Vaginal and Vulval Treatment Options

“The good news is that effective treatment options, such as nonhormone remedies or different forms of low-dose estrogen applied directly to the vagina, are available”.1

Umbrella
What may the Vaginal and Vulval Treatment Options Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Vaginal Estrogen/Oestrogen Products
  • Vaginal Inserts
  • Vaginal and Vulval Lubricants/Moisturizers
  • Vaginal and Vulval Treatment Options

Vaginal and Vulval Treatment Options

What are some menopause vaginal and vulval or Genitourinary Syndrome of Menopause (GSM) treatment options?

On page one and two in Vaginal Dryness: Treatment Options the North American Menopause Society (NAMS) elaborate on:

Vaginal and Vulval Treatment Options

“There are many effective treatment options for GSM, including over-the-counter and prescription therapies. First-line therapies for less severe symptoms include nonhormone over-the-counter lubricants used as needed for sexual activity and moisturizers used regularly (several times per week) to maintain moisture. Prescription therapies include low-dose vaginal estrogens, vaginal dehydroepiandrosterone inserts, and oral ospemifene. Nonhormone lubricants and moisturizers can be combined for optimal symptom relief and can be used in combination with prescription therapies for more severe symptoms.

  • Nonhormone Remedies
    • Vaginal Lubricants…
    • Vaginal Moisturizers…
    • Regular Sexual Stimulation…
    • Expanding Your Views of Sexual Pleasure…
    • Vaginal Dilators…
    • Pelvic Floor Exercises…
  • Vaginal Hormone Therapy…
    • Low-dose local estrogen…
    • FDA-approved low-dose vaginal estrogen products…
    • Dehydroepiandrosterone (DHEA; Prasterone)
    • Low-dose vaginal estrogen or DHEA and a history breast or uterine cancer…
  • Systemic Estrogen Therapy
  • Other Therapies…
    • Ospemifene
    • Vaginal Laser Therapy…”.2

Vaginal Moisturizers and Vaginal Lubricants

What vaginal moisturizers and vaginal lubricants are available?

In Vaginal Atrophy: Diagnosis & Treatment – Treatment the (United States) Mayo Clinic elaborate on:

“To treat genitourinary syndrome of menopause, your doctor may first recommend over-the-counter treatment options, including:

  • “Vaginal moisturizers. Try a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) to restore some moisture to your vaginal area. You may have to apply the moisturizer every few days. The effects of a moisturizer generally last a bit longer than those of a lubricant
  • Water-based lubricants. These lubricants (Astroglide, K-Y Jelly, Sliquid, others) are applied just before sexual activity and can reduce discomfort during intercourse. Choose products that don’t contain glycerin or warming properties because women who are sensitive to these substances may experience irritation. Avoid petroleum jelly or other petroleum-based products for lubrication if you’re also using condoms, because petroleum can break down latex condoms on contact”.3

In Vaginal Dryness: Care and Treatment – How Is Vaginal Dryness Treated? Lubricants and Moisturizers for Vaginal Dryness the Cleveland Clinic explain:

“Lubricants and moisturizers are available without a prescription and can be purchased at drug or grocery stores. They work by replenishing your vaginal tissue and making it wet, which can help with pain during sex. You shouldn’t use moisturizers (such as for your face or body) that aren’t meant for your vagina.

  • Vaginal moisturizers: Apply vaginal moisturizers to the inside of your vagina every few days to keep your vaginal lining healthy. Some examples include Replens™, Luvena® and KY® Liquibeads.
  • Vaginal lubricants: Apply lubricants just before sexual intercourse to ease discomfort caused by sex. Astroglide® and KY® Jelly are examples of water-based vaginal lubricants. There are also silicone-based and oil-based lubricants”.4

Vaginal Estrogen

What is vaginal estrogen?

In Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide the European Menopause and Andropause Society (EMAS) explain:

Vaginal and Vulval Treatment Options

“An individualized approach is required for the management of VVA. Topical low-dose estrogens are effective and also alleviate urinary incontinence and prevent recurrent urinary tract infections. Women should not be denied long-term use of topical estrogens as long as they feel that this treatment is of benefit to them, because the safety data are reassuring.

Non-hormonal preparations (lubricants and moisturizers) should be the first-line treatment for VVA in women taking adjuvant endocrine therapies for cancers considered to be hormone-dependent. They can be used over the long term”.5

On page one in Deciding About Hormone Therapy Use, published July 2022, the NAMS elaborate on:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina. (The MenoNote “Vaginal Dryness” covers this topic in detail)”.6

In Vaginal Atrophy: Diagnosis & Treatment – Treatment the Mayo Clinic elaborate on:

  • “Topical Estrogen
    • Vaginal Estrogen Cream (Estrace, Premarin)…
    • Vaginal Estrogen Suppositories (Imvexxy)…
    • Vaginal Estrogen Ring (Estring, Femring)…
    • Vaginal Estrogen Tablet (Vagifem)…
  • Ospemifene (Osphena)…
  • Prasterone (Intrarosa)…
  • Systemic Estrogen Therapy…
  • Vaginal Dilators…
  • Topical Lidocaine…
  • If you’ve had breast cancer…”.7

On page three in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, published 10 June 2022, one of the recommendations is:

  • “Low-dose and ultra-low dose vaginal oestrogen preparations can be taken by perimenopausal and menopausal women experiencing genitourinary symptoms and continued for as long as required. All vaginal oestrogen preparations have been shown to be effective in this context and there is no requirement to combine vaginal oestrogens with systemic progestogen treatment for endometrial protection, as low-dose and ultra-low dose vaginal oestrogen preparations do not result in significant systemic absorption or endometrial hyperplasia”.8

Other Options

What other options are available?

In Vaginal Atrophy: Diagnosis & Treatment – Treatment the Mayo Clinic elaborate on:

  • “Ospemifene (Osphena)…
  • Prasterone (Intrarosa)…
  • Systemic Estrogen Therapy…
  • Vaginal Dilators…
  • Topical Lidocaine…
  • If you’ve had breast cancer…”.9

Health Care Provider

What if I would like to make down there less bothersome?

If you would like to make down there less bothersome, it may be in your best interest to choose to talk to your health care provider about this.

In Vaginal Discomfort: Discomfort Not Directly Related To Menopause the NAMS note:

“Because vaginal discomfort can arise from so many different sources, persistent symptoms of dryness, irritation, burning, itchiness, or pain should be evaluated by a healthcare provider to determine their cause”.10

In Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor the Mayo Clinic encourage us to:

“Make an appointment with your doctor if you have any unexplained vaginal spotting or bleeding, unusual discharge, burning, or soreness.

Also make an appointment to see your doctor if you experience painful intercourse that’s not resolved by using a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) or water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others)”.11

Health Topics A-Z

Where may I find Health Topics related to Vaginal and Vulval Treatment Options?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

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Links

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New or Updated

  1. Are Probiotics Good for Vaginal Health?
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  3. Australian and New Zealand Vulvovaginal Society: Patient Information About Vulval Diseases
  4. Bioidentical Hormones Explained – A British Menopause Society Video
  5. Bioidentical Hormones: Are They Safer?
  6. Caredownthere.com.au
  7. Complementary Medicine Options for Menopausal Symptoms
  8. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  9. Consumer Health: Treating Vaginal Dryness After Menopause
  10. Deciding About Hormone Therapy Use
  11. Disorders of the Vulva: Common Causes of Vulvar Pain, Burning, and Itching
  12. Douching
  13. Dr. Stephanie Faubion – Genitourinary Syndrome of Menopause
  14. Early Menopause: Women’s Experiences – Resources and Information
  15. Early Treatment of Vulvovaginal Atrophy May Prevent Distressing Symptoms
  16. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity In Women With Postmenopausal Vaginal Symptoms A Randomized Clinical Trial
  17. Estrogen (Vaginal Route)
  18. Experiencing Vaginal Dryness? Here’s What You Need To Know
  19. Find A Menopause Practitioner [United States and Other]
  20. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  21. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  22. Five Things You Didn’t Know About Vaginas & Vulvas — Free Health Article
  23. Gynecologic Cancer Awareness Month [September, United States]
    VulvaVulva
  24. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  25. Hormone Replacement Therapy (HRT): Alternatives
  26. Hormone Replacement Therapy (HRT): Types
  27. Hormone Therapy: Is It Right for You?
  28. How Do I Deal With Vaginal Atrophy? — Ask Dr Jean
  29. International Society for the Study of Vulvovaginal Diseases: Patient Handouts
  30. International Society for the Study of Women’s Sexual Health: Find A Provider
  31. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Hormone Replacement Therapy (HRT) [+ Video: Is HRT Bad for You?]
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  37. Menopause FAQs: Menopause Symptoms – Q. How can I counteract vaginal dryness during menopause?
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  39. Menopause Preparedness Toolkit Video Series: Common Conditions Associated With Menopause and Midlife
  40. Menopause Symptoms and Relief
  41. Menopause Treatments: What Works, What Doesn’t
  42. Menopause: Diagnosis & Treatment
  43. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  44. Menopause: Menopause – Hormone Treatments
  45. Menopause: Symptoms & Causes
  46. National Center for Complementary and Integrative Health: Herbs At A Glance
  47. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  48. National Center for Complementary and Integrative Health: Menopausal Symptoms: In Depth
  49. National Center for Complementary and Integrative Health: Natural Doesn’t Necessarily Mean Safer, or Better
  50. National Center for Complementary and Integrative Health: Sage
  51. Non-Estrogen Treatments for Menopausal Symptoms
  52. Patty Brisben Foundation for Women’s Sexual Health
  53. Patty Brisben Foundation for Women’s Sexual Health: Guide To Sexual Health Providers
  54. Patty Brisben Foundation for Women’s Sexual Health: New! Vulvovaginal Pain Log
  55. Safety of Vaginal Estrogens: A Recap of A Systematic Review [Video]
  56. Statement from FDA Commissioner Scott Gottlieb, M.D., on Efforts To Safeguard Women’s Health From Deceptive Health Claims and Significant Risks Related To Devices Marketed for Use In Medical Procedures for “Vaginal Rejuvenation” [Food and Drug Administration, United States]
  57. Symptoms of Menopause
  58. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  59. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data
  60. The Vaginal Laser Therapy Versus Vaginal Estrogen Therapy: The VeLVET Trial
  61. Tips To Help Manage Menopause Symptoms
  62. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide
  63. Urogenital Atrophy Explained – A British Menopause Society Video
  64. Urogenital Problems
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  66. Vaginal Atrophy
  67. Vaginal Atrophy: Diagnosis & Treatment – Treatment
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  69. Vaginal Dryness
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  71. Vaginal Dryness
  72. Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it?
  73. Vaginal Dryness Alternative Treatments
  74. Vaginal Laser Therapy
  75. Video Series-2021: Common Issues Surrounding Sexuality and Menopause
  76. Video Series-2021: Treatment Options for Vaginal Dryness and Urinary Issues
  77. Video Series-2022: Discussing Sexual Health Concerns With Your Health Care Professional
  78. Vulva & Vaginal Irritation: Management & Treatment [+ Video]
  79. Vulvovaginal Atrophy
  80. Vulvovaginal Health
  81. Webinars: Previous – Sexual Health Issues In Menopause
  82. What Is Vaginal Steaming and Is It Safe?
  83. When Sex Hurts – Podcast [Vaginismus and Vulvodynia]
  84. When Sex Is Painful
  85. Why You Should Never Douche
  86. Wild Yam

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Vaginal Dryness: Treatment Options. 2022:1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 04 January 2023
  2. Vaginal Dryness: Treatment Options. 2022:1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 04 January 2023
  3. Vaginal Atrophy: Diagnosis & Treatment – Treatment. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/diagnosis-treatment/drc-20352294 Accessed: 04 January 2023
  4. Vaginal Dryness: Care and Treatment – How Is Vaginal Dryness Treated? Lubricants and Moisturizers for Vaginal Dryness. Last Reviewed: 26 July 2022. Cleveland Clinic https://my.clevelandclinic.org/health/symptoms/21027-vaginal-dryness Accessed: 04 January 2023
  5. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide. 13 April 2021. European North Menopause and Andropause Society https://www.maturitas.org/article/S0378-5122(21)00061-X/fulltext Accessed: 04 January 2023
  6. Deciding About Hormone Therapy Use. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 04 January 2023
  7. Vaginal Atrophy: Diagnosis & Treatment – Treatment. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/diagnosis-treatment/drc-20352294 Accessed: 04 January 2023
  8. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 04 January 2023
  9. Vaginal Atrophy: Diagnosis & Treatment – Treatment. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/diagnosis-treatment/drc-20352294 Accessed: 04 January 2023
  10. Vaginal Discomfort: Discomfort Not Directly Related To Menopause. North American Menopause Society https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/vaginal-discomfort Accessed: 04 January 2023
  11. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 04 January 2023
Topic Last Updated: 04 January 2023 – Topic Last Reviewed: 04 January 2023

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