The previous understanding when talking about vaginal dryness was often associated with dryness due to hormone deficiency in menopausal or postmenopausal women. However, recent medical studies have found that vaginal and vulvar dryness, also known as Vulvovaginal atrophy (VVA), is more common than previously thought but often goes unreported. The main cause is the decreased estrogen hormone levels in the vaginal tissues, and it can occur in women of all ages at some point in life when estrogen is deficient. About 50% of cases are found in menopausal women.
What are the symptoms of vaginal dryness?
- Feeling hot, burning, dry, and irritated in the vagina
- Lack of lubrication and pain during intercourse, bleeding after intercourse
- Frequent urination, burning sensation during urination, urinary leakage, inability to hold urine
- Vaginal inflammation, frequent and recurrent discharge that is difficult to cure. During reproductive age, women have normal estrogen levels, so the vaginal skin is moist, thick, and ruffled. When entering menopause, estrogen deficiency causes thinning of the vaginal walls, reduced elasticity, decreased blood supply to the vaginal area, reduced lubrication secretion, and decreased acidity, becoming more alkaline due to lack of estrogen. Along with the shedding of vaginal wall cells, this increases vaginal alkalinity, which is an environment where beneficial bacteria, lactobacilli, that protect the vagina cannot survive. This leads to the growth of pathogenic bacteria, making vaginal infections easier and more frequent.
What is clearly seen during physical or internal examination?
When patients come for a physical or internal examination, the following symptoms are observed:
- The vagina appears pale, dry, may have bleeding spots, vaginal rugae disappear, and the cervix may be flattened against the vagina
- For a more definitive diagnosis, pH testing can be done, which will show alkalinity with a pH value greater than or equal to 4.6
- Urinalysis often shows red blood cell contamination (in menopausal women, during annual health check-ups, urine tests often show red blood cell contamination; if urinary tract diseases have been ruled out, this is usually due to vaginal dryness)
Causes of vaginal dryness
- Decreased estrogen hormone levels in the body due to aging. In the premenopausal stage, estrogen levels range from 10-800 pg/ml, varying according to the menstrual cycle phase. However, in menopause, estrogen levels are usually less than 30 pg/ml, and the source of estrogen is mainly E1 type, which is converted from fat deposits in the upper arms, thighs, and abdomen
- Decreased estrogen levels due to side effects of medications, including:
- Chemotherapy drugs used in cancer treatment, which in some cases cause ovarian failure, leading to estrogen deficiency and subsequent vaginal and vulvar dryness. Data shows this problem occurs in 23-61% of breast cancer patients who have undergone chemotherapy
- Medications with anti-estrogen mechanisms used to treat certain conditions such as endometriosis, chocolate cysts in the ovaries (endometriosis found in the ovaries), and injections to reduce uterine fibroid size before surgery, which may cause vaginal dryness as a side effect
Differential diagnosis of other vaginal conditions from vaginal dryness
It is necessary to always consider differential diagnoses before treatment because the treatments differ.
- Vaginitis caused by infections such as bacterial, protozoal, or fungal infections, which may present with burning, itching, painful urination along with vaginal discharge
- Vaginal irritation from allergic reactions to soaps used for intimate hygiene, underwear, or sanitary pads
- Skin rashes around the vulva and vagina
- Precancerous or cancerous stages of the vagina or vulva, which may cause dryness, itching, and chronic irritation. Therefore, if symptoms occur, consult a doctor for examination and diagnosis first
Treatment of vaginal dryness
- Treatment with estrogen hormone
- Oral estrogen hormone therapy is suitable for treating menopausal symptoms such as hot flashes and body aches. Clinically, it helps control blood cholesterol levels and prevent osteoporosis (if there are no contraindications to hormone use). However, it is not very effective in relieving vaginal dryness, with 10-20% of patients still experiencing symptoms
- Topical estrogen hormone therapy in the vagina, which uses low-dose estrogen, has been studied by The North American Menopause Society (NAMS) in 2007 and found effective in treating vaginal dryness, whether in tablet, cream, ring, or vaginal insert forms. Currently, even low-dose vaginal estrogen use has been shown to increase blood estrogen levels, so caution is needed, especially in cases with contraindications to hormone use. Always consult a doctor first. However, ongoing medical research is developing estrogen drugs that specifically act on the vagina without affecting other organs
- Treatment with non-hormonal moisturizers, similar to moisturizers used on dry skin on the body. These come in liquid, gel, or vaginal insert forms and can be used long-term without systemic effects because they contain no hormones. They coat and protect the vaginal skin to keep it moist and are applied every 2-3 days
- Use of lubricating gels for cases where the main problem is pain and burning during intercourse. Lubricants can be applied during sexual activity to the vagina, vulva, or male genitalia
- There is no clear evidence from studies supporting the use of vitamin supplements such as vitamin E and vitamin D for treating vaginal dryness
- Fractional CO2 laser treatment is a new technology for rejuvenation therapy. The device emits 360-degree laser light to stimulate fibroblast cells, enhancing collagen fiber production and arrangement. This increases vaginal secretions and moisture. The laser treatment is painless, requires no anesthesia, is quick, and patients can resume normal activities immediately after
Vaginal and vulvar dryness may sound like dry skin, but when it occurs in the vagina, it affects multiple systems because the vaginal wall supports the bladder and urethra. This causes symptoms of dryness, irritation, burning, painful urination, and affects sexual activity. Therefore, if symptoms occur, consult a doctor for diagnosis and appropriate treatment.
