Vaginal Dryness
Vaginal dryness (VD)
Vaginal dryness is a problem for all reproductive aged women and older
Vaginal dryness is common during and after menopause.
Can be a symptom of vaginal atrophy (a thinning and loss of elasticity
of the vaginal lining and shortening of vaginal canal). A consequence of
hormonal changes, usually a disproportionate complete loss of
PROGESTERONE compared to only ~40% drop in
estrogen - termed
estrogen dominance .Vaginal dryness is also experienced by reproductive age women. E.g. 17% of women aged 18-50
during
sex Womens Health Concern, 2020 )Vaginal dryness is especially prevalent in pre-menopausal women with low levels of
estrogen . E.g. breastfeeding mothers, those who have had ovaries removed or received chemotherapy,
which can damage ovaries.
The vagina is normally lubricated by its mucus membranes
The walls of the vagina
have a mucus-membrane lining covering muscles (normally in a relaxed
state), which touch each other and have many folds (rugae).
These folds enable the vagina
to expand during intercourse and childbirth (and also provide a large surface
for topical absorption of medications).
Estrogen
supports a lubricated and thick vaginal lining. Estrogen is
known to proliferate these cells and the layers below it to thicken the
vaginal wall.
Topical and systemic estrogen
increases membrane collagen content and supports lubrication (increases mucopolysaccharides
and hyaluronic acid)
Vaginal lubricating fluid
Vaginal lubricating fluid is slightly acidic and travels slowly through the
vagina removing dead cells. This keeps the mucous membrane lining clean, supple
and moist, supporting a healthy microflora. When the hormone
progesterone peaks during the luteal (post-ovulation) phase,
vaginal secretions turn cloudy or white. When estrogen is the dominant hormone (pre-ovulation),
discharge tends to be clear, stretchy, or watery.
Lubricating fluid comes from 3
sources (The
vagina itself does not contain lubricating glands)
1. Produced by glands at the cervix
(at neck of womb)
Cervical mucus is secreted by epithelial cells lining the
cervix to facilitate sperm travel to the uterus and remove microbes.
Predominantly composed of water and mucins, dervical mucus also contains high levels of immuno-active
proteins such as immunoglobulin A (IgA), lactoferrin and lysozyme which protect
against infection by blocking adhesion and mediating microbial killing.
Additionally, some vaginal lubrication originates from the uterus.
2. Ultrafiltrated blood
( from the vaginal capillaries)
Fluid
is composed of
water and small proteins combined with dead epithelial cells from the vaginal
lining. Sufficent blood pressure in the pelvic area, requiring the
bioavailability of nitric oxide (NO) , pushes this lubricating fluid from the
capillaries through intracellular gap junctions between vaginal epithelial
cells. Gaseous NO is produced in capillary endothelia to induce vasodilation and
its production depends on the enzyme NO synthase (eNOs), which is enhanced by
steroid hormones, most notably
estrogens: Estriol
and Estradiol , and
is decreased by hyperglycemia. Since an inflammatory environment
invokes feedback mechanisms in the body to suppress high NO production (which
can increase production of free radicals), low inflammatory conditions are more
conducive to supporting the bioavailability of NO in facilitating vaginal
lubrication.
3.the two Bartholin'sglands and
the Skene glands
(at the entrance of the vagina)
Extra moisture is provided by these glands when stimilated
by sexual excitement for sexual intercourse.
What can cause vaginal dryness?
Dehydration
Water - 2/3
of you!
Low estrogen levels
May be due to:
Menopause - estrogen
levels decrease with ageSevere stress and/or depression.
Anti-estrogen /
estrogen -lowering medications - such as
antidepressants: fluoxetine (Prozac) and sertraline (Zoloft). use of
nuvaring for birth control.Thyroid disorders Polycystic ovary syndrome (PCOS)Low functioning pituitary gland Low body weight Excessive exercise Stopping
estrogen -based birth control (BC). The body reduces
estrogen production to adjust to exogenous
estrogen in BC. Estrogen levels
may be low until the body readjusts its production levels after stopping BC.
Chemotherapy Radiation to pelvic area Smoking Removal of ovaries / Ovarian insufficiency Chronic kidney disease Post childbirth / breast-feeding
Stress ==> low PROGESTERONE
levels => low ALDOSTERONE => fluid loss
All kinds of stress (such as anger, anxiety, depression, trauma, sleep
deprivation, over-exercising, nutrient deficiencies . . . you name it!) promote
production of stress-related hormones. Produced by the "stress
management" adrenal glands, these hormones are the neurotransmitter
adrenaline (epinephrine) , and
glucocorticoids, such as
CORTISOL, to induce "fight or flight" mechanisms to cope with the stress.
The steroid hormone Progesterone is the raw
material used to synthesize the glucocorticoids, such as
Cortisol , as well as the mineralocorticoids, such as
ALDOSTERONE
(a hormone which balances water and salt in the body), DHEA
hormone
(the precursor to both the male and female sex steroid
hormones, and the neurotransmitter NOREPINEPHRINE .
Chronic (ongoing) stress can both deplete the body's available PROGESTERONE and also cause adrenal fatigue, which
then decreases production of
ALDOSTERONE and CORTISOL (and
other glucocorticoids).
ALDOSTERONE promotes water retention and swelling. Conversely, a
deficiency of
ALDOSTERONE will cause fluid loss and so contribute to vaginal dryness.
(Although a
building block of ALDOSTERONE , under normal ALDOSTERONE
presence, PROGESTERONE
also blocks ALDOSTERONE receptors, thereby
promoting normal
PROGESTERONE:
increases Epidermal growth factor-1 (EGF-1) -
which plays a vital role in the production of collagen,
elastin, and hyaluronic acid for epithelial / epidermal growth - needed to
prevent vaginal atrophy. EGF has
estrogen -like effects in the promotion of cell growth in the reproductive tract
and EGF may serve as an important mediator of estrogen action in vivo.
PubMed mice study Optimizes libido / restores normal sexy feelings;
Is calming and anti-depressive.
In the brain, PROGESTERONE activates
receptor sites for GABA , an inhibitory neurotransmitter, which decreases anxiety
and depression. (Anti-depressants and barbituates bind these same receptors). PROGESTEROne also
raises SEROTONIN hormone
levels in brain;
Functions of PROGESTERONE in the body
Antidepressants / Anti-anxiety medications
Antidepressants SSRIs (E.g. Prozac)
and/or SNRI's (E.g. Cymbalta) have been shown to cause vaginal
dryness , decreased genital sensations, decreased libido, and difficulty
achieving orgasm
Post-SSRI/SNRI Sexual Dysfunction (PSSD). Newly recognized by some as iatrogenic (caused by medication or medical treatment),
described as a long-term (months /years) after-effect of taking SSRI's or
SNRI's. Well-referenced article
Canadian PSSD Society
SNRI's (Serotonin and
norepinephrine reuptake inhibitors). Used to
treat major depressive disorder, anxiety disorders, social phobia,
chronic neuropathic pain, fibromyalgia syndrome, and menopausal symptoms. SNRIs increase the presence of the hormonal
neurotransmitters SEROTONIN and
NOREPINOPHRINE (aka. NORADRENALINE, released by
adrenal glands atop the kidneys).
Side-effects of SNRIs are mouth and vaginal dryness and reduced libido.
E.g. Cymbalta (duloxetine). This SNRI drug is used to
treat depression, anxiety, and certain nerve or muscle pain conditions.
Duloxetine INCREASES estrogen levels.
Interestingly, the FDA warns that one of its side-effects is to cause suicidal
tendencies, especially in younger people.
SSRI's (Serotonin reuptake inhibitors). Used to increase the presence of
the hormonal neurotransmitter SEROTONIN . SNRI's are used to increase the presence of the hormonal
neurotransmitters SEROTONIN .
E.g. Prozac (fluoxetine) and Zoloft (sertraline). These drugs are used to
treat depression, obsessive-compulsive disorder (OCD), panic attacks,
post-traumatic stress disorder (PTSD), and social anxiety. Twoof the side-effects of
SSRI's are to DECREASE
estrogen and cause
mouth and vaginal dryness
Imbalanced vaginal microbiome / pH
A healthy vaginal state is usually dominated by Lactobacillus, low diversity
of anaerobic bacteria, and a balanced vaginal immune system (e.g.
pro-inflammatory and anti-inflammatory cytokines).
Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining
vaginal health
The Lactobacillus bacterial species dominates the normal vaginal flora.
They metabolize the high concentration of glycogen in vaginal epithelial cells into lactic acid, which
(1) helps maintain the healthy acidic pH of 3.5 to 4.5 in the vagina and (2)
produce antimicrobial substances, to discourage the growth of pathogenic
microorganisms which can cause vaginal infections, such as UTI's and bacterial vaginosis (BV). Estrogen
stimulates the epithelial cells lining the vaginal walls to produce glycogen,
a food source for Lactobacillus .
The most common species found
in the vagina are Lactobacillus crispatus, L. gasseri, L. iners,
and L. jensenii . Most probiotics and yogurt contain other species, such as L.
rhamnosus or L. acidophilus (more common in the gut).
Aerobic vaginitis (AV) is a form of vaginitis characterized by a some level
of disruption of the usual lactobacilli flora, combined with inflammation,
atrophy and the presence of predominantly aerobic microflora (Staphylococcus
aureus and Escherichia coli) , some possibly
pathogenic. Sometimes AV presents a yellow discharge with AV.
Contact dermatitis
Causes an itchy rash - look for any change that may be the culprIt, possibly causing an
allergic reaction:
Vaginal lubricants and spermicides; latex condoms / diaphragms; Scented toilet paper, shampoos and body wash, fabric softeners,
laundry detergent, tampons and sanitary pads.
Sjogren's syndrome
This autoimmune condition damages the body's secretory glands preventing tears and saliva, as well as secretions of the vagina
and gastrointestinal tract. It mainly affects women aged 40 - 60.
Women are more susceptible to auto-immune diseases than men. A study using
mice found that
increased autoantibody production in females can be attributed to the effect of
estrogen on the immune response.
PubMed
PubMed
Many lifestyle changes, including stress or nutrient deficiencies / excesses can
result in an Imbalance between hormones - major ones being
estrogen ,
testosterone , progesterone ,
cortisol , insulin , and
thyroid hormone . Even a slight
imbalance between these hormones can lead to inflammation, cell dysfunction, and
tissue damage --- all contributing factors in autoimmune conditions.
Miscellaneous
Soaps, laundry detergents, lotions, perfumes, or douches in vagina.
Can exacerbate irritation
UTIs, Yeast infection
Treatments to aid vaginal lubrication
Hydrate / Drink water
Relieve stress
Successful non-drug
techniques to use include:
SOTA Bio-Tuner and
Meridian Tapping
Technique
Personal habits
Wear loose pants or dresses and soft cotton underwear
Avoid perfumed soaps when washing the vaginal area
Increase estrogen presence in vaginal lining
LOW DOSE topical natural estrogen (applied to vaginal membranes) -
The dose should be low enough to have only localized effects. Systemic estrogen is not advised, since it
enters the blood and can cause hormonal imbalance in
the body. Also TESTOSTERONE and/or
DHEA may be appropriate.
Maintain a healthy gut microbiome. In
vitro analysis
demonstrated the ability of 35 bacterial enzymes in the human gut to
reactivate two distinct estrogen glucuronides (estrone-3-glucuronide and
estradiol-17-glucuronide) to estrone and
estradiol , allowing estrogens to be reabsorbed into
the body instead of exiting via the gut.
PubMed
Increase NO presence in vaginal capillaries to increase blood
flow
The main factors involved in eNOS activity (the enzyme
promoting nitric
oxide (NO) production and increased blood flow) include estrogens
(Estriol or
estradiol) , phyto-estrogens in flaxseed / soy products, testosterone, some medicines,
vitamins and supplements, niacin (B3) ,
calcium , ginseng, and ACE inhibitors (ACE-i).
Vitamins / nutrients
Vitamin A - helps moisture content
and collagen production for mucous membranes
Vitamin B-Complex (50mg / day)
Vitamin E - aids
hydration - topical application of vit E suppositories, supplement natural
mixed-tochopherols or consume E in sunflower
and pumpkin seeds;
Omega-3 - Daily: 2 Tbsp. flax seed (grind and consume within 20
minutes) + 1 Tbsp. quality
flax oil (E.g. Flora, Spectrum) made water-soluble by first mixing with 1
Tbsp. whey protein powder OR 2 Tbsp. cottage cheese OR 3 Tbsp yogurt. Can add to
blender drink or use your imagination. It must not be heated above about 110
deg. F.Omega-7 - Sea buckthorn oil;
topical application to vaginal membranes
Calcium - required for eNOS
enzyme, used to convert L-arginine to NO and increase blood flow.
Calcium in green leafy
vegetables, dairy products, nutsL-Arginine - this amino acid
is the raw material for NO production. Foods HIGH IN L-ARGININE include: nuts (almonds, walnuts, hazelnuts),
berries, chocolate, beans, fish, chicken, sunflower and flax seed
Probiotics
Probiotics improve lubrication throughout the body, including vaginal secretion, tears
and saliva.
Probiotics can be
taken orally to support the vaginal microbiome via the gut microbiome. Probiotics are usually freeze-dried and lactic acid species such as
Lactobacillus are generally susceptible to temperatures above 50C (122F).
Study link
Oral probiotics. Follow dose suggested on label. If you do not
feel any discomfort, such as an upset stomach, take twice daily the first month to boost recovery. After 1 month, you can
return to the usual health maintenance dose.
Probiotics inserted into the vagina have localized benefits.
Make a suppository by mixing contents of probiotic capsule with some kind of fat
that hardens when cold (e,g, cocoa butter)..Some women insert active
Lactobacillus -containing yogurt into the
vagina whilst laying on their back (can use a syringe or make
home-made frozen suppositories). Vaginal inserts can be messy!
Not all lactobacilli probiotic strains are effective in the vagina. A commercial probiotic strain, L.
rhamnosus GG , is apparently not well
suited to colonizing the vagina nor is L.
acidophilus. L. fermentum RC-14 and L. rhamnosus GR-1 represent the first
probiotic combination taken orally to reduce vaginal colonization by pathogenic
bacteria and yeast.
Link
References
Myrtle Wilhite MD, MS, in Integrative
Medicine (Fourth Edition) , 2018
