Vaginal dryness: a major problem for menopausal women

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.

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.

Why is estrogen important?

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.

Problems that arise from estrogen deficiency are:

1. 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.
2. Thinning of the vaginal lining causing dryness, irritation, and in some cases burning, which can limit or affect certain activities.
3. Urinary tract infections occur easily because the alkaline vagina does not help prevent pathogens, making it easier for infections to spread to the urethra.
4. 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.

What causes vaginal dryness?

1. Menopause: Hormone deficiency changes the vaginal balance, or from ovary removal without hormone replacement therapy.
2. Hormonal fluctuations during pregnancy and breastfeeding, stress, lack of rest, or excessive exercise.
3. 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.
4. After treatment of vaginal infections, the epithelium needs time to recover.
5. 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.
6. Vaginal douching disrupts the balance of the vaginal ecosystem.

Effective specific treatments for vaginal dryness

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.

Holistic care and maintenance

1. Drink plenty of water to keep body cells hydrated.
2. Reduce both physical and mental stress.
3. Have regular sexual intercourse and avoid using condoms containing nonoxynol-9 as it increases vaginal dryness.
4. Exercise and perform pelvic floor exercises to increase blood circulation.
5. Consume probiotics such as kimchi, natto, tempeh, apple cider vinegar, and fermented rice, as gut balance also affects the vagina.
6. Eat vegetables and fruits, especially those containing isoflavones such as soybeans and soy products, celery, apples, cherries, young coconut water, etc.
7. Avoid smoking, which is very important for overall health.