Vaginal dryness and itching are common symptoms for menopausal women. Some doctors disregard the problems as simply being annoying and "part of getting older." But there is help, and you should not take no for an answer. In short, as women approach and move into menopause, ovarian production of estradiol drops dramatically, which causes thinning of the vaginal walls and inflammation. The most direct solution is to use estradiol applied directly to the vagina to correct the deficiency. For some women, vaginal dryness and itching may be the only, or primary symptom. For others, it could be one of many symptoms. In those cases, systemic estradiol, given orally, by patch, cream, or otherwise might be the best solution. Some women might benefit from both systemic and localized estradiol. Your gynecologist can work with you to find the solution best for you.
Unfortunately, some women find that, even after using estradiol, their symptoms of vaginal itching and dryness persist. Here are some other options to consider:
1. Try a different form of vaginal estrogen. Vaginal suppositories and tablets are available in a wide range of doses and formulations because each woman has different needs. There are also estradiol rings that can stay in the vagina for three months. Your doctor can work through this with you to figure out what’s best.
2. Most of the estradiol receptors in the vagina are near the opening. Additionally, there are many nerves and pain receptors located there. Consider using an estradiol cream applied to the opening instead of or in addition to suppositories or a ring. This is also a good solution for vulvar itching.
3. Vaginal DHEA suppositories might help. Unfortunately, it might take as long as 2 months before you see positive results.
4. Switch to a non-irritating soap like Cetaphil or CereVe. The perfumes and dyes in some soaps, even the ones you used most of your life until now, might now be irritating. You may need to avoid using soap on the vulva altogether. It is important to wash with water alone if this is the case.
5. Don’t forget to be seen by your doctor to rule out other common causes of vaginal irritation and burning, such as a yeast infection or bacterial vaginosis which are easily treated.
6. Lichen sclerosis is another inflammatory skin condition often seen in menopausal women that causes these symptoms. It is easily identified on exam and treated with a steroid.
7. If you have incontinence, use pads intended for incontinence. Menstrual pads will leave you wet and foster infection and irritation.
8. Don't use baby wipes, flushable wipes, or other vaginal creams, gels, or wipes. Those products are irritating and drying.
9. Use a quality water-based or silicone-based lubricant for sexual intercourse to avoid damaging the tissue, which will leave it more dry and itchy.
10. Get some vaginal “exercise” - be it sexual activity (with or without a partner); stretching exercises with lubricated vaginal dilators; and/or pelvic floor physical therapy.
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