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. The protective vaginal surface lining is mostly comprised of squamous epithelial cells. 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 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)
(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.
( 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.
(at the entrance of the vagina)
Extra moisture is provided by these glands when stimilated by sexual excitement for sexual intercourse.
May be due to:
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), the 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 other mineralocorticoids) 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 fluid loss and decreasing swelling).
PROGESTERONE:
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 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
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.
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.
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.
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.
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.
Soaps, laundry detergents, lotions, perfumes, or douches in vagina. Can exacerbate irritation
UTIs, Yeast infection
Successful non-drug techniques to use include: SOTA Bio-Tuner and Meridian Tapping Technique
Wear loose pants or dresses and soft cotton underwear
Avoid perfumed soaps when washing the vaginal area
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
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).
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
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
Myrtle Wilhite MD, MS, in Integrative Medicine (Fourth Edition), 2018
