Vaginal Symptoms
“Genitourinary syndrome of menopause” (GSM) is the umbrella medical term for vaginal, vulvar, and urinary symptoms occurring during menopause. Increased UTIs and vaginal dryness usually begin in the later stages of peri-menopause and tend to become more pronounced during post-menopause. Of post-menopausal women, 58% report symptoms of genitourinary syndrome. Some women experience only mild discomfort, while others suffer from painful penetration during sexual intercourse, difficulty walking, and itchiness in their vaginal area.
50% of post menopausal women experience vaginal symptoms
Women may find discussing these types of symptoms difficult and menopausal vaginal health problems are often under-diagnosed and under-treated. A recent study (2021) found that 66% of the women do not discuss the impact of their symptoms on sexuality with their gynecologist. Menopausal symptoms involving your vagina will not resolve themselves spontaneously. It is important that you discuss what you are experiencing with a trusted healthcare professional who can provide treatment options. Once treated, you will experience relief from symptoms and will ensure that symptom compounding does not occur.
Why is this happening?
During peri-menopause, the walls of the vagina will become thinner and less moist. Vaginal secretions that normally lubricate the vaginal wall, particularly noticeable during intercourse, are reduced. The change occurring to the vaginal walls is due to lower levels of the hormone estrogen. Lowered estrogen leads to increased levels of pH and a chain-reaction involving a less acidic environment and noticeable alterations to the vaginal epithelium. This results may result in one or more of the following:
- Vaginal dryness or discomfort through itchiness, soreness, burning in the vaginal area, often noticed during penetrative sexual intercourse
- Pain during sex (“dyspareunia”), either persistent or recurrent before, during, or after sex
- Deep Dyspareunia refers to pain from deep vaginal penetration
- Urinary Tract Infections we have covered this topic in more detail here.
The various vulvar and vaginal symptoms are also referred to as VVA or “vulvar and vaginal atrophy” and may result in or contribute to a low sexual desire (lowered libido). Which makes sense, because who would want to have sex when it hurts? We have written more on the topic of lowered Libido here, but please please know that sex should NEVER be painful. If it is, or if you are experiencing any other symptom related to a change in your vaginal comfort (such as itchiness, dryness, burning feeling, soreness, stinging), please consult a medical professional. These symptoms are very common during this phase of your life and there are effective treatments that will help return things to normal quickly. Having a positive sex life and vaginal comfort are important for a woman, regardless of her age.
Other impacted areas
The primary area of concern when considering the amplification of menopausal symptoms stemming from VVA is sexual enjoyment. A study of menopausal women suffering from VVA symptoms indicated that 59% also experienced a decrease in their enjoyment of sex. VVA symptoms interfered with quality of sleep (24% of women studied), inhibited the enjoyment of normal activities (23%), and negatively affected a woman’s mood (23%).
Any symptoms suffered which involve our genitalia or reproductive areas can cause correlated struggles in normal sexual experiences. As these matters are often private and not discussed, there is a danger of amplifying conditions if initial symptoms are left untreated. It is important to realize the chain-reaction effect from physical symptoms which could impact your enjoyment of typical and common sexual satisfaction. Aside from our libido’s operation and the reality of sexual pleasure, sex activates positive neurotrasmitters and provides extensive physiological and psychological benefits. If any of your menopausal symptoms are interfering with your normal enjoyment of sexual activity, it is important to address your underlying symptoms with appropriate treatment so you can quickly regain your complete quality of life.
Diagnosis
Testing and diagnosis for VVA is performed through self-reporting assessments. When you meet with your healthcare professional, it is wise to note any changes to your body, emotions, relationships, or daily activities that you have noticed recently. This information will help your doctor to accurately diagnosis symptoms of a clinical nature and will allow for treatment options that encompass all of the menopause effects your body’s lowered hormone levels are triggering. All of our bodies are different and, like the onset of menstruation in our teen years, our ability to conceive during our reproductive years, and our experiences of menstrual pain, each woman’s menopausal symptoms and experience are slightly different.
Possible triggers or risk factors
“Vaginismus” is a medical term referring to physiological reactions a woman may experience due to fear of vaginal penetration. Specifically, the vaginal muscles tighten involuntarily and can not be controlled. Vaginismus can occur even if a woman has previous vaginal penetration without problematic muscle response.
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Treatments & remedies
There are several treatment options available, and the good news is that treatment of VVA symptoms is often possible through the self-application of simple and topical medic
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Nutrition
There are no known dietary treatments for VVA symptoms. Women experiencing recurrent UTIs have found benefit in using cranberry extract (note that cranberry juice is high in sugar and not recommended), but the scientific evidence for this is weak and inconclusive at best.
Exercise
Exercise has a positive impact on physical and mental wellbeing during menopause. Specifically for VVA symptoms, regular participation in yoga activities and a focus on Kegel pelvic-floor exercises are beneficial. Kegel exercises, in combination with vaginal dilators and cognitive behavioral therapy (CBT) has been found to reduce involuntary tensing of the vaginal muscles (“vaginismus”) that sometimes accompanies VVA symptoms, particularly when dyspareunia (pain during intercourse) is present.
Mindset
A healthy lifestyle promotes optimal, overall health. Maintaining an advisable weight and participating in regular exercise are important menopausal considerations.
Participating in sexual activities as often as you feel able has health benefits and releases important neurotransmitters in a woman’s brain. Women who participate in regular sexual activity show lower blood pressure, improved immune system operations, improved cardiovascular health, higher levels of self-esteem, better quality sleep, increased feelings of intimacy and connection in valued relationships, reduction in life stress levels, and increased enjoyment of pleasurable feelings.
Supplements
- DHEA supplements contain natural hormones (dehydroepiandrosterone). Topically-applied hormones interact with your body’s estrogen and testosterone levels through ingested or cream-based products. It is important to consult with a medical professional before using DHEA supplements.
- A study of women in post-menopause found that oral consumption of sea buckthorn oil supplements resulted in an improvement in the women’s vaginal epithelium. Sea buckthorn oil may be an effective alternative for women who are unable to use hormonal treatments.
OTC Products
There are several over-the-counter products available to help relieve the symptoms of VVA. As a first treatment, many women choose to use lubricants during intercourse. Alternatively, any sexual stimulant that increases a woman’s arousal will improve the secretion of natural moisture. For some women this is enough, but for many others it is not. Don’t be discouraged if this doesn’t work for you, there are plenty of other treatment options available.
- Vaginal dilators and internal vibrators have been found to produce medically quantifiable results for women suffering from vaginismus and should not be considered a taboo treatment alternative.
- Vaginal moisturizers are also available. Through consistent (multiple times each week) application of vaginal hyaluronic acid (for example, Vagisil Prohydrate External Hydrating Gel), women experience a reduction in vaginal dryness and its associated symptoms. Natural vaginal moisturizers also include unrefined coconut oil and Vitamin E oil.
- Chamomile vaginal gel. Although additional research is required, recent studies have shown that consistent usage of chamomile vaginal gel can have a positive effect for post menopausal women experiencing vaginal athrophy (dryness) and dyspareunia (pain during sexual intercourse)
- Vaginal probiotic supplements including pills and suppository capsules that are inserted into the vagina using an applicator, are quite popular amongst women in this age group. Despite manufacturers making efficacy claims, clinical research supporting these claims is virtually nonexistent. However, taking them can’t hurt and may help. Look for probiotics containing the bacteria Lactobacillus rhamnosus and Lactobacillus reuteri.
Vaginal stimulants, lubricants, and moisturizers can be used in tandem with hormonal treatment options.
Prescription
Ospemifene is an estrogen receptor agonist/antagonist (selective estrogen receptor modulator, SERM) used in the treatment of vulvar and vaginal atrophy. It has a unique non-hormonal composition and may be effective for women suffering from low libido symptoms concurrent with other vaginal conditions related to menopause.
Hormone Treatment
VVA symptoms are often treated with localized vaginal estrogen replacement therapy. This is a hormonal replenishment treatment (Hormone Replacement Therapy “HRT”) that provides topical application of estrogen following naturally lowered levels of hormone production during menopause. Localized HRT involves a low-dose of estrogen and is prescribed in cream, ring, or tablet form. Effectiveness of vaginal estrogen treatments can take up to 3 months and more than one type of HRT application may be necessary simultaneously (i.e. internal application by one method and external genitalia application by another). Systemic HRT - taken orally or transdermally - is also usually effective in treating VVA.
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FAQ
Should I go to the doctor for vaginal dryness?
Absolutely. A recent study (2021) found that 66% of the women do not discuss the impact of their symptoms on sexuality with their gynecologist. Menopausal symptoms involving your vagina will not resolve themselves spontaneously. It is important that you discuss what you are experiencing with a trusted healthcare professional who can provide treatment options. Once treated, you will experience relief from symptoms and will ensure that symptom compounding does not occur.
Is vaginal dryness common?
Yes vaginal dryness is very common with about 55% of women reporting the symptom, usually during the later stages of peri-menopause and in post menopause.
What causes vaginal dryness
During peri-menopause, the walls of the vagina will become thinner and less moist. Vaginal secretions that normally lubricate the vaginal wall, particularly noticeable during intercourse, are reduced. The change occurring to the vaginal walls is due to lower levels of the hormone estrogen. Lowered estrogen leads to increased levels of pH and a chain-reaction involving a less acidic environment and noticeable alterations to the vaginal epithelium (the inner lining of the vagina).
What are the symptoms of Menopause?
There are roughly 34 symptoms of Menopause with the most commonly experienced being:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Fatigue
- Sleep problems
- Mood changes and irritability
- Weight gain
- Thinning hair and dry skin
Medically reviewed and detailed symptom fact sheets can be found here, and a general overview of what (peri) menopause is and entails can be found here.
References
Baquedano Mainar L, Sánchez Méndez S, Dieste Pérez P, Hernández Aragón M, Mendoza Ladrón de Guevara N; COMEM Study Spanish investigators. Women's knowledge about the genitourinary syndrome of menopause: adherence to its treatments in the COVID-19 era in a sample of them: COMEM-GSM study. BMC Womens Health. 2021 Nov 30;21(1):398. doi: 10.1186/s12905-021-01548-2. PMID: 34847892; PMCID: PMC8631561.
Bosak Z, Iravani M, Moghimipour E, Haghighizadeh MH, Jelodarian P, Khazdair MR. Evaluation of the influence of chamomile vaginal gel on dyspareunia and sexual satisfaction in postmenopausal women: A randomized, double-blind, controlled clinical trial. Avicenna J Phytomed. 2020 Sep-Oct;10(5):481-491. PMID: 32995326; PMCID: PMC7508318.
Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013 Jul;10(7):1790-9. doi: 10.1111/jsm.12190. Epub 2013 May 16. PMID: 23679050.
Krychman M, Graham S, Bernick B, Mirkin S, Kingsberg SA. The Women's EMPOWER Survey: Women's Knowledge and Awareness of Treatment Options for Vulvar and Vaginal Atrophy Remains Inadequate. J Sex Med. 2017 Mar;14(3):425-433. doi: 10.1016/j.jsxm.2017.01.011. Epub 2017 Feb 12. PMID: 28202319.
Liu JH, Bernick B, Mirkin S. Estradiol softgel inserts for the treatment of VVA symptoms: an expert opinion. Expert Opin Drug Deliv. 2020 Nov;17(11):1573-1581. doi: 10.1080/17425247.2020.1810662. Epub 2020 Sep 2. PMID: 32877254.
Nall, R. M. (2019, September 11). What Causes Vaginal Dryness? Healthline.
Peters KJ. What Is Genitourinary Syndrome of Menopause and Why Should We Care? Perm J. 2021 May;25:20.248. doi: 10.7812/TPP/20.248. PMID: 33970091; PMCID: PMC8817901.
The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020 Sep;27(9):976-992. doi: 10.1097/GME.0000000000001609. PMID: 32852449.
Zahra Bosak, Mina Iravani, Eskandar Moghimipour, Mohammad hosein Haghighizadeh, Parivash Jelodarian, Effect of Chamomile Vaginal Gel on the Sexual Function in Postmenopausal Women: A Double-Blind Randomized Controlled Trial, The Journal of Sexual Medicine, Volume 19, Issue 6,
2022, Pages 983-994, ISSN 1743-6095, https://doi.org/10.1016/j.jsxm.2022.03.536.
Vaginal Symptoms
“Genitourinary syndrome of menopause” (GSM) is the umbrella medical term for vaginal, vulvar, and urinary symptoms occurring during menopause. Increased UTIs and vaginal dryness usually begin in the later stages of peri-menopause and tend to become more pronounced during post-menopause. Of post-menopausal women, 58% report symptoms of genitourinary syndrome. Some women experience only mild discomfort, while others suffer from painful penetration during sexual intercourse, difficulty walking, and itchiness in their vaginal area.
50% of post menopausal women experience vaginal symptoms
Women may find discussing these types of symptoms difficult and menopausal vaginal health problems are often under-diagnosed and under-treated. A recent study (2021) found that 66% of the women do not discuss the impact of their symptoms on sexuality with their gynecologist. Menopausal symptoms involving your vagina will not resolve themselves spontaneously. It is important that you discuss what you are experiencing with a trusted healthcare professional who can provide treatment options. Once treated, you will experience relief from symptoms and will ensure that symptom compounding does not occur.
Dr. June Tan Sheren
Why this is happening
During peri-menopause, the walls of the vagina will become thinner and less moist. Vaginal secretions that normally lubricate the vaginal wall, particularly noticeable during intercourse, are reduced. The change occurring to the vaginal walls is due to lower levels of the hormone estrogen. Lowered estrogen leads to increased levels of pH and a chain-reaction involving a less acidic environment and noticeable alterations to the vaginal epithelium. This results may result in one or more of the following:
- Vaginal dryness or discomfort through itchiness, soreness, burning in the vaginal area, often noticed during penetrative sexual intercourse
- Pain during sex (“dyspareunia”), either persistent or recurrent before, during, or after sex
- Deep Dyspareunia refers to pain from deep vaginal penetration
- Urinary Tract Infections we have covered this topic in more detail here.
The various vulvar and vaginal symptoms are also referred to as VVA or “vulvar and vaginal atrophy” and may result in or contribute to a low sexual desire (lowered libido). Which makes sense, because who would want to have sex when it hurts? We have written more on the topic of lowered Libido here, but please please know that sex should NEVER be painful. If it is, or if you are experiencing any other symptom related to a change in your vaginal comfort (such as itchiness, dryness, burning feeling, soreness, stinging), please consult a medical professional. These symptoms are very common during this phase of your life and there are effective treatments that will help return things to normal quickly. Having a positive sex life and vaginal comfort are important for a woman, regardless of her age.
Approximately 50% of post-menopausal women experience one or more symptoms of VVA.
Other impacted areas
The primary area of concern when considering the amplification of menopausal symptoms stemming from VVA is sexual enjoyment. A study of menopausal women suffering from VVA symptoms indicated that 59% also experienced a decrease in their enjoyment of sex. VVA symptoms interfered with quality of sleep (24% of women studied), inhibited the enjoyment of normal activities (23%), and negatively affected a woman’s mood (23%).
Any symptoms suffered which involve our genitalia or reproductive areas can cause correlated struggles in normal sexual experiences. As these matters are often private and not discussed, there is a danger of amplifying conditions if initial symptoms are left untreated. It is important to realize the chain-reaction effect from physical symptoms which could impact your enjoyment of typical and common sexual satisfaction. Aside from our libido’s operation and the reality of sexual pleasure, sex activates positive neurotrasmitters and provides extensive physiological and psychological benefits. If any of your menopausal symptoms are interfering with your normal enjoyment of sexual activity, it is important to address your underlying symptoms with appropriate treatment so you can quickly regain your complete quality of life.
Diagnosis
Testing and diagnosis for VVA is performed through self-reporting assessments. When you meet with your healthcare professional, it is wise to note any changes to your body, emotions, relationships, or daily activities that you have noticed recently. This information will help your doctor to accurately diagnosis symptoms of a clinical nature and will allow for treatment options that encompass all of the menopause effects your body’s lowered hormone levels are triggering. All of our bodies are different and, like the onset of menstruation in our teen years, our ability to conceive during our reproductive years, and our experiences of menstrual pain, each woman’s menopausal symptoms and experience are slightly different.
Possible triggers or risk factors
“Vaginismus” is a medical term referring to physiological reactions a woman may experience due to fear of vaginal penetration. Specifically, the vaginal muscles tighten involuntarily and can not be controlled. Vaginismus can occur even if a woman has previous vaginal penetration without problematic muscle response.
Treatments & Remedies
There are several treatment options available, and the good news is that treatment of VVA symptoms is often possible through the self-application of simple and topical medic
Products
- DHEA supplements contain natural hormones (dehydroepiandrosterone). Topically-applied hormones interact with your body’s estrogen and testosterone levels through ingested or cream-based products. It is important to consult with a medical professional before using DHEA supplements.
- A study of women in post-menopause found that oral consumption of sea buckthorn oil supplements resulted in an improvement in the women’s vaginal epithelium. Sea buckthorn oil may be an effective alternative for women who are unable to use hormonal treatments.
There are several over-the-counter products available to help relieve the symptoms of VVA. As a first treatment, many women choose to use lubricants during intercourse. Alternatively, any sexual stimulant that increases a woman’s arousal will improve the secretion of natural moisture. For some women this is enough, but for many others it is not. Don’t be discouraged if this doesn’t work for you, there are plenty of other treatment options available.
- Vaginal dilators and internal vibrators have been found to produce medically quantifiable results for women suffering from vaginismus and should not be considered a taboo treatment alternative.
- Vaginal moisturizers are also available. Through consistent (multiple times each week) application of vaginal hyaluronic acid (for example, Vagisil Prohydrate External Hydrating Gel), women experience a reduction in vaginal dryness and its associated symptoms. Natural vaginal moisturizers also include unrefined coconut oil and Vitamin E oil.
- Chamomile vaginal gel. Although additional research is required, recent studies have shown that consistent usage of chamomile vaginal gel can have a positive effect for post menopausal women experiencing vaginal athrophy (dryness) and dyspareunia (pain during sexual intercourse)
- Vaginal probiotic supplements including pills and suppository capsules that are inserted into the vagina using an applicator, are quite popular amongst women in this age group. Despite manufacturers making efficacy claims, clinical research supporting these claims is virtually nonexistent. However, taking them can’t hurt and may help. Look for probiotics containing the bacteria Lactobacillus rhamnosus and Lactobacillus reuteri.
Vaginal stimulants, lubricants, and moisturizers can be used in tandem with hormonal treatment options.
Ospemifene is an estrogen receptor agonist/antagonist (selective estrogen receptor modulator, SERM) used in the treatment of vulvar and vaginal atrophy. It has a unique non-hormonal composition and may be effective for women suffering from low libido symptoms concurrent with other vaginal conditions related to menopause.
Lifestyle
There are no known dietary treatments for VVA symptoms. Women experiencing recurrent UTIs have found benefit in using cranberry extract (note that cranberry juice is high in sugar and not recommended), but the scientific evidence for this is weak and inconclusive at best.
Exercise has a positive impact on physical and mental wellbeing during menopause. Specifically for VVA symptoms, regular participation in yoga activities and a focus on Kegel pelvic-floor exercises are beneficial. Kegel exercises, in combination with vaginal dilators and cognitive behavioral therapy (CBT) has been found to reduce involuntary tensing of the vaginal muscles (“vaginismus”) that sometimes accompanies VVA symptoms, particularly when dyspareunia (pain during intercourse) is present.
A healthy lifestyle promotes optimal, overall health. Maintaining an advisable weight and participating in regular exercise are important menopausal considerations.
Participating in sexual activities as often as you feel able has health benefits and releases important neurotransmitters in a woman’s brain. Women who participate in regular sexual activity show lower blood pressure, improved immune system operations, improved cardiovascular health, higher levels of self-esteem, better quality sleep, increased feelings of intimacy and connection in valued relationships, reduction in life stress levels, and increased enjoyment of pleasurable feelings.
Holistic
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