Menopause and premenstrual disturbances
LOVE AND LONGEVITY. THE LAST SEXUAL TABOO
Vaginal Dryness "VD" is fixable, but many women just wont talk about it
If ever there was a symptom that makes a woman feel her sexuality Is on the line, it's vaginal dryness. In our youth-oriented culture, it is widely regarded as a sign of aging, a signal of menopause. However, for most baby-boomer women, there is a far simpler explanation, and something that can be done.
First, though, the subject needs to be brought out into the open. "Vaginal dryness is still a taboo topic," says Morrie Gelfand, M.D., professor of obstetrics and gynecology at McGill University in Montreal. "Women don't even tell their partners. But it has physical, psychological and relationship consequences."
Without enough lubrication, intercourse can be painful for both partners. As a result, they may avoid lovemaking. Abstinence causes even more problems. The man may assume that he is doing something wrong in bed or is no longer able to turn on his partner. Perhaps he thinks she is having an affair. Or he may develop sexual problems of his own. One study found that in some cases where women avoided sex with their husbands, the men, who kept on trying to encourage lovemaking but were rejected developed impotence.
There is a toll, too, on the woman's peace of mind. "When I began to have difficulty lubricating," says one 42- year-old woman, "I thought at first it was because I was starting menopause. So I had my estrogen level checked. It was okay. Then I thought it was because I was depressed. So I went to a therapist and started taking an antidepressant. That didn't help either. Finally, I concluded it must be due to some deep, dark psychological problem. And I didn't want to know about that."
It is all to the good that vaginal dryness is being talked about today. It is certainly more common than has been recognized. According to figures supplied by manufacturers of lubricants and moisturizers, about 35 percent of American women under 40 or roughly 25 million women suffer at some time from vaginal dryness. And for women over 40, the figure is 60 percent. According to research by Johnson & Johnson, the maker of K-Y Jelly, one out of three women uses a lubricant to relieve vaginal dryness during intercourse. Another study found that more than 50 percent of Consumer Reports readers surveyed use commercial lubricants along with condoms to reduce what can be unpleasant friction.
One reason vaginal dryness is suddenly in the news is that manufacturers of lubricants and moisturizers are trying to create a new marketing niche. There's a vast array of products that promise to help. What's the difference and what will they do for you? Where do hormones fit into the picture? And what causes vaginal dryness in the first place?
Normally, our bodies produce a constant coating of moisture for all our mucous membranes, including those lining the vagina. This changes dramatically when a woman first feels erotic stirrings. Her brain sends a signal that triggers the walls of her vagina to sweat. Droplets form and trickle down, and the woman begins to feel pleasantly wet. This is one of the telltale signs of sexual arousal in females and has become a powerful symbol of sexiness and youth.
Since estrogen is responsible for keeping the vagina moist, it's not surprising that lack of lubrication often has to do with low levels of the hormone. "Estrogen levels vary throughout the menstrual cycle," says Joan Kennedy, R.N., director of mid-life health services at University MacDonald Womens Hospital in Cleveland. "Dryness could take place during those periods when estrogen slacks off." This may happen at certain predictable times in a woman's menstrual cycle namely, the second half, when less estrogen is secreted. Kennedy's advice to women: Track your cycle and understand how your pattern of dryness changes over the month.
A second reason for dryness can be a woman's fitness routine, particularly if it's very active. It's well known that intense athletic activity can lead to amenorrhea the loss of menstrual periods entirely (implying lack of estrogen production). But even at a more tempered pace, a woman's workout may cause dryness because it alters her hormone levels.
Yet another thoroughly contemporary explanation is the increased use of condoms. Even those that are prelubricated can dry out during sex and cause discomfort. Worse, they can also develop tears, according to a 1988 report by the Surgeon General. The FDA advises that lubricants should routinely be used with all condoms even prelubricated ones to guard against breaks or tears.
Certain medications can also - cause vaginal dryness by interfering with estrogen production. These include antidepressants, the fertility drug Pergonal and the endometriosis drug Danocrine.
Even some over-the- counter drugs can contribute to lack of moisture. "Women may be on a cold medication like an antihistamine that causes moisture throughout the body to be less available," says Mary Ellen Rousseau, R.N., assistant professor of nursing at the Yale School of Nursing and one of the investigators on Yale's Mid-Life Study; a comprehensive look at women's middle years.
Oral contraceptives are also a problem. Although exact figures on the incidence of vaginal dryness among women taking birth-control pills are not known, Gelfand reports that the progestin component in oral contraceptives can reduce natural moisture. Other conditions that upset hormone levels such as stress, childbirth and breast-feeding may also take their toll.
With all of these possible culprits, a woman may wonder how to know if her vaginal dryness is indeed the harbinger of menopause. And she doesn't have to be in her late forties to be concerned. "It takes seven to ten years of downshifting of estrogens before menopause occurs at the average age of 50.5," Rousseau points out.
"Even a 35-year-old woman may feel some effects. But often she gets no validation for her symptoms from her physician or peers. Her complaints are written off as personal problems rather than sporadic shifts in estrogen."
If premenopausal body changes are causing dryness, the most prominent clue is that a woman's menstrual cycle becomes shorter, contracting to less than 21 days, or longer, perhaps stretching out to 30 to 40 days. If a woman notices that her cycle has changed, Rousseau suggests that she keep track of her symptoms in a journal and then compare the pattern with her menstrual cycle. "The key to a hor-mone component is cyclicity," she says, meaning that the symptom recurs at a predictable time during the menstrual cycle.
Armed with such a journal, a woman will have hard evidence to take to her physician when she goes for a complete workup. The exam should include a maturation index (not the same as a Pap smear), which measures the amount of estrogen in a vaginal smear, as well as an analysis of the estrogen level in her blood. If the problem is a result of premenopausal downshifting, the physician may suggest hormone therapy or, as Gelfand does, a vaginal moisturizer.
No matter what the cause of a woman's lack of lubrication, she doesn't need to resort to hormones. The shelves of drugstores and specialized "sex stores" are stocked with an array of short-acting lubricants with such colorful names as Wet (which contains the spermicide nonoxynol-9), Slip, Astroglide and Foreplay Sensual Succulent (which comes in various flavors and scents), as well as K-Y Jelly and Ortho Personal Lubricant. Longer- acting moisturizers include Gyne- Moistrin, Replens (in tampon like applicators) and Lubrin Vaginal Inserts (suppositories).
A lubricant is intended to ease the friction during intercourse, and may last no longer than the act itself—if that long. A moisturizer, on the other hand, binds the moisture from the vagina. "The moisturizers release water continuously," says Gelfand.
"They also return the vagina to its normal acid content" good for vaginal health because it protects against bacterial growth. Gelfand routinely recommends Replens to patients who complain about vaginal dryness, and reports good results.
Another difference between lubricants and moisturizers is the timing of application. Lubricants are used just before sex. Moisturizers can be used the same way, but they are recommended for use on a routine basis every few days. This has the advantage of not interfering with sexual spontaneity.
Whatever a woman uses, she should make sure the term "water-soluble" appears on the label. Petroleum jelly and anything in an oil base (including the creative use of mineral oil, baby oil, coconut oil and body lotions) can be harmful. "It blocks the pores in the vagina and doesn't allow any of the body's natural moisturizer to come out," says Kennedy. "On the other hand, preparations that are water-soluble are absorbed into the skin and tissues." The use of petroleum or oil-based products could actually incubate a vaginal infection, says Gelfand.
Oil-based lubricants are also dangerous from another point of view: They can break down the latex in condoms within seconds, creating tears and breaks. This puts a woman at risk not only for pregnancy, but also for sexually transmitted diseases.
Lubricants and moisturizers aside, there is one potential remedy for vaginal dryness that is strictly organic and homemade namely, more sex. "Studies have shown that the more sexual stimulation you have, the more moisture," Kennedy says. "Like any organ, the vagina has better circulation if it's used," adds Rousseau. What a welcome.
By Linda Murray
Menopause and premenstrual disturbances