One of the most frustrating problems women face in menopause is vaginal dryness. Vaginal dryness in very common, almost universal. Vaginal secretions largely come from the blood vessels in the tissue beneath the vaginal wall. These vessels are estrogen receptive, so when estrogen levels drop at menopause, the blood vessels diminish and so do secretions. So, even with sexual excitation, lubrication is much decreased. Many women find that intercourse becomes very painful, and many women stop having vaginal penetration. This is a big loss for many couples, and may adversely affect a relationship.
Women may think this is abnormal, but it is not. Some women do not feel comfortable discussing this with their doctors. Please don’t be shy. You are not alone, and there are many avenues to treat this problem. Many types of vaginal lubricants are available over-the-counter and are used each time a couple has intercourse. Even with lubricants, some women experience a burning type of pain with intercourse. This is due to the thinning of the vaginal walls, another result of the lack of estrogen. Topical estrogen can be applied to the vagina, with minimal systemic absorption, and is very safe for most women. For those who do not have an adequate result, sometimes systemic hormone therapy can be used, especially in patients who may have other reasons to take hormones.
There still remain women who do not respond to any of these treatments, or prefer or cannot use estrogen. I learned about a vaginal laser treatment in 2014, when it had just been introduced to the U.S. Developed in Italy, Dr. Salvatore of Milan experimented with using a laser in animal models and found marked changes in the vaginal tissue after using a fractioned carbon dioxide laser. Dermatologists had been using this treatment for about 25 years on the skin, to diminish wrinkles and rejuvenate the face.
The procedure which he developed uses a laser to penetrate the vaginal and vulvar tissue in little dots that penetrate the vaginal skin and beneath it. The laser energy is interpreted by the tissue as an injury, and the response to the injury is repair. Biopsies before and after the laser treatments demonstrated that the blood vessels grew back, and collagen and elastic fibers were formed. This left the vaginal tissue much closer to the premenopausal state. Patients noted much more lubrication and more comfort with intercourse. Some patients note a decrease in urinary tract infections, and less discomfort of the vulva, the external genitalia.
The procedure is performed in the doctor’s office, takes less than 10 minutes, and is painless.
There is some mild discomfort after the procedure, likened to a mild sunburn, which usually lasts only a couple of hours, Three treatments six weeks apart are recommended initially, and one touch-up treatment is usually performed yearly after that. The initial studies in Italy demonstrated a 90% satisfaction rate. There are virtually no serious complications. It is great to have one more treatment in our “tool box” to treat this very difficult problem.
Marilyn Jerome, M.D.