Bill Klaproth (Host):  Vaginal dryness is a common symptom of menopause and can really impact a woman’s sex life. So, what can be done? Here to talk with us about menopausal vaginal dryness is Dr. Gayle Richmond, a board-certified obstetrician and gynecologist at Tidelands Health. Dr. Richmond, thank you for your time today. So, how common is this?

Gayle Richmond, MD (Guest):  Well, thank you so much for having me. Yes, this is a very common symptom because when a female goes through menopause, the vaginal tissue is very dependent on estrogen and so what it means to go through menopause is that your estrogen levels fall because your body does not produce estrogens which come from the ovaries and that tissue can get very thin and dry. And it does not lubricate well and can get significant symptoms from that including painful intercourse.

Bill:  Are there any other symptoms that a woman should watch out for besides painful intercourse?

Dr. Richmond:  Well, a lot of times people will present with a burning sensation or just a general feeling of discomfort because the tissue is sensitive and thin and dry and that is a lot of the presentation. It could be vaginal dryness. So, even people who are not sexually active can complain with the vaginal – it’s called vaginal atrophy where the tissue actually becomes very thinned out.

Bill:  Now you mentioned that decrease in estrogen as a woman ages and goes through menopause. Are there other causes that we should be aware of?

Dr. Richmond:  Well, for the most part, it is a lack of estrogen. So, any kind of condition where you have decreased estrogen or estrogen production; that’s going to lead to this condition. So, if you have surgery and your ovaries are removed, as those are the primary sources of estrogen that is an issue. If you have been diagnosed with certain cancers, particularly breast cancer, and you are on estrogen blockers, as many of the breast cancers are estrogen and progesterone receptor positive, so you would end up being on a blocker; that is going to decrease your production of estrogen in the body and these symptoms can occur, so if you get breast cancer early on, then you are going to – these symptoms can happen at that time.

Bill:  And Dr. Richmond, at what point should a woman consult her doctor if she is feeling these symptoms?

Dr. Richmond:  Well, I think that the – for the most part, people are doing the exams in women and there are other symptoms associated with menopause, so this is just one of them. So, if you are seeing a physician and you should through the average age of menopause is 50 so most women are seeing a professional. This conversation comes up all the time and frequently it becomes you know I’m having hot flashes, and several other symptoms of menopause, so this is part of the regular discussion as well.

Bill:  So, Dr. Richmond, when a woman does come to see you, how do you diagnose this?

Dr. Richmond:  So, when a woman comes to see me about this and we usually are having the discussion about menopausal symptoms, that is one – the symptoms are one, but the clinical diagnosis is also important and the tissue upon examination is often very thin and dry. It appears red and just not very healthy tissue.

Bill:  So, when it comes to treatment; what are the options?

Dr. Richmond:  There are several options for treatment now. If you – since the tissue is so dependent on estrogen, if you are able to take any type of estrogen, then you can use even estrogen by mouth or you can even use creams. Sometimes a lot of women are trying to avoid estrogen therapy in that sometimes there is an increased risk with breast cancer on a long-term use of estrogen therapy when taken by mouth. Now the creams, there is not very much that is absorbed through the body so that’s a little bit safer on a long-term basis. So, there are creams or tablets that you can place vaginally to help restore this tissue. There is also a pill that you can take by mouth called Osphena and there are other treatments include – there is laser treatments that can also happen that are easy simply treatments that happen in the office and what they do is they – laser treatments, they don’t have any pain to them. They increase the collagen production vaginally. So, it is a laser that goes into the vagina, stimulates the collagen in the tissue to become thicker and lubricated as it was when – many years ago. And that’s a good option especially for people who cannot take or do not wish to have any estrogen products or any of the – anything that might increase the risk of breast cancer. So, that one is – those are good options for treatment. Laser treatment is about three treatments every six weeks and then that normally restores the tissue.

Bill:  And generally, Dr. Richmond, how effective are these treatment options?

Dr. Richmond:  So, the treatment options are good when using them, now sometimes the people don’t want to – don’t continue with the therapy. If you are going to continue to use the therapy, you have to keep using it. So, if you are going to say I’m going – if you are going to commit to the therapy, if you are going to use an estrogen cream, you are likely going to have to use it two to three times a week for – continue to use it throughout your menopause years. If you are going to – same with a pill that you can take. And there are some vaginal inserts, same thing, but it is something you have to chronically do. So, the laser treatment that we have, the Mona Lisa treatment, that’s a little – you do three treatments, one every six weeks and normally that will last several years. Or you can use – want a touch up treatment in a year or two. Because it works differently. It stimulates the collagen in the vagina to become thicker and grow so it allows the tissue to basically rejuvenate.

Bill:  So, when a woman first feels these symptoms coming on, is it a good idea to try over the counter items such as lubricants at first?

Dr. Richmond:  The lubricants are good. You can try that at first. So, lubricants are going to only relieve the symptoms. They are not going to get to the root of the problem. So, they may work initially, in that they do lubricate so the dryness is better, so you can certainly do that, but as far as actually the tissue though, however is again dependent on estrogen, so it’s going to require estrogen to stay thicker and stronger and that in the end, is – normally the lubricants will work for a period of time but then they stop working because they are not really treating the underlying physiologic issue.

Bill:  Right, well that’s good to know and are there any things women should avoid like baths and scented soaps and other products that can worsen the dryness?

Dr. Richmond:  You know the only thing, certainly everybody loves the bath, you don’t want irritating bath salts or something that can get into the vaginal tissue especially on the outside that can be detrimental to the tissue and can dry it out even more. The other sometimes women will tell me that they actually douche and that I do not recommend for the same reason. It flushes out a lot of the bacteria that is naturally in the vagina that you want, but also, it’s very irritating and drying to the tissue so it usually makes the problem worse.

Bill:  Well, Dr. Richmond thanks for the great discussion today and lastly, why should a woman choose Tidelands Health for their healthcare needs?

Dr. Richmond:  So, Tidelands Health has very excellent physicians, well-trained physicians and we are all very interested in our community and keeping the health of the community in women’s services to the highest level that we can achieve, and we absolutely are very focused on women’s issues and women’s health issues and this is a perfect place to get your healthcare.

Bill:  Alright Dr. Richmond, thank you again for your time today. We appreciate it. For more information about Tidelands Health physicians, services and facilities, visit www.tidelandshealth.org that’s www.tidelandshealth.org. This is Better Health Radio, I’m Bill Klaproth. Thanks for listening.