Vaginal dryness in menopause

By Lee Hye-jun

Samantha is a beautiful 55-year-old lady. She looks 10 years younger than her friends and maintains good health with regular check-ups. Recently, she faced a problem with her husband. She had pain during sexual intercourse and sometimes vaginal bleeding occurred. But she never discussed the problem with her husband or went to see her gynecologist. She did not want to admit her body was getting old.

After menopause, women experience severe estrogen deprivation. They suffer from hot flashes, unexplained joint pain, night sweats and vaginal dryness. Decreased estrogen induces thinning and loss of elasticity of the vaginal walls and reduction in vaginal lubricating fluid. Approximately half of postmenopausal women report they have vaginal discomforts such as dryness, itching, irritation and pain during intercourse and urination, but fewer women seek medical advice because they are unaware of the problems and the availability of treatment.

Samantha noticed the discomfort began around her menopause four years ago. She assumed it was an inevitable postmenopausal change as women grew older. Although she knew postmenopausal hormonal treatment could improve the discomfort, she refused for fear of potential risks. However, what she had not realized was that she had more than 20 years ahead of her.

The average age of menopause is 51 years and the current life expectancy is around 80 years. Therefore, women live almost 40 percent of their lives in a postmenopausal state. Many menopausal women learn to live with the vaginal discomforts or avoid sexual activity itself. In a study, only 50 percent of women reported to be interested in sex after the age of 50. However, the more sexually active they are, the more blood circulation reaches the vagina and the less vaginal dryness occurs. Menopause should not be considered an end of womanhood, but a transition into a new chapter.

At a regular check-up with her gynecologist, Samantha was surprised to hear there were ways to improve her symptoms other than systemic hormonal treatment. The first treatments of choice for vaginal dryness are vaginal moisturizers and lubricants. Moisturizers stay longer and decrease vaginal dryness effectively. On the other hand, lubricants are temporary and decrease friction during sexual activity. So, lubricants are applied right before sexual intercourse and moisturizers are applied internally on a regular basis.

Unfortunately, Samantha did not respond to the treatment. Her doctor recommended local estrogen therapy that carried relatively low risk of side effects. There were cream, tablets and ring types of vaginal estrogen. Her doctor told her the most important factor for sexual activity for older women was the strong relationship with their partners. Samantha disclosed her problem to her husband during the treatment. Thanks to his emotional support and estrogen therapy, she regained her sex life.

The writer is a doctor at Maria Fertility Hospital in Seoul. For further questions, send an e-mail to the writer at hyejunlee@mariababy.com, call the hospital’s English-speaking coordinator at (02) 2250-5577, or visit the hospital’s website, https://eng.mariababy.com/.