Do you suffer from vaginal dryness and pain? (Vaginal Atrophy / GSM) Let's talk about this

Many women, especially as they approach or pass menopause, start to experience various discomforts related to the vagina. Think about it, the vagina becomes dry, itches all the time, and it hurts during sex. Many people think that it is embarrassing and uncomfortable to talk about these things openly. But in fact, this is a common, very common condition for many women. So this is not something to tolerate and suffer from. This is what we are talking about today.

Simply put, what is vaginal atrophy?

Simply put, Vaginal Atrophy is a condition in which the lining of your vagina becomes dry and thin. The main reason for this is the decrease in the hormone estrogen in the body. Estrogen is a very important hormone for the female body. It is what keeps the vagina moist, stretchy, and healthy. It is like a moisturizer for our skin.

With menopause, the body's estrogen levels naturally drop significantly. The lining of the vagina becomes thin, dry, and easily damaged.

Doctors are now using a new name for this condition. It is Genitourinary Syndrome of Menopause (GSM) . The reason for using this name is because this condition affects not only the vagina, but also the urinary system. This means that things like urinary tract infections and urinary tract infections are also associated with this.

How common is this condition?

It's more common than you think. Studies have found that at least one in two women going through menopause will experience some form of these symptoms. Often, the first sign is vaginal dryness. It's especially noticeable during sex. So if you're feeling alone, remember that many others are going through this experience.

What are the main symptoms of this?

GSM can cause symptoms related to the vagina as well as the urinary system. To understand these clearly, see the table below.

Why does this happen? What are the risk factors?

As we've discussed before, the main cause is a decrease in the hormone estrogen . Menopause is the main cause of this. However, there are other reasons why estrogen can decrease.

• Cancer treatment: Some anti-cancer drugs, radiation, or chemotherapy can cause decreased ovarian function and decreased estrogen production.
• Oophorectomy: When the ovaries are removed, estrogen production stops and symptoms of menopause suddenly appear.
• Certain medications: This condition can also be caused by some birth control pills or drugs that act against estrogen (e.g. Tamoxifen).
• Breastfeeding: During this time, estrogen levels in the body are temporarily low.
• Smoking: Women who smoke may have lower estrogen levels, and they are also at risk of early menopause.
• Decreased sexual activity: This may sound surprising, but it's true. Regular sexual activity increases blood flow to the vagina. Just as exercise increases blood flow to our muscles. This increased blood flow keeps the vaginal tissues healthy and flexible. When sexual activity stops or decreases, this benefit is lost, and dryness and atrophy can occur more quickly.

What complications can occur due to this condition?

This is not a life-threatening disease, but it can have a significant impact on your quality of life .

These physical discomforts can also affect you mentally. You may experience things like loss of interest in sex and loss of self-confidence. All of these feelings are very normal. The most important thing is to talk to your doctor about this and ask for help.

How does a doctor diagnose this?

A doctor can usually diagnose this condition by listening to your symptoms and performing a physical exam (pelvic exam). During this exam, the doctor will examine your vagina and cervix. You may see signs like these:

• Shortened or narrowed vagina
• Dryness, redness, and slight swelling
• Decreased elasticity of tissues
• Pale color inside the vagina
• Small scratches or cracks near the vaginal opening

Sometimes, the doctor may also perform some tests to make sure there are no other medical conditions:

• Pap test: Checks for abnormalities in cervical cells.
• Urine sample: Check for a urinary tract infection.
• Ultrasound scan: Examine the uterus and ovaries.
• Measuring vaginal acidity (Vaginal pH).

What are the treatments?

There are several treatments for this. Depending on the nature and severity of your symptoms, your doctor will decide which treatment is best for you.

Hormonal Treatments

These are the most effective treatments for this condition.

• Topical Estrogen: This involves inserting a low dose of estrogen directly into the vagina. This ensures that only the tissues in the vagina receive the estrogen. Therefore, the estrogen levels in the entire body do not increase significantly. This comes in three forms:
• Vaginal estrogen cream: This is applied into the vagina using a special applicator.
• Vaginal tablet: Inserted into the vagina using an applicator.
• Vaginal ring: A flexible ring that is inserted into the vagina by a doctor. It releases estrogen gradually over a period of 3 months.

• Systemic Hormone Replacement Therapy (HRT): If you have other severe symptoms of menopause (such as hot flashes) in addition to vaginal dryness, your doctor may recommend this treatment. It comes in the form of pills, patches, or gels. It provides estrogen throughout your body.

Non-hormonal Treatments

Some women cannot take hormone therapy (for example, those with a history of cancer). For those women or those who do not want hormone therapy, these alternatives can be used.

Can this situation be prevented from getting worse?

Since estrogen decline is a natural part of aging, it's impossible to completely prevent this condition. However, there are things you can do to control its severity.

• Avoid irritants: Avoid using scented soaps, shampoos, detergents, and perfumes in the vaginal area. These can further irritate the delicate skin of the vagina.
• Don't douche: Avoid washing the inside of the vagina with water or other liquids. This destroys the natural, protective bacteria in the vagina and increases the risk of infection.
• Regular sexual activity: As we discussed earlier, regular sexual activity (with or without a partner) increases blood flow to the vagina, helping to keep the tissues healthy.

When should you see your doctor?

Even if you are not menopausal, if you experience vaginal dryness, pain, itching, burning, unusual bleeding or discharge, or urinary problems, be sure to see a doctor.

If you buy a moisturizer from a pharmacy and use it for a few weeks but there's no difference, that's also a good reason to tell a doctor.

Vaginal Atrophy, Genitourinary Syndrome of Menopause, GSM, Vaginal Atrophy, Vaginal Dryness, Menopause, Estrogen, Sexual Pain, Dyspareunia, Urinary Tract Infections, Women's Health