Vaginal dryness

Specialty: Nephrology and urology.

• vaginal atrophy
• vulvovaginal dryness
• genitourinary syndrome of menopause

Why it occurs

• Postmenopausal hypoestrogenism (the drastic decrease in circulating estrogens causes thinning of the vaginal epithelium, loss of collagen, less vascularization and drastic reduction in the lubricating secretions of the cervical and Bartholin glands)
• Breastfeeding (elevated levels of systemic prolactin temporarily suppress ovarian estrogen secretion, inducing a transient hypoestrogenic state)
• Use of gonadotropin-releasing hormone (GnRH) agonists or pelvic chemotherapy/radiotherapy (oncological treatments that induce rapid-onset medical menopause)
• Drugs with antisecretory effects (such as systemic antihistamines or decongestants that reduce mucous secretion generally)
• Recurrent use of vaginal douches or inappropriate soaps (which eliminate the saprophytic flora and the natural protective lipid layer of the vagina)

Initial workup

Gynecological visual inspection to document the loss of vaginal elasticity, paleness of the mucosa, disappearance of vaginal wrinkles (folds) and vascular fragility (contact petechiae); determination of vaginal pH (which characteristically rises above 5.0 in vaginal atrophy due to loss of lactobacilli and lactic acid); Vaginal smear for cell maturation index if necessary.

Standard management

• Estriol in 0.1% vaginal cream or Estradiol in low-dose vaginal tablets — 10 mcg; Local estrogen therapy that restores the thickness of the vaginal epithelium, normalizes vaginal pH and improves local vascularization without producing significant systemic effects or requiring opposition with progesterone in women with an intact uterus.
• Vaginal moisturizers based on hyaluronic or polycarbophilic acid — regular non-hormonal application 2-3 times a week to improve background tissue hydration
• Water-based or silicone-based vaginal lubricants (direct application during sexual intercourse to reduce immediate mechanical friction).