When it’s dry as the Sahara Desert down there, you are in need of some major water. In the case of the vagina, water doesn’t come from a bucket or a well but from estrogen. Think of estrogen as a hose. Without a hose, you have no water, and without water, you are going to face a drought. And as we have all seen on the news or lived through in real life, droughts are not fun. As a result, vaginal dryness is not just a pesky problem but rather a major pet peeve. It can cause pain, bleeding, itching, daily discomfort, and urinary symptoms (infections and incontinence). Here’s how to get the water flowing again.
Vaginal dryness is best treated with vaginal estrogen…seems intuitive, right? If you have a fire, pouring water on it is the best way to put it out. Vaginal estrogen comes in creams, rings, and tablets. They are placed, in one of these three forms, into the vagina and deliver a low dose of estrogen directly to the vaginal tissue. While the doses and composition may vary, most of the vaginal estrogens function in a similar way. Going back to our fire reference, when you pour water on a fire, the water doesn’t typically spread. It does its job on those flames only. Vaginal estrogen is not absorbed into the bloodstream (like oral estrogen); therefore, the hormonal effects on other parts of the body (think breast, ovarian, uterus, etc.) are very small. The limited spread of vaginal estrogen makes it appealing too many.
On the flip side, if you are experiencing both vaginal dryness and hot flashes you should start searching for a wider and bigger hose. Vaginal estrogen can’t put out those fires, and they can be hot! In these cases, oral estrogen or an estrogen patch is the better way to go.
While vaginal dryness is no joke, it’s particularly unfunny in women who have or have had a history of an estrogen-sensitive cancer. In such situations, using estrogen, be it oral or vaginal, can be risky and somewhat taboo. Therefore, OB/GYNs usually like to start twisting the faucet by using non-hormonal approaches. Some of these include vaginal moisturizers, vaginal lubricants, and topical anesthetics. And while they are not estrogen, they are pretty good at temporizing the torrid situation. When they don’t and the dryness is debilitating, we must look for other options. In select cases, even in women with estrogen-sensitive cancers, we will give vaginal estrogen a go for a short period of time.
Anything that impacts your quality of life should sound the sirens. You shouldn’t live in pain. We may not put the fire out on the first try, but we have many other firehouses and engines that we can call for back up. If you sound the sirens, we will find a way to put it out!