I recently bought some feminine hygiene products from a company called Sustain Natural. They make condoms, tampons and pads that are organic and non-toxic and delivered to your door! My box arrived with a little purple card inside that said, “Vaginas Matter.” YES, I thought, they do! Rarely do we talk about vaginal health as we age, but today we’re gonna do it.
Women in my practice fill out symptom questionnaires for me when they come in for their annual physical exams, and more than 50% have concerns about low libido. When I press further, much of the time the libido is related to vaginal discomfort or pain during intercourse. Vaginal changes are incredibly common as hormones shift in perimenopause and menopause. Some women sail through without a problem, but most women have concern.
Estrogen is the key player for vaginal tissue. It keeps the tissue elastic or stretchy, well lubricated and plays an important role in maintaining the strength of the muscles that support the vagina (the pelvic floor). As Estrogen starts to decline with age (typically in a woman’s 40s), the vagina loses much of its lubrication and stretch power and pelvic floor muscles get weaker. Without treatment, these symptoms can worsen, making sex downright painful and for some women, impossible. It can also increase your risk for vaginal and urinary tract infections.
We don’t want that to happen! What can we do?
Vaginal lubricants
There are a few oils that can improve vaginal tissue integrity or health. None of these oils are safe to use with Latex condoms, as they may degrade the latex (not great; remember you can still get pregnant in perimenopause!).
* Vitamin E—try using 400IU of Vitamin E vaginally each night for 2 weeks and then 2-3x per week thereafter. You can use softgels (pierce them with a clean needle to allow the oil to release quicker) or find a liquid from a brand like Carlson’s.
* Coconut Oil—this oil loves the vagina! I have many women that use it as a lubricant during sex. It also has a healing effect on the tissue and can be used in the same way as Vitamin E—every night for 2 weeks, and then 2-3/week thereafter. Coconut oil is messy. A patient pointed me in the direction of this clever website which helps you make your own coconut oil suppositories: www.luckyvagina.com
* CBD—I’ve mentioned CBD in prior posts as a tool to improve sleep when used orally. This amazing oil is also available to use vaginally and will improve libido, lubrication and orgasm. It also reduces anxiety and pain. You use this as needed, or when you are going to have sex. It’s amazing stuff! The brands I recommend are “Bond Oil” and “Velvet Swing” (I know, the names…). In Washington State, you can find one or both of these at most of the Cannabis dispensaries around. Outside of our beautiful state, Privy Peach is a great option.
Vaginal Hormones
* Estrogen
This is the most important hormone for vaginal tissue and is often recommended as a treatment to improve symptoms caused by low levels (things like painful sex and frequent UTIs). The most common form of estrogen prescribed is Estradiol, but Estriol is also available. These are prescription medications that come in creams, tablets and a ring. Dosing depends on the type you use. Several strengths are available.
* DHEA
Some women are not good candidates for estrogen therapy (for example, women who have had certain types of cancers or who have a strong family history of certain cancers). DHEA can be a safer alternative. It is a precursor hormone to both estrogen and testosterone, and when used vaginally, can have similar effects to the tissue as estrogen. It also improves libido in many women (bonus!). It does not increase estrogen systemically, it’s effects are localized to the vagina. This hormone is typically prescribed and compounded into a cream or suppository.
Vaginal Tools
These tools are awesome, as many women do not find benefit from the lubricants and can’t tolerate or don’t want hormone treatments
* Vaginal Weights…Wait, What? Yes, there are various weights available whose purpose is to strengthen the pelvic floor muscles. When these muscles are weak, women notice less sensation during sex and often some urinary incontinence. Options here are the Intimate Rose system of weighted tampons or Kegel Balls (also called Ben Wa Balls). There are many different styles of Kegel balls available, and most adult toy stores have several (we like Babeland in Seattle). If you choose the weighted tampons, you use these daily for 15 minutes and advance through the increasing weights as you get stronger.
* Vfit+
This is a vaginal device that uses a combination of red light LEDs and light vibrational therapy to stimulate healing of the vaginal tissue, restore normal cell function and decrease pain and inflammation. The vibration also recruits and strengthens the pelvic floor muscles. It is used at home several times per week for 8 weeks and then weekly for maintenance. The success rates for this device are incredible: 89% of women experienced more confidence and improved sensation with sex after the 8 week period. I have one patient noticing these benefits after 3 weeks! This device is only available in physician offices. Here’s a link to more info. We now have this available at the clinic! I’m happy to talk to you more about this in person or via a telemedicine visit.
* Pelvic Floor PT
Usually when I recommend this therapy, women are dumbfounded that it is actually a “thing”. These very important, typically female, physical therapists are skilled at identifying and treating pelvic floor issues that may be making sex painful. This is particularly helpful after childbirth or pelvic surgery. Typically, a physician refers you to one of these specialists after you’ve discussed if it’s a good option for you.
What I’ve learned from working with women is that our bodies are high maintenance. It takes a lot of work to feel good! We have to eat well, move often, get good rest, brush and floss…ugh. Our vaginas also need their own maintenance, if we want to prevent common infections and maintain a long and healthy sex life.
Want to chat more about your own personal struggles and which of these options may be the best for you? Call the office to make a phone or in-person visit. My practice is open to new patients again. Please tell your girlfriends!
Do you have a favorite vaginal treatment that wasn’t mentioned? Please let me know so I can share with other women! You can send me a private email to [email protected].
I love that Dr. McCarty isn’t afraid to talk about these types of topics and I am so glad she is my PCP. With her help and by my side, I know perimenopause will be manageable. I already made the little coconut oil vaginal heart-shaped suppositories and ordered the Intimate Rose system. Vaginas matter!!!