ช่องคลอดแห้งปัญหาใหญ่ของหญิงวัยทอง

<p>A healthy vagina in women of reproductive age is moist and elastic. The vaginal walls are thick pink with small wave-like ridges along the entire length. The superficial epithelial layer of the vaginal lining, which is important for the vaginal ecosystem, is about 15% thick, while the basal cell layer is only 5% thick of the epithelial layer.</p>
<p>&nbsp;</p>
<p>The balance of the vaginal ecosystem is very important. A normal vagina contains many types and billions of microorganisms. A healthy vagina has beneficial microorganisms called Doderlein’s lactobacilli, which make up 60-80% of the total microorganisms, more than any other microorganisms including pathogens.</p>
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<h2><span style="color: #00826a;">Why is estrogen important?</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>Estrogen not only affects the strength of the vaginal walls but also influences the balance of the vaginal ecosystem, especially the number of superficial epithelial cells. The superficial epithelial cells normally contain abundant glycogen, which serves as food for lactobacilli. When glycogen is sufficient, lactobacilli multiply, which is important for producing lactic acid and is associated with the production of hydrogen peroxide (H2O2) as well as the formation of biofilm. This makes the vagina of women of reproductive age acidic with a pH of 3.8-4.5, which is suitable for natural immunity and helps prevent infections from various pathogens. However, when estrogen is lacking, there are no superficial epithelial cells in the vagina, no glycogen to feed beneficial microorganisms, causing lactobacilli to gradually decrease. This results in a lack of lactic acid, making the vaginal pH in menopausal women alkaline, increasing to pH >4.5 up to pH 6-7.</p>
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<h2><span style="color: #00826a;">Problems that arise from estrogen deficiency are:</span></h2>
<ol>
<li>Discharge with odor caused by infection from other pathogenic microorganisms that prefer alkaline conditions, especially anaerobic bacteria. The discharge has a color and smell similar to rotten seafood.</li>
<li>Thinning of the vaginal lining causing dryness, irritation, and in some cases burning, which can limit or affect certain activities.</li>
<li>Urinary tract infections occur easily because the alkaline vagina does not help prevent pathogens, making it easier for infections to spread to the urethra.</li>
<li>Pain during sexual intercourse due to thinning of the vaginal walls from the epithelial layer to the connective tissue beneath, resulting in loss of strength, reduced secretions, and loss of vaginal elasticity.</li>
</ol>
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<h2><span style="color: #00826a;">What causes vaginal dryness?</span></h2>
<ol>
<li>Menopause: Hormone deficiency changes the vaginal balance, or from ovary removal without hormone replacement therapy.</li>
<li>Hormonal fluctuations during pregnancy and breastfeeding, stress, lack of rest, or excessive exercise.</li>
<li>Lack of regular sexual intercourse, which can slow vaginal atrophy by increasing blood flow to the vagina, promoting epithelial cell turnover, increasing secretions, and exercising pelvic and vaginal muscles.</li>
<li>After treatment of vaginal infections, the epithelium needs time to recover.</li>
<li>Medications such as long-term contraceptives, breast cancer drugs, various antihistamines reduce secretions throughout the body, and antibiotics affect lactobacilli, so they should be used only when necessary.</li>
<li>Vaginal douching disrupts the balance of the vaginal ecosystem.</li>
</ol>
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<h2><span style="color: #00826a;">Effective specific treatments for vaginal dryness</span><strong><span style="color: #00826a;"><br />
</span></strong></h2>
<p>Treatment is done by hormone replacement therapy, especially in cases with other menopausal symptoms. For those with only vaginal dryness, topical hormones should be used. Currently available are Estriol (E3) + Lactobacilli vaginal suppositories and the use of vaginal moisturizers containing Polycarbophil, which can penetrate the vaginal walls, increase thickness, softness, moisture, and help adjust the pH balance to be more suitable. Specific treatment overall is very effective.</p>
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<h2><span style="color: #00826a;">Holistic care and maintenance</span></h2>
<ol>
<li>Drink plenty of water to keep body cells hydrated.</li>
<li>Reduce both physical and mental stress.</li>
<li>Have regular sexual intercourse and avoid using condoms containing nonoxynol-9 as it increases vaginal dryness.</li>
<li>Exercise and perform pelvic floor exercises to increase blood circulation.</li>
<li>Consume probiotics such as kimchi, natto, tempeh, apple cider vinegar, and fermented rice, as gut balance also affects the vagina.</li>
<li>Eat vegetables and fruits, especially those containing isoflavones such as soybeans and soy products, celery, apples, cherries, young coconut water, etc.</li>
<li>Avoid smoking, which is very important for overall health.</li>
</ol>
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<div align="right"><span style="color: #00826a;"><strong>Dr. Puthchat Lumleerkittikul</strong></span><br />
Anti-Aging and Wellness Medicine Physician<br />
Obstetrician-Gynecologist and Sexual Medicine Physician<br />
Anti-Aging Medicine Center, Phyathai 3 Hospital</div>


Treatment of vaginal dryness can be done by hormone replacement therapy, especially in cases with other menopausal symptoms. If the problem is only vaginal dryness, topical hormones should be used along with moisturizers.

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Vaginal dryness: a major problem for menopausal women

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