any age, more than half of all women experience it during menopause. When estrogen levels decline, the vaginal tissue becomes thinner, drier, and less elastic. Management of atrophic vaginitis includes both OTC and prescription treatments.
Menopause Is Not the Only Cause
Although menopause is the leading cause of vaginal atrophy and atrophic vaginitis, it is not the only trigger. Other medical conditions or factors that reduce estrogen levels, including childbirth, ovary removal, chemotherapy, radiation therapy, and immune disorders, can also lead to the thinning of the vaginal lining. Smoking, douching, feminine sprays, allergy medications, and some antidepressants can also increase the risk of the condition. Vaginal dryness is more likely to develop in women who are not sexually active or who have not delivered children vaginally.
Symptoms Are Uncomfortable
Atrophic vaginitis usually causes burning and itching of the vaginal tissue, painful sexual intercourse (occasionally with mild bleeding afterward), vaginal discharge, and irritation when wearing form-fitting clothes. Because of the proximity of the vagina to the urethra, urinary tract irritation and infection can occur. Symptoms of urinary tract infections include a burning sensation when urinating, urgency, and incontinence.
It is common for women with vaginal dryness to develop vaginal yeast or bacterial infections as well. This happens because the vagina becomes more hospitable to infectious agents as vaginal acidity decreases.
Vaginal atrophy and vaginitis are diagnosed via a pelvic examination, which entails a visual assessment of the vaginal tissue. If they are present, the vaginal tissue appears thin, irritated, shiny, pale, or red from irritation. In addition to the examination, vaginal acidity levels (pH), blood tests for hormone levels, and urinalysis also help with the diagnosis and to rule out other conditions.
First-Line Treatments Include Lubricants, Moisturizers
The first options for treating vaginal dryness are lubricants and moisturizers. Lubricants are OTC products used immediately before intercourse. They work by reducing friction and providing temporary relief from pain and discomfort that may occur during sex. It is essential to use lubricants specifically formulated for use with latex condoms or diaphragms to prevent damage to the latex. Such lubricants are water- or silicone-based, versus lubricants containing petroleum jelly, baby oil, or mineral oil. Damage to latex products can increase the risk of pregnancy and exposure to sexually transmitted diseases. Regular sexual activity can help to prevent atrophic vaginitis by maintaining flexibility and elasticity of the vagina. Vaginal moisturizers work differently from lubricants: They help the vaginal tissue retain water rather than just reducing friction. Moisturizers are applied to the vagina several times a week and relieve dryness on a continual basis.
Hormone replacement therapy (HRT) is sometimes prescribed to treat vaginal dryness. Localized HRT entails applying estrogen directly into the vagina and helps to relieve symptoms by restoring vaginal blood flow, thickening the vaginal tissue, and increasing elasticity. Although some estrogen is absorbed into the bloodstream with localized delivery, the amount is minimal and the risk of side effects is small. Several products are available for localized vaginal estrogen therapy, including small, flexible rings, intravaginal tablets, and creams.
Systemic HRT involves oral tablets, skin patches, or implants that supply estrogen to the whole body. Systemic HRT is the most effective treatment for atrophic vaginitis, but it is associated with significant potential side effects. Also, women with breast cancer, a history of breast cancer, or a high risk of certain types of breast cancer should not use systemic estrogen therapy.
To comment on this article, contact rdavidson@uspharmacist.com.
