Clean water is perfectly adequate for washing there. Avoid using lotions and perfumed products on the inner vulva as well. Menopause-related vaginal dryness often leads to pain with penetration and during deep intercourse, and can be associated with arousal difficulties as well. Many different topical vaginal treatments are available, from nonprescription, nonmedicated lubricants and moisturizers to prescription-only topical forms of estrogen therapy see table.
Examples of commonly used lubricants, moisturizers, and vaginal estrogen products Lubricants Water-based: There may be a more serious cause of your discomfort that should be diagnosed and treated. You and your healthcare provider can also discuss low-dose vaginal estrogen products.
These prescription-only products deliver estrogen directly to the vagina, with minimal absorption to the rest of the body, and restore vaginal tissue thickness and flexibility.
These actions may help prevent other sexual problems such as worsening pain during sex, vaginismus, or diminished arousal or orgasm that can result from chronically painful sex. Vaginal lubricants work by reducing the friction associated with thin, dry genital tissue. Lubricants are not absorbed into the skin, are immediate-acting, and provide temporary relief from vaginal dryness and related pain during sex. They are particularly appropriate for midlife women whose vaginal dryness is an issue only or primarily during sex.
A wide variety of lubricants are commercially available, either as water-based, silicone-based, or oil-based products. Water-based lubricants have the advantage of being nonstaining. Oil-based lubricants such as petroleum jelly and baby oil should be avoided, as they can cause vaginal irritation and are associated with high rates of latex condom breakage that can lead to sexually transmitted infections.
Polyurethane condoms do not break with oil-based lubricants. One of the warming lubricants, Zestra, has been shown to enhance sexual response in research studies. While some women experience pleasurable warming sensations with these products, others report that they cause stinging or burning pain. Like lubricants, vaginal moisturizers reduce the painful friction that sex can cause as a result of vaginal atrophy. Additionally, moisturizers, unlike lubricants, are absorbed into the skin and cling to the vaginal lining in a way that mimics natural secretions.
Another difference is that moisturizers are applied regularly, not just before sex, and their effects are more long-term, lasting up to 3 or 4 days. Some moisturizers have an applicator to help place the product into the vagina. Because moisturizers maintain vaginal moisture and acidity, they are particularly appropriate for midlife women who are bothered by symptoms of vaginal dryness such as irritation and burning that are not limited to sexual activity.
Some women who regularly use moisturizers still use a lubricant as needed before sex, for additional lubrication and comfort. Low-dose vaginal estrogen therapy. Estrogen products designed for vaginal application have been proven to restore vaginal blood flow and improve the thickness and stretchiness of vaginal tissue in peri- and postmenopausal women. These products act to reverse the thinning and dryness of vaginal tissues rather than just providing the temporary relief that lubricants and moisturizers do.
For this reason, low-dose vaginal estrogen is appropriate in most cases for peri- and postmenopausal women who do not get sufficient relief from moisturizers or lubricants or whose symptoms of vaginal atrophy are interfering with their quality of life. Severe vaginal atrophy may respond more quickly to vaginal estrogen therapy than to hormone pills or patches. However, for women without those other menopause symptoms, vaginal estrogen should be used since it is concentrated where it is needed and minimizes blood levels and possible side effects of estrogen on the rest of the body.
Additionally, severe vaginal atrophy may respond more quickly to vaginal estrogen therapy than to hormone pills or patches that deliver estrogen throughout the body. Vaginal estrogen should be used at the lowest effective dose, again to limit any effects elsewhere in the body.
Vaginal estrogen is available in several forms, all of which require a prescription: Vaginal creams are applied in small amounts 0. The low-dose vaginal ring, Estring, is inserted into the vagina and worn for 3 months before being taken out and replaced; it does not need to be removed before sex. This low-dose estrogen ring is designed only to treat vaginal dryness and should not be confused with Femring, which is another vaginal ring that releases higher doses of estrogen for treating hot flashes and other symptoms of menopause.
Many women find the estrogen tablet less messy than estrogen creams. The form chosen should be based on your individual preference, factoring in cost and insurance coverage, after discussion with your healthcare provider.
If low-dose vaginal estrogen therapy is right for you, you may also use lubricants and moisturizers as needed. Sometimes, after estrogen therapy has restored the vaginal tissues to a more healthy state, it can be stopped and nonhormonal lubricants or moisturizers can be used alone. To maintain the benefit, however, it is important to continue regular vaginal sexual activity.