When you think of symptoms of menopause, what first comes to mind? Hot flashes, weight gain, mood swings? One of the most common reasons for people to seek medical intervention during menopause is actually because of vaginal dryness causing pelvic pain, vaginal irritation, and pain during intercourse.
It’s estimated that approximately 15% of premenopausal women and up to 57% of postmenopausal women experience vaginal dryness. The vaginal dryness is typically caused by a vaginal or vulvovaginal atrophy which is a thinning and drying of the vaginal tissue caused by a drop in estrogen.
While menopause is a big cause of vaginal dryness, breastfeeding, stress, diabetes, IBS/IBD, chronic heart failure, multiple sclerosis, antidepressant use, and chemotherapy and radiation treatments can also be causes.
During the perimenopausal time, there is a drop in estrogen levels. This drop in estrogen causes the vaginal walls to atrophy or thin out. The vaginal and vulvar tissues become inflammed and this leads to less natural vaginal lubrication. The primary symptoms people report with atrophy are dryness (55%), painful sex (44%), vaginal irritation or burning (37%).
There are several treatments for vaginal atrophy and dryness. You may need to use more than one treatment option.
Physical therapy can be helpful with internal massage to improve blood flow through the muscles which will in turn make the tissue more pliable and less brittle.
Other treatments are estrogen creams for the vagina, hormone replacement therapies, selective estrogen receptor modulator such as ospemifene, personal lubricants and moisturizers, and laser treatments. Two of the least invasive and still very effective treatments are physical therapy and personal lubricants and moisturizers.
We often get asked, “Ok, so I need lube. But what kind?”. There are many different lubrications and moisturizers out on the market.
First, it is important to distinguish lubrications from moisturizers. Lubrications should be used during sex or sexual activity. They act fast to provide short-term relief from vaginal dryness and related pain during sex. They may be water, silicone, mineral oil, or plant-oil based products. Water-based lubricants tend to have the least amount of vaginal irritation or symptoms related with them. Silicone based (like Uberlube) contain no water, so they do not have a pH or osmolality value, which will make them less likely to change the bacterial environment in the vagina.
Vaginal moisturizers rehydrate dry mucosal tissue. They are absorbed into the skin and are used more on a daily basis. They adhere to the vaginal lining and help to reduce vaginal dryness. The effects of moisturizers is long term. They are more needed for women experiencing pain or irritation on a daily basis and not just during intercourse.
So, which lubrication is best? The WHO (World Health Organization) recommends lubrications with an osmolality (or concentration) of somewhere around or less than 380 mOsm/kg. However, anything under 1200 mOsm/kg is acceptable. They recommend this because anything over that will cause epithelial or tissue damage. Some commonly prescribed lubrications such as Astroglide and KY jelly have very high osmolalities and can be very irritating!
Also, the WHO recommends trying to match the pH of the lubrication to the pH environment of the vagina – which is typically a little more acidic from the estrogen (pH 3.8-4.5). The rectal mucosa has a higher pH (more basic than vaginal) and would require a different lubrication which is closer to a pH of 7.0. You want to avoid lubrications that have parabens and microbicides, however its becoming less common to have these ingredients.
Some lubrications that have good osmolalities and pH include:
Good Clean Love has the best overall osmolality and pH similar to that of the vagina. If you are looking for a silicon-based product which is a little thinner and slicker, uberlube is a good product.
Bottom line is there are many lubrications and moisturizers on the market. You want to find one with a pH around 3.8-4.5 for vaginal use and an osmolality of less than 1200 mOsm/kg. If not listed on the box/bottle, you can always search on the internet for these values.
If you have more questions about correct lubrications and moisturizers, ask your pelvic floor physical therapist for help!
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