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Dry Vagine (atrophy ugh!)
[00:00:00] Many, many requests for dry drive. , the word we use is vaginal atrophy, which sounds so dreadful, but it is the word that is the medical term. It really means, um, not vaginal dryness, which is kind of the common vernacular that a lot of us use. That's actually not so accurate. What I really tell patients is it means our vagina is less.
Elastic. Okay. So what we want, especially when we get arou sexually, is for the vagina to lengthen and, um, actually become lubricated, but also become more elastic and accommodating to something that might enter it when you are in the state of vaginal atrophy, which we'll discuss why that happens for different reasons.
your vagina, even if it can, lubricate has a much harder time with elasticity. And then if something is rubbing against it over a period of a couple of minutes, sometimes a couple seconds, it will actually feel like it's burning, like literally as if you've gotten [00:01:00] rug burn. If you, if you rubbed something that was tau and not elastic, it will be uncom.
but I use a lubricant, you might say, as many patients say to me, but I used a lubricant that didn't seem to help. And my response is, I know because it's not just about lubricating it again, it is about making it more elastic. So when and why would you have vaginal atrophy? The obvious time would be when you're post-menopausal.
Menopause again is defined as a year with no period. So post-menopausal, certainly even perimenopausal, which can be up to 10 years preceding menopause, we'll have to have another menopause discussion at some point. Um, and so those times when you're estrogen levels are low, your vagina will be less elastic.
Atrophy a troph. Bad word I know, but just think of it as less elastic. So that's the most common time is perimenopause and certainly post-menopausal. And while many post-menopausal women's, [00:02:00] other symptoms will improve over time, like hot flashes, night sweats over a period of a couple years will improve for many women and sometimes it can take five or six years.
Vaginal atrophy unfortunately only marches on and gets worse and worse and worse. So I can say with confidence, unfortunately, that almost all women who are menopausal will have vaginal a. Now for some of them, for many of them, it does not bother them because they're not having sex and so they don't notice that it feels less elastic.
Other times they might notice would be just generally anything, um, bo touching down, they will make it more sensitive. So someone will say, God, now when I travel and I use different toilet paper, different, so. I feel more irritated and they can become more susceptible to urinary tract infections. But again, many women, I'll look at them, I'll be doing their Pap sm and I'll say, oh, is it bothering you?
Are you having intercourse? If it, if you have intercourse, does it bother you? And they either say no, because they're not having intercourse. Some of them. Merely use a lubricant. And [00:03:00] while I kind of push like you're sure it's not bothering you, they say, no, I believe them, but I suspect that maybe they just don't wanna voice it no matter how many times I ask.
Um, so again, most common time is when there's lack of estrogen from menopause. Two other times, which are lesser known, but very common are when you are nursing. When you are breastfeeding and nursing your hormones suppress your estrogen and you are not ovulating and therefore you will. Atrophic or dry, which is the wrong word.
Again, it's really inelastic now doesn't make sense cuz when you think about it, when you are in that postpartum period, and I know people don't like to believe this, cuz at six weeks we go, Hey, guess what? You can have sex. But the truth is that in that entire year, postpartum where nature would have a nurse for the year, that year of nursing would lead to suppression of ov.
That means no pregnancy, which means should we be having sex? No. Cuz in nature we were having sex merely to procreate. Now, how did nature [00:04:00] stop you from getting pregnant and stop you from having sex when it's natural to have sex? Well, it made your libido low from lack of estrogen, and it made your vagina yucky and dry and atrophic and inelastic.
So that you were like, no, no, no. Back at, you know, again, evolutionarily speaking, you did not wanna have sex with your partner for that period of a. Until you stopped nursing and then your hormones came back and your vagina became more elastic and you started to feel like you were interested in sex, maybe.
Maybe. And then you got pregnant. And that's why in Nature babies tended to be spaced out at about two years. what can be done. We'll talk about that in a second, third, and most common time where you will be atrophic that is very, um, poorly recognized is when women, even young women, are on birth control pills.
Because over time when you're on the birth control pill, it evens out your hormones and that will make it less elastic. Now, you might say, but wait. The birth control pill often has estrogen [00:05:00] in it. Doesn't that help? And that would be very wise, except that it doesn't, because the estrogen that's in the birth control pill is not exactly what we normally have in our body, nor does that matter.
Because even if you took bioidentical, Excuse me, estrogen, it won't necessarily work on the end organ as the vagina. It will work on things like hot flashes, but it won't help the vagina. So how do we help the vagina? Well, we can, the good news is we actually have far more choices than we used to have. We used to only have estrogen cream that could be used vaginally.
Now we have estrogen cream, we have estrogen tablets that are used vaginally. We have an estrogen ring that is used vaginally. Um, we have. A suppository that has, instead of estrogen, it has D A G A S that converts into testosterone and estrogen locally in the vaginal cells. Um, we have vaginal lubricants that are different forms of suppositories.
We have procedures which are a bit controversial as far as FDA approval, but there are [00:06:00] a few, there's in fact, one in particular that my practice happens to do, um, that can. stimulate collagen, much like people do it on their skin when they do microneedling. , you might remember that I did microneedling with radiofrequency.
So a radiofrequency device can actually be put into your vagina and it, um, zaps the tissue and stimulates collagen. That can also be d done with a laser. Um, again, outside of the scope of this conversation, but it really can be useful for atrophy, though you have to do your research because many of the machines have not been FDA approved and had the ability to burn.
Um, some. Caused that less likely, um, insurance will not cover the procedure because insurance does not care about mine. Or your dry vagina, by the way, even though they would cover your partners with Viagra, right. To your congressman, right. To your insurance companies about that ladies. Um, but getting back to it, the most, um, straightforward, safe, easy way is using [00:07:00] some form of vaginal, estrogen, and even women who have had breast cancer that was estrogen receptor.
Are able to use them, but you should talk to your oncologist because they will direct you as to which one they feel comfortable with. By and large, they will say the vaginal estrogen tablet or the vaginal estrogen, sorry, the vaginal D H E A S tablet, because those have less absorption Systemically, though, even the cream has been shown in multiple studies to not have any absorption in your system, but because of the potential for using too much of the.
The oncologist will often ask you to instead use the vaginal tablets. Okay. So atrophy really means any elasticity. It happens in a setting of low estrogen. Most commonly would be menopause. Also nursing, also continuous birth control pills. Okay. Um, you can treat it. By improving the elasticity of the vagina, which means using cream, pill, ring, all that, [00:08:00] go into the vagina and penetrate into the vaginal wall and plump it back up again.
Totally different than just using a lubricant if you choose to only use a lubricant. My pick to my patients is to use coconut oil because coconut oil actually has, um, better properties than just one of the classic, I won't mention the names, but the two initial. Something, something jelly, um, which is just clear jelly and that just makes it slippery, but it doesn't help the elasticity at all, whereas the oils will tend to, so coconut oil does tend to, um, there's a product I actually will name it, called V Magic on Amazon that I have learned about from different people.
Um, patients actually came to me talking about it from different people that they had been recommended to use it from. And it is coconut oil with essential oil. V Magic on Amazon. Um, and that can be a better lubricant. So some of my patients just don't wanna use estrogen because they don't wanna have to keep up with it.
And so they just use lubricants. And again, the oil lubricants are better. Be [00:09:00] cautious with condoms because oil can break a condom. When you use the vaginal estrogens, you have to use them regularly. It's not just, oh, I'm having sex tonight. Repeated and regular usage. It can take about six weeks for it to kick in, and depending off its cream or tablet or suppository, it can be anywhere from two to seven nights a week that you need to use it.
All right, ladies. I hope that helped for all of you who have been requesting stuff about our verine. Okay.