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I'm Talking W.A.P., W.A.P., W.A.P....That's Some W.A.P!

Do I have your attention?! Great!

In today's blog post, I'm going to be sharing information about "Vaginal Dryness: Lubricants and Moisturizers".

When asked, why use this platform to discuss such a personal topic?
My reply is always "why not?".

Also, as a person who identifies as a woman, has a vulva, enjoys vaginal penile penetrative sex, and who's in the mid-40s (age where perimenopause/genitourinary syndrome of menopause symptoms began to manifest)...vaginal dryness is a topic that comes up in many of the women circles that I find myself in, with patients whom I serve in my mobile clinic practice, and most recently during a conversation with a family member of mine.

Lastly, I want to use this platform to bring awareness to the health needs of an area of the body that is often overlooked until there’s a problem(hello pelvic floor dysfunction), yet whose function is an integral part of one's identity and overall health.

So let's get into it!


WHAT IS VAGINAL DRYNESS?
Vaginal Dryness, is simply defined as decreased lubrication in the vaginal area.
While most commonly associated with physiological changes that occurs during the perimenopausal period, vaginal dryness can be experienced by women of all ages.

When not adequately addressed and/or managed, vaginal dryness can lead to a decreased quality of life. Negatively impacting interpersonal relationships, disrupting participation in preferred occupations including sexual activity due to pain with vaginal penetration (penile or tool use), and increase risk of genitourinary complications such as urinary tract infection (UTI) .

Thus, when educating my clients about vaginal dryness, it is a goal that my clients' leave our session feeling empowered and more knowledgeable about this phenomenon in order to make the best informed decision regarding the most optimal plan of care.

Some of the key points that's included in our discussion includes, but is not limited to knowing and understanding the risk factors, symptoms, and available treatment options.

RISK FACTORS
As previously mentioned, advanced age is the most commonly known risk factor for vaginal dryness. However, other risk factors include, but are not limited to hormonal changes (down regulation of Estrogen), menopause, breastfeeding (yes..breastfeeding: estrogen vs prolactin levels), stress, cold and allergy medications, and antidepressant use.

MORE ABOUT ESTROGEN AND ANTI-DEPRESSANTS
During the reproductive years, estrogen plays a key role in maintaining the normal vaginal environment. As estrogen levels fall (menopause or during the lactating period), vaginal atrophy, thinning and inflammation of the vaginal walls and vulval tissues can occur, which can result in decreased vaginal lubrication.

While research evidence has shown an association between anti-depressants and vaginal dryness, it is recommended that individuals not stop taking their anti-depressants, but instead discuss their experience with their healthcare provider in order to explore one of the vaginal treatment options discussed below. Before getting into the treatment options, lets first highlight some of the associated symptoms.

ASSOCIATED SYMPTOMS
When it comes to vaginal dryness..dryness is not the only symptom when there is decreased lubrication in the vagina. Other symptoms may include:
Skin irritation
Burning
Itching
Discomfort in the vulva and/or vaginal areas
Pain/discomfort with penetration
UTI

TREATMENT OPTIONS
Treatment Options includes the use of non-pharmacological treatments (lubricants and/or moisturizers), topical vaginal estrogen, hormone replacement therapy, and selective estrogen receptor modulator, i.e.,Ospemifene (non-hormonal)).

Non-pharmacological treatment options are generally considered the first line of defense and in most instances is often commercially available for over the counter purchases.

MORE ABOUT LUBRICANTS
1. Commercially available as water-, silicone-, mineral oil-, or plant oil-based
2. Generally applied to the vagina and vulva prior to sex
3. Acts rapidly to provide short term relief
4. Beneficial for bodies whose vaginal dryness is a concern only or mainly during sex
5. Excipients added to water-based lubricants will have an impact on pH and osmolality

MORE ABOUT MOISTURIZERS
1. Rehydrate dry mucosal tissue and is absorbed into the skin and adhere to the vaginal lining, mimicking natural vaginal secretion
2. Applied regularly, i.e., everyday to 2-3 days/week
3. The frequency of use is severity dependent (mild, moderate, severe vaginal dryness)
4. The effects are longer lasting compared to lubricants
5. Changes the fluid content of the endothelium and lower vaginal pH, thereby maintaining vaginal moisture and acidity

Despite the availability of these and other evidenced-based treatment options... ill-informed held beliefs, societal expectations, "cultural norms", feelings of shame, and conversations about vaginal dryness being considered "taboo"...vaginal dryness is a condition that is often underreported and under treated..leaving many to "normalize" experiences that is contradictory to their health.


ANTICIPATORY GUIDANCE WHEN CHOOSING A LUBRICANT OR MOISTURIZER
When choosing a lubricant or moisturizer, factors to consider SHOULD include the following:
1. Intended Use: Acute vs Daily; In other words, short term vs long term use.
2. Primary based composition (water, silicone, or oil-based)
3. pH (vaginal pH is 3.8-4.5, making it an acidic environment, protecting against harmful bacteria complications)
4. Osmolality (refers to a substance’s ability to draw moisture out of tissues and cells)

It is recommended to choose a product that is water based, has a pH that is within the pH range of vaginal environment, and whose osmolality value does not exceed 380 mOsm/kg, with and upward limit of 1200 mOsm/kg. Despite these guidelines, it should be known that there is no one commercially available product whose composition satisfy all of these recommendations. Therefore, finding a lubricant/moisturizer that best meet your individual need may require a trial and error period. For comparison purposes, click HERE for a list of lubricants and their corresponding pH and osmolality values.

In closing, it is my hope that you find the formation in this post informative, as well as helpful in initiating a much needed health promoting conversation for those who may be experiencing signs and/or symptoms of vaginal dryness.

Until next time...

Elle

References:

Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric. 2016 Apr;19(2):151-61. doi: 10.3109/13697137.2015.1124259.

Goncharenko V, Bubnov R, Polivka J Jr, Zubor P, Biringer K, Bielik T, Kuhn W, Golubnitschaja O. Vaginal dryness: individualised patient profiles, risks and mitigating measures. EPMA J. 2019 Mar 2;10(1):73-79. doi: 10.1007/s13167-019-00164-3.

Sarmento ACA, Kamilos MF, Costa APF, Vieira-Baptista P, Eleutério J Jr, Gonçalves AK. Use of Moisturizers and Lubricants for Vulvovaginal Atrophy. Front Reprod Health. 2021 Dec 23;3:781353. doi: 10.3389/frph.2021.781353.

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Waetjen LE, Crawford SL, Chang PY, Reed BD, Hess R, Avis NE, Harlow SD, Greendale GA, Dugan SA, Gold EB; Study of Womenʼs Health Across the Nation (SWAN). Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study. Menopause. 2018 Oct;25(10):1094-1104. doi: 10.1097/GME.0000000000001130.

Women's Voices for the Earth. (2023).Slipper slope: Potential hazards of lubricants for vaginal tissue. Retrieved from https://womensvoices.org/lubricants-womens-health/


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