Vaginal problems: treatments

VAGINAL DRYNESS

Lack of estrogen can cause dryness and thinning of the vaginal tissues making intercourse uncomfortable or even painful. The first sign of an effect of reduced estrogen on the vagina is reduced lubrication during sexual activity. HRT can alleviate this but even if you cannot take systemic HRT you may still be able to use estrogen topically to the vagina. This is available in a few forms; creams administered via applicators, waxy pessaries, small tablets inserted with an applicator or a vaginal ring which stays in place for 3 months at a time. For creams, pessaries or vaginal tablets, the initial dose is 1 application nightly for 2 weeks, followed by the maintenance dose of 1 application twice weekly. Low dose vaginal estrogen preparations can be used long term without causing any known systemic effect, and without needing any progestogenic protection of the lining of the womb.

Even if you cannot or do not want to use hormones there are other options. Over the counter bio-adhesive vaginal moisturisers are very effective. A range of products are available, many of which are easier to use than KY jelly, which is water based and more slippery. These moisturizers are also slightly acidic which helps prevent vaginal infections. One other advantage is that they do not need to be used at the time of intercourse. Some women have found a Tea tree oil based product helpful. Several non-hormonal vaginal products can be also be prescribed and include Replens MD, Hyalofemme, Sylk, And the vaginal ovule Repadina.

Please note: Patients should consult a health professional to decide on the appropriate treatment option to be prescribed.

Local estrogen can be used for vaginal and bladder symptoms, when systemic treatment is not desired or appropriate. For some women, vaginal estrogen may be required along with systemic HRT.

• Estrogen creams, pessaries and tablets - initial dose is nightly for 2 weeks, followed by twice weekly applications for maintenance.
• Vaginal ring should be replaced every 3 months.
• Repadina – I vaginal ovule nightly until symptoms controlled, then used as required.
• Replens – 1 application 3 times weekly in the morning.
• Sylk - use as required.
• Hyalofemme - once every 3 days.

Download a checklist of vaginal atrophy symptoms you can print out and take to your GP or nurse to help you start a discussion: PDF (47K) or Word (47k)

Page last updated: 6 December 2011