Is your vagina dry? Is it painful? Let's talk about (Vaginal Atrophy / Genitourinary Syndrome of Menopause - GSM)

Have you ever felt discomfort, pain, or dryness in your vagina? Do you feel pain during sex? You may feel a little embarrassed to talk about these things. However, these are really common issues that affect many women, but we don't talk about them much, but they are a topic that needs to be discussed. Today, we will talk about this in detail .

What is this condition called? What exactly is it?

Simply put, this is a condition where the tissues surrounding the vagina become thinner and drier. It used to be called `(Vaginal Atrophy)`. But now a new medical name is used, which is `(Genitourinary Syndrome of Menopause)` or `(GSM)` for short. The reason for using this new name is because this condition affects not only the vagina, but also the urinary system. What happens in this is that the delicate membranes that line the inside of your vagina dry out and thin out. Think of it like the ground cracking when it dries. This is why symptoms like itching, burning, and pain during sex occur. Not only that, but urinary tract infections (UTIs)` and urinary incontinence can also come with it. This condition often occurs as you approach or after menopause. The reason for this is that the level of the hormone estrogen produced by your ovaries decreases. During treatment for cancer or when your ovaries are surgically removed, this level of estrogen can also decrease. When this hormone level decreases, it can cause some very uncomfortable symptoms. These can also affect your normal life.

How common is this? (How common is this?)

In fact, at least half of all women going through menopause experience some form of the condition known as Genitourinary Syndrome of Menopause (GSM). Often the first sign is vaginal dryness . You may first notice this during sex.

What are the symptoms of this? (What are the symptoms of this?)

When you have a condition called ``Vaginal Atrophy'' or ``GSM'', the tissue lining the walls of the vagina becomes thin, dry, and susceptible to infection. Let's take a look at what these symptoms are.

Vaginal symptoms:

• Feeling of vaginal burning and/or itching .
• Pain during sexual intercourse. This is medically called ``Dyspareunia''.
• Abnormal vaginal discharge (often yellow in color).
• Vaginal bleeding or spotting, especially during sex.
• Itching sensation around the labia (external genital area).

Symptoms related to the urinary system:

This condition can also affect your urinary system, causing symptoms like:

• Frequent urinary tract infections (UTIs).
• Incontinence is the inability to control urination.
• Needing to urinate more often than normal.
• Painful urination. This is called `(Dysuria)`.
• Blood in the urine. That is called `(Hematuria)`.
• A burning sensation when urinating.

Why does this happen? What are the causes? (Why does this happen? What are the causes?)

During menopause, your body produces a lot less of the hormone estrogen. Without this estrogen, the walls of your vagina can thin and lose elasticity. Your vagina can become narrower and shorter. When estrogen levels drop, the amount of natural vaginal fluid decreases, and the acid balance in your vagina changes. All of this makes your vaginal tissue more delicate and more susceptible to infection. In addition to menopause, there are other times when your body can lose estrogen. For example:

• When you are breastfeeding a child.
• When undergoing treatment for cancer (e.g. `(Chemotherapy)`, `(Radiation therapy)`).
• If you have had your ovaries surgically removed (`( Oophorectomy )`).

In cases like this, a decrease in estrogen can lead to a condition called "Vaginal Atrophy".

Who is most at risk for this condition?

Women who are going through menopause are most likely to develop this condition, as their bodies naturally produce less estrogen. However, there are other reasons why estrogen levels can drop, leading to this condition:

• Decreased ovarian function due to anti-cancer treatments (Chemotherapy or Radiation therapy).
• Using certain medications that reduce estrogen levels. Examples include medications like Tamoxifen, Medroxyprogesterone, and Nafarelin.
• Surgical removal of the ovaries (`(Oophorectomy)`).
• Some types of birth control pills.
• Certain immune system diseases.
• Breastfeeding time .
• Smoking tobacco .

Importantly, the less frequently you have sex (with or without a partner), the higher your risk of developing moderate to severe vaginal atrophy. Research has shown that people who have sex more often have less severe vaginal atrophy than those who have stopped having sex. This is because sexual stimulation increases blood flow to the vagina, which increases the elasticity of the vaginal tissue.

What are the complications that can occur due to this?

Vaginal Atrophy (GSM) can affect your quality of life and your relationship with your partner. It has both physical and psychological side effects. Physical symptoms such as pain, burning, itching, and discharge can interfere with every aspect of your life. It can also have a psychological impact. When you have these symptoms, you may experience a loss of interest in sex, a loss of desire for intimacy, or a loss of self-confidence. Please remember that all of these feelings are normal and that your doctor is there to help you.

How is this diagnosed?

A doctor can diagnose vaginal atrophy based on your symptoms and a pelvic exam, which examines your vagina and cervix. Common signs of this condition during a pelvic exam include:

• The vagina is shortened or narrowed.
• Dryness, redness, and swelling.
• The one that has lost its elasticity.
• A whitish vaginal discharge.
• Skin conditions, such as sores and/or red spots, around the labia.
• Small cuts (lacerations) near the vaginal opening.
• Decreased size of the labia.

What tests are done to confirm this?

Doctors often diagnose atrophic changes or GSM based on symptoms and examination. However, they may also perform tests to rule out other conditions, such as:

• Pap test.
• Testing a urine sample.
• Ultrasound examination.
• Testing the pH (acidity) of the vagina (`(Vaginal pH)`).
• Tests for vaginal infections.

Questions your doctor might ask:

• Are you going through menopause?
• What medications do you use?
• Have you recently had a baby?
• Does vaginal intercourse hurt?
• Have you tried using lubricants or moisturizers that you can buy at the pharmacy?
• Did you notice any discharge coming out of your vagina?
• Did you notice any blood-like discharge or spotting?
• How long have these symptoms been present?

It's normal to feel embarrassed when talking about the symptoms of `(Vaginal Atrophy)`. But if you think you have these symptoms, don't be shy about telling your doctor about them. There are many effective treatments for this.

Let's look at treatments: Hormonal treatments

Estrogen therapy and dehydroepiandrosterone (DHEA) are the hormonal treatments for vaginal atrophy.

Topical estrogen

This works by treating only the symptoms of the vagina without increasing the level of estrogen in your blood. It can be taken as a cream, a vaginal tablet, or a ring. Your doctor can explain each of these methods to you and help you choose the one that is best for you.

• Vaginal estrogen cream: This cream is inserted into the vagina using an applicator. Most people need to apply it every day for a few weeks, then only two or three times a week.
• Vaginal ring: This is a thin, flexible ring. Your doctor inserts it into your vagina. It releases a low dose of estrogen for three months. Your doctor then removes it and inserts a new one.
• Vaginal tablet: This is also a small tablet that is inserted into the vagina using an applicator. Like other estrogen treatments, it is used daily at first, then reduced to two to three times a week.

Hormone Replacement Therapy (HRT)

This is also called `(Systemic estrogen therapy)`. If you have other symptoms of menopause, such as hot flashes and sweating, this treatment may be helpful. This is a higher dose of hormones, and it goes not only to the vagina, but also to other cells in the body. If you have been postmenopausal for more than 10 years, or if you only have vaginal dryness, `(Local therapy)` is often used. However, if you need `(Systemic hormone therapy)`, it can also have benefits such as improving vaginal health, improving sleep, reducing `(Hot flashes)`, and improving mood. You and your doctor can decide if this treatment is right for you.

What are the non-hormonal treatments?

You and your doctor should work together to develop a treatment plan for your vaginal atrophy. Your doctor will help you decide which treatment is most effective based on your symptoms and their severity. Estrogen and DHEA are the most effective treatments. However, these treatments are not suitable for everyone. There are also several non-hormonal treatments that can be used.

Lubricants and Moisturizers

Lubricants and moisturizers treat vaginal dryness. This can reduce discomfort during sex. You can buy these at your nearest pharmacy or supermarket. They come in a variety of brands.

• Vaginal lubricants are used to reduce friction and pain during sexual intercourse. They are made from water, silicone, or oil. They only work for a short time.
• Vaginal moisturizers stick to the vaginal tissues and help retain moisture in the cells. These are usually used one to three times a day, as they work for a longer period of time.
• Some natural oils, such as olive oil and coconut oil, can also be used as lubricants and moisturizers.

Laser Treatments

Non-invasive, non-surgical treatments called CO2 lasers are said to help regenerate vaginal tissue, increasing its strength and elasticity. However, these devices are not yet approved by the U.S. Food and Drug Administration (FDA) for the treatment of vaginal atrophy, as long-term research on their use is still limited.

Dilators

Dilators are devices used to widen the vagina to reduce discomfort during sexual intercourse. Many people start with a small dilator and then gradually move on to larger ones.

Ospemifene (Ospemifene - Osphena®)

Osphena® is a pill that is taken daily. It has similar benefits to estrogen, but it does not contain estrogen. However, a rare serious side effect is an increased risk of blood clots. Some people may experience increased sweating and hot flashes (hot flashes), but most people do not experience any symptoms.

Are there any side effects/complications of treatment?

Be aware of any new symptoms that appear after you start treatment. These may include skin irritation, increased pain, and/or vaginal discharge. Talk to your doctor about any side effects. If you are feeling uncomfortable with your treatment plan, don't hesitate to ask your doctor about it.

How long does it take to treat this condition?

The length of time it takes to treat your symptoms of (GSM) varies depending on the method you use and the severity of your condition. Your doctor will discuss all of your options with you, based on your health history and your condition. He or she will help you determine the most effective treatment plan. Keep in mind that many people find success using a combination of treatments.

Can this be prevented?

Estrogen loss is part of your body's natural aging process. It can't be stopped completely. However, there are ways to prevent vaginal atrophy from getting worse. Avoid using things that are harmful to the vagina (perfumes, dyes, shampoos, detergents, and douching). Remember, being sexually active is good for vaginal atrophy because it increases blood flow to the vaginal tissues.

What can I expect if I've been diagnosed?

You don't have to "just live" with vaginal atrophy. Even if you're in menopause or postmenopausal, it doesn't mean you have to suffer from frequent urinary tract infections (UTIs), vaginal itching, or pain during sex. Treatment for vaginal atrophy is very effective. Don't be afraid to try different treatments, and work with your doctor to find the one that works best for you.

Can this condition be completely cured? (Can this be completely cured?)

Vaginal Atrophy cannot be cured completely, but you don't have to live with the discomfort. With proper diagnosis and treatment, the symptoms can be controlled.

Can this condition get worse if left untreated?

Yes, this condition can get worse. That's why it's important to get treatment early. The sooner you get treatment, the less likely your vaginal atrophy will get worse. For example, the longer you go without estrogen, the drier your vagina can become. If left untreated, your vaginal atrophy can get worse. Sometimes, this condition can be so severe that the opening of the vagina can become significantly narrowed. In that case, if you delay starting treatment, it can be difficult to treat.

What is it like living with this? (What is it like living with this?)

Vaginal atrophy can seriously affect not only your sex life, but also your overall quality of life. Symptoms such as pain, dryness, burning/itching, spotting, bleeding, urinary problems, frequent urinary tract infections (UTIs), and vaginal discharge can be very uncomfortable and can interfere with your daily activities. About one in four women report that vaginal atrophy has negatively affected other aspects of their lives, including their sleep, sexual health, and general well-being.

How do I take care of myself? (How do I take care of myself?)

Like all other aspects of your health, make your sexual health a priority. Seek help from your doctor to find answers to any questions or concerns you may have.

When should I see a doctor?

Even if you are not menopausal, tell your doctor about any symptoms such as dryness, pain, burning/itching, urinary problems, unusual spotting or bleeding, or vaginal discharge. If you have been using over-the-counter moisturizers for your dryness for several weeks and there is no improvement, you should see a doctor. Also, if you have any symptoms that are interfering with your daily life, be sure to see a doctor.

What questions should I ask my doctor?

When you see your doctor, you can ask questions like these:

• What kind of things do you recommend I can buy at the pharmacy?
• What treatments do you recommend that I get without a prescription?
• Is this situation of mine temporary?
• Are there other ways to treat my condition?
• Are there any risks in the treatment?
• How long does it take to recover from treatment?
• Do I have any other medical conditions besides Vaginal Atrophy?
• What else can I do to stop my vaginal atrophy from getting worse?
• How can I help my partner?

What's the difference between vaginal atrophy and a yeast infection?

Both vaginal atrophy and yeast infections can cause symptoms like dryness, itching, redness, and pain. However, vaginal atrophy is caused by a lack of estrogen, while a yeast infection is caused by a fungal infection. So talk to your doctor about your symptoms and what condition you have, and together you can decide.

So, what's the most important thing from what we discussed?

Vaginal atrophy is a serious condition. It can affect your quality of life, causing discomfort, frequent trips to the bathroom, frequent urinary tract infections (UTIs), inflammation, pain during sex, and more.

Fortunately, there are many treatments for this, and your doctor can help you find the best option for your symptoms.

Find treatment. Don't be afraid to talk to your doctor and your partner about this. Always follow your doctor's advice and do what you can to manage your condition. Remember, you are not alone, and help is available.