What are the treatment options for vaginal dryness?

Treatment Options for Vaginal Dryness

Non-hormonal, water-based lubricants and moisturizers are the first-line treatment for vaginal dryness, providing effective symptom relief with minimal side effects. 1

First-Line Treatment Options

Non-Hormonal Moisturizers and Lubricants

• Moisturizers: Apply 2-3 times weekly for ongoing maintenance
  • Work by hydrating vaginal tissues and providing longer-lasting relief
  • Examples include hyaluronic acid-based products, which have shown an 84.44% improvement rate in clinical symptoms 2
• Lubricants: Use during sexual activity as needed
  • Water-based lubricants are preferred for most women
  • Silicone-based products may last longer than water-based or glycerin-based products 3

Application Recommendations

• Moisturizers should be applied regularly (2-3 times weekly) regardless of sexual activity
• Lubricants should be used specifically during sexual activity
• A combination of both therapies may provide additional short-term comfort 3

Second-Line Treatment Options

Pharmacological Options

• Ospemifene (Osphena): FDA-approved oral medication for moderate to severe vaginal dryness
  • Dosage: One 60 mg tablet with food once daily 4
  • Clinical trials showed statistically significant improvement in vaginal dryness compared to placebo 4
  • Contraindications:
    • Undiagnosed abnormal genital bleeding
    • Known or suspected estrogen-dependent neoplasia
    • Active DVT, pulmonary embolism, or history of these conditions
    • Active arterial thromboembolic disease or history of these conditions 4

Topical Hormonal Options

• Low-dose vaginal estrogen: Consider if non-hormonal measures are ineffective

  • Available as vaginal tablets, creams, or rings
  • Results typically take 6-12 weeks to become noticeable 3
  • Caution: The safety in women with a history of breast cancer is not well established
  • Contraindicated: In women on aromatase inhibitors and those with estrogen-dependent neoplasia 3, 1

• Vaginal DHEA (prasterone): May be suitable for women who cannot use estrogen

  • Contraindicated: In women with a history of breast cancer 1

Special Considerations

For Breast Cancer Survivors

• Non-hormonal options are strongly preferred
• The American Cancer Society and American Society of Clinical Oncology recommend:
  • Non-hormonal, water-based lubricants and moisturizers as primary treatment 3
  • Avoid hormonal therapies for women on aromatase inhibitors 3

For Dyspareunia Secondary to Vaginal Dryness

• Consider additional interventions:
  • Vaginal dilators for vaginal stenosis
  • Pelvic floor relaxation techniques 3
  • Pelvic floor physical therapy may improve sexual pain, arousal, and satisfaction 1

Monitoring and Follow-up

• Regular follow-up is necessary to assess symptom improvement
• Monitor for any abnormal vaginal bleeding, which warrants further investigation 1
• For women using hormonal therapies, annual clinical review is essential to assess ongoing need and compliance 1

Complementary Approaches

• Topical vitamins (D or E) may help alleviate vaginal dryness and burning sensations 1
• Increased fluid intake may help with overall hydration 1
• Cognitive behavioral therapy can address psychological aspects of sexual dysfunction related to vaginal dryness 1

Common Pitfalls to Avoid

1. Using products with unphysiological pH or high osmolality, which can cause irritation 5
2. Delaying treatment, which can lead to worsening symptoms and sexual dysfunction
3. Using hormonal therapies in women with contraindications
4. Failing to recognize that vaginal dryness may be underreported due to embarrassment or stigma

By following this treatment algorithm and selecting appropriate options based on individual contraindications and preferences, vaginal dryness can be effectively managed in most women.