Is your vagina happy? PMDD treatment and vaginal dryness

Is your vagina happy?

WARNING – this blog contains the words vagina, discharge, and the dreaded one; moist! Enter at your peril!

For reasons that can probably be attributed to the deep rooted societal conditioning where women are considered uncivilised for discussing their intimate health, we often find ourselves too embarrassed to talk about how our vaginas feel.

Where menopausal or hormonally supressed women will openly discuss and seek medical support for symptoms such as hot flushes, night sweats and sleep disturbances we are much less likely to reach out for support with all things vagina related. Even I, who as a practising midwife has no qualms in asking other women about their intimate health find myself to be the shrinking violet when it comes to talking about my own vagina.

As naturally occurring oestrogen reduces or stops entirely, your vagina loses its ability to remain naturally moist and lubricated. In turn the tissues become less elastic, loose their strength and become thinner. This is known as vaginal atrophy and can occur in up to 40% of menopausal women (Portman 2014). Vaginal atrophy is a sneaky beast that can cause a whole array of physical unpleasantness that we need to start talking about (Bachman, 2016; NHS, 2018; YES, 2018) Our vaginas can become very sore, itchy and inflamed, our need to pass urine can increase, sex can become painful and some women may even experience bleeding after intercourse as the superficial tissue layer inside the vaginal canal can tear due to very much unwanted friction!

The challenge for women who are living with a premenstrual disorder lies where they find themselves in a position where they need to supress their ovaries. Not every woman who has such a condition needs to have such a therapy, but where is it the case, there needs to be a discussion about how to ensure ongoing vaginal health. Understandably it wouldn’t be at the forefront of the woman’s mind.

I speak from personal experience here, where I know my vaginal lubrication didn’t even feature on my list of concerns when undergoing treatment for my Pre-menstrual Dysphoric Disorder (PMDD).  I personally opted to undergo a total vaginal hysterectomy with bilateral oophorectomy. This means that my ovaries were removed along with my uterus and cervix with a vaginal cuff creating the end of my vaginal canal. After about six months, I found sexual intercourse to be increasingly unpleasant, with a burning sensation continuing for several days. I also started to experience vaginal thrush and my labia minora was frequently red and sore. Too much information? Feeling uncomfortable? Good! I’m challenging our societal conditioning here, in the hope that I can make those other 4 in 10 women experiencing the same thing feel less alone and isolated!

The good news is that companies are starting to sit up and listen and there are now a variety of treatment options for this particularly unpleasant side effect of my PMDD therapy. Firstly, hormone replacement therapy (HRT) will help to improve the situation, but I am mindful that this is not always an option for every woman. Again, from a personal perspective, my tolerance of oestrogen is relatively low, so my prescribed dosage of HRT lessens my symptoms, but does not resolve them entirely.

To compliment any HRT, one option is to use a vaginal moisturiser regularly. We use face and hand cream, so why shouldn’t we treat our most intimate tissues with the same due regard? The challenge is that many of these products contain artificial oestrogen. One of the more exciting products available is the YES vaginal moisturising range as it is organic, Ph balanced, free from hormones and carries the seal of approval from Nick Panay:

 In my capacity as a Consultant Gynaecologist with a special interest in premature menopause, I see many women suffering from menopausal vaginal atrophy. Based on my professional experience of such products, and the feedback from my patients I can say without hesitation that the YES range proves to be the one of the most successful in combating the discomfort of dryness. I have confidence that its natural formulation affords effective re-moisturisation, while treating sensitive tissues with great gentleness. – Mr Nick Panay BSc MBBS MRCOG MFSRH – Director of the West London Menopause and PMS Centre

A vaginal moisturiser soothes and rehydrates our vaginal tissues so that they can become lubricated and healthy. A moisturised vagina is stronger and more able to fight bacterial and fungal infections, and is more supply and better able to stretch during sexual intercourse.

So how is your vagina today? Is she happy? Or does she need a bit of tlc? If she does, have you simply not given it much thought? Or have you been hiding her under a bush? Sorry couldn’t resist! If you are menopausal, peri-menopausal or having any form of hormone suppressive therapy you need to give your vagina some one-to-one attention. In fact I challenge you to speak to another woman in your life and ask her about how her vagina is. Irrelevant of what stage of menstrual health we are in we must start to take more accountability for our intimate wellbeing and not be afraid to speak up. My vagina suffered in silence for far too long – but now I can confidently say; “I have a happy vagina” – can you?

Resources and references:

Bachman G, et al. (2016) Clinical manifestations and diagnosis of vaginal atrophy

Healthline (2018) Postmenopausal atrophic vaginitis

International Association for Premenstrual Disorders

Mayo Clinic (2018) Vaginal Atrophy

My Menopause Doctor (2018) Vaginal Dryness Factsheet

NHS (2018) Menopause

NHS (2018) Vaginal Dryness

Portman DJ, et al. (2014) Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Menopause. 2014;21:1063.

YES (2018) Menopausal Dryness.

YES is sponsoring the PMDD & Me 2019 conference and is available to offer support and advice surrounding vaginal health to those women undergoing hormone suppression therapy.