There comes a point in time when our body starts to produce less estrogen and with that, vaginal atrophy can occur.
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If you are facing vaginal atrophy problems due to menopause, breastfeeding, or simply because you are taking oral contraceptives, do not suffer in silence. We interview Dr Stefan Salvatore to find out more about vaginal atrophy and what are the ways you can deal with it.
1. What exactly is vaginal atrophy? Does it just mean dryness in the vagina?
Vaginal atrophy is a condition secondary to a significant drop of circulating estrogens when its production is reduced or stopped by the ovary. This can physiologically happen after menopause but it may also occur in other situations, such as during breast feeding and in 20-30% of women taking oral contraceptives or as a secondary adverse effect of treatments for breast cancer. The concerns related to vaginal atrophy certainly include vaginal dryness but also some other important symptoms such as vaginal burning/itching, painful sexual intercourses (dyspareunia), a feeling of vaginal laxity in some cases and the increased likelihood to develop vaginal and urinary infections.
2. Why does vaginal atrophy happen?
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Vaginal atrophy is the consequence of a significant reduction of circulating estrogens. These are produced by the ovaries that, in proximity of menopause (mean age in developed countries between 42 and 54 years old), progressively lose this function. Estrogens are very important factors in maintaining “youth” in different parts of women’s body. In the vaginal tissues, they are important for the following reasons:
- They stimulate a constant turn-over in the production of good collagen and elastic fibers,
- They determine the production of glycogen that is the most important factor for a normal vaginal lubrication and for a normal vaginal acidity. The reduction in glycogen production in the vaginal canal, in fact, modifies the vaginal acidity (pH) that becomes more alkaline. As a result, there is a reduction in Lactobacilli, that are “good bacteria” colonising the vaginal canal and creating a natural defence barrier against the “nasty bacteria”. For this reason, there is an increased risk of developing vaginal and urinary tract infections.
3. Will topical creams or moisturizer ease the discomfort? Any oral medications available to treat this?
Topical estrogen creams /vaginal tablets are certainly very effective in treating vaginal atrophy, even more than oral. Despite the efficacy and safety profile of local estrogens, the long term usage of this treatment is not very good. Generally, women do not like taking hormones pills and some women with a history of breast cancer or other neoplastc conditions responsive to estrogens cannot use them. Topical creams, lubricants and moisturisers are recognised therapies for alleviating vaginal atrophy symptoms. However, they can certainly help, particularly in ensuring a better sexual life, but they do not restore the changes determined by the condition. A recent oral preparation of a new selective estrogen receptor modulator (a molecule that can act as an estrogen in some part of the body and as a non-estrogen in some others) has shown good efficacy and safety data for the treatment of vaginal atrophy.
4. We heard about the laser treatment, MonaLisa Touch®. How does it help patients who are affected by vaginal atrophy?
MonaLisa touch is an office procedure performed with a CO2 laser. This type of laser has the capability to regenerate tissues in the skin as well as in the vagina. This process will help to generate an increase in the vaginal wall thickness with an increase in collagen and elastic fibres, a greater content of water, an increase of lubrication and a restoration of the normal vaginal acidity with an increase in Lactobacilli. In other words, MonaLisa touch is able to regenerate a vaginal tissue similar to one in a young woman. The results include a significant reduction in vaginal dryness and pain during sexual intercourse, a reduction in urinary symptoms including incontinence and urinary tract infections. There are non-contraindications to MonaLisa touch although it should not be performed in the case of a vaginal or urinary tract infection. These conditions, in fact, should be treated first and then MonaLisa could be performed. This office procedure does not require any kind of preparation or pain killers. The only precaution is to avoid sexual intercourse for the 3 days after the procedure. The treatment usually consists of 3 sessions performed with a distance of 30 days one after the other. Its duration is generally one year.
5. One important question that many of us want to know. Does the MonaLisa Touch® treatment hurt? Is numbing cream used?
MonaLisa Touch is an office procedure that does not require any anaesthesia or any analgesia. It is completely painless and well-tolerated. No cream, gel or lubricant is used because it can interfere with laser absorption, making the procedure less effective. However, because of the absence of pain during the procedure, it is also unnecessary to do so.
6. Any downtime for the MonaLisa Touch® treatment?
The MonaLisa Touch procedure includes for postmenopausal atrophy a cycle of three treatments with an interval of 30-40 days between procedures. The duration of the treatment is, as average, one year since the first treatment. The only precaution is to avoid sexual intercourses for the 3 days after the procedure.
7. Will our diet worsen or improve vaginal atrophy?
There are some elements in diet that can alleviate the symptom of vaginal dryness.
8. If it does, any diet tips for ladies who are affected by it?
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Foods that include phytoestrogens can improve symptoms of vaginal atrophy. Phytoestrogens are plant-based, natural estrogen replacements. The foods where we can find phytoestrogens are: soybeans, soy milk, fermented soy products, tofu, flaxseed and flaxseed oil, and red clover. Additionally, phytoestrogens are present in cherries, legumes, apples, nuts and seeds, although not in quantities as high as those found in soy products.
Vitamin E can also improve symptoms of vaginal dryness. Vitamin E can be found in nuts, seeds and nut butters, avocados and all vegetable oils including wheat germ oil.