Videos of Dr Nikki Ramskill
That embarrassing topic: What to do about dry vaginas?
Description:
Genitourinary Syndrome of Menopause (GSM) is a condition that affects many women, caused by reducing circulating oestrogen in the body. It can also be known as vaginal atrophy or atrophic vaginitis, but it is so much more than just vaginal dryness! It can significantly impact a woman's quality of life, yet it often goes undiagnosed and undertreated in the majority of those with these symptoms. GSM classically occurs in premature ovarian insufficiency, menopause and perimenopause, but vaginal dryness can also occur when breastfeeding due to the hormonal changes after pregnancy and with the depo contraceptive injection. According to The Lowdown, 42% of women say they experience vaginal dryness with the injection. https://thelowdown.com/contraceptives/depo-provera/cause-vaginal-dryness Postpartum dryness has been shown to affect 43% of breastfeeding women! https://www.ahyes.org/blogs/blog-posts/tips-on-how-to-ease-vaginal-dryness-from-breastfeeding And up to 80% of postmenopausal women experience troubling GSM symptoms and despite this, only 25% of women seek help and less than 10% start any treatment. https://www.ucc-today.com/journals/issue/launch-edition/article/genitourinary-syndrome-of-the-menopause-gsm-ucct So it's a common problem that sadly isn't talked about enough, let alone treated! Symptoms include: 1. Vaginal dryness: One of the hallmark symptoms of GSM is vaginal dryness, which can result in discomfort, itching, and pain during sexual intercourse. 2. Genital burning or irritation: Women with GSM may experience a sensation of burning or irritation in the genital area, making daily activities uncomfortable. 3. Dyspareunia: Painful sex (aka dyspareunia), is common in women with GSM due to vaginal dryness and thinning of the vaginal tissues. 4. Urinary symptoms: GSM can also affect the urinary tract, leading to symptoms such as urinary urgency, frequency, and recurrent urinary tract infections. 5. Vaginal wall prolapse: The decrease in oestrogen levels can cause the vaginal tissues to become less elastic and resilient. It's a myth that this only happens to women who have given birth vaginally. What medication is used for GSM? - HRT - I like to start with HRT if a woman can have it. 10% of women also need vaginal oestrogen, but systemic HRT can help to alleviate many of the symptoms. - Vaginal oestrogen - there are many forms of vaginal oestrogen including gels, creams, pessaries, tablets and an oestrogen ring. These can also be used for GSM and dryness associated with breast feeding and contraceptive injection use. It can even be used for those who have had breast cancer in the past. https://www.ucc-today.com/journals/issue/launch-edition/article/genitourinary-syndrome-of-the-menopause-gsm-ucct - Vaginal DHEA - intrarosa is a pessary that is inserted into the vagina and is licensed for symptoms of GSM but not dryness associated with breastfeeding or contraception. The active substance of Intrarosa, prasterone, is converted into oestrogens and androgens when inserted into the vagina. The hormone levels increase in the local area which boosts the cells of the tissues and relieves the symptoms. https://www.ema.europa.eu/en/medicines/human/EPAR/intrarosa - Steroid cream - high potency steroid cream can be really helpful for severe itch symptoms while waiting for the oestrogen or DHEA to do it's job! What alternatives can help GSM? - Regular pH balanced moisturising - companies like Yes VM are helpful for this. Moisturise "down there" every day (like you would for your face!) - Lubrication- oil and water based lubricants together can really help during sex (unless using condoms so should be water based only) - Wearing cotton underwear, avoiding synthetic panty liners and not using anything other than water to wash with can help to keep the natural flora of the vagina healthy (be gone femfresh!!) What new/innovative treatments are available for GSM? Lasers can help with vaginal wall prolapse, stress incontinence and vaginal dryness. For example the monalisa touch is a CO2 laser that gently acts on the vaginal walls causing painiless micro-lesions that triggers production of new collagen and therefore improvement in symptoms. https://www.monalisatouch.com/monalisatouch-the-laser-therapy/ Ospemifene is a selective oestrogen receptor modulator that has an oestrogen-like effect in the vagina. It is licensed in the UK for use in women who have completed their breast cancer therapy. There is a lack of long-term safety data from clinical trials though, so if this is something you'd liketo try, then a discussion with your breast cancer specialist would be a good idea first. https://bnf.nice.org.uk/drugs/ospemifene/ https://thebms.org.uk/wp-content/uploads/2023/10/03-BMS-ConsensusStatement-Management-of-symptoms-after-breast-cancer-SEPT2023-A.pdf Don't suffer in silence! If you need help, reach out to me and we can set up a consultation. https://thefemalehealthdoctor.com