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Sexual Desire

Protect your vulvar and vaginal health at every age

by Deborah Saltman, AM MD PhD

For a long time, vulvar and vaginal dryness, irritation and pain have been thought to be problems of menopause. It’s true that they are. But now that women and clinicians are aware of the sensitive perineum (the area between the vulva and the anus), there is increasing recognition that vulvar and vaginal dryness can affect women of any age.

In fact, any condition that reduces the level of the reproductive hormone, estrogen, can cause vulvar and vaginal dryness. Reduced estrogen levels cause changes in the tissues of the vulva, vagina and bladder as the membranes of the vagina produce less lubricating fluid.

This causes dryness that is often accompanied by pain, discomfort and/or itching, and uncomfortable or painful sexual intercourse. It’s not just inconvenient: dryness can affect your daily functioning, your mood, your intimate relationship, and your overall wellbeing.

Once vulvar and vaginal dryness settles in, it is difficult to manage, let alone cure. The answer is to moisturize down there regularly. It is important to find a moisturizer that feels comfortable and long-lasting through the day, but isn’t runny – like Satisfem and Satisfaite™

Younger women are increasingly realizing that their perineum is not just for sexual pleasure and bringing out babies. They are complex organs that need to be taken care of at every age.

Perspiration can dry us out

The body’s fluid regulation and heat regulation are affected by reproductive hormones. Perspiration or sweating is the mechanism by which your body loses heat to cool down. Research shows that during exercise, 70-100% of your metabolism is released as heat in order to maintain the body’s heat balance.

Progesterone, the hormone that regulates the uterus lining also increases your core body temperature, which in turn, delays sweating. Research has shown that estrogen has the opposite effect: it reduces the onset of the sweating threshold, resulting in higher sweat rates for a given core temperature.

However, sweat can create problems for your perineum as it can prevent the body from retaining the fluid necessary to keep your skin and mucosal surfaces moist, plump and hydrated; and not dry, itchy and painful. This is a big problem, particularly for women whose exercise involves some sitting, such bicyclists, triathletes, and rowers. But this problem isn’t limited to athletes. Many of us sit in air conditioning all day, potentially drying us out.

Exercise has a role throughout life

Research has shown that reproductive hormones and exercise are interrelated. Elite athletes have known this for some time. It’s part of what is known as “the female athlete triad” – the phenomenon of low energy availability (i.e. burning more calories than one is taking in) causing menstrual dysfunction and the loss of estrogen, which causes vaginal dryness and low bone mineral density.

Cancer treatment causes early menopause

A diagnosis of cancer and its treatments that can affect the whole body and bring on early menopause at any age. Both chemotherapy and endocrine (hormone) therapies, such as aridimiex, femara and tamoxifen, can cause menopause to occur.

Although cancer is less commonly diagnosed in younger women, more than 250,000 younger women (under 40) are diagnosed with breast cancer alone in the U.S. each year. This early onset menopause and its accompanying symptoms, including vulvar and vaginal dryness, can be particularly challenging for young cancer patients to deal with in the phase of life that they are in, for many reasons.

Childbearing can stretch out delicate tissues

Pregnancy and childbirth can also create challenges for our vulvas and vaginas. After giving birth, your estrogen levels drop, and this can cause vulvar and vaginal dryness and its associated problems.

Stretched tissues that are caused by childbirth create a larger surface area to keep moisturized. The tissues can return to close to their pre partum size and shape, but until they do, the dryness problem can be serious -- especially after the first baby, when most of the damage is done.

Then there’s the complex matter of sexual desire. Research now shows that during the postpartum period, mothers are more sensitive to sensory stimuli created by their babies and less sensitive to those with sexual interest and arousal. This results in some of the mechanisms for lubrication, sexual desire and intercourse, to be diminished, which research showscan affect the sexual and emotional intimacy of couples may be affected due to the changes in women’s sexual function.

Prevention is almost always better than cure. Although vulvar and vaginal dryness can affect women of every age, the good news is that you don’t have to suffer. Moisturize early and often. Set up a plan for a lifetime of enjoying your healthy perineum and not turning the dryness into a medical problem that may be difficult to control.

References:

  • Lester J, Pahouja G, Andersen B, Lustberg M. Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue. J Pers Med. 2015;5(2):50-66. Published 2015 Mar 25. doi:10.3390/jpm5020050
  • Naumova I, Castelo-Branco C. Current treatment options for postmenopausal vaginal atrophy. Int J Womens Health. 2018;10:387-395. Published 2018 Jul 31. doi:10.2147/IJWH.S158913
  • Institute of Medicine (US) Committee on Military Nutrition Research; Marriott BM, editor. Nutritional Needs in Hot Environments: Applications for Military Personnel in Field Operations. Washington (DC): National Academies Press (US); 1993. 3, Physiological Responses to Exercise in the Heat. Available from: https://www.ncbi.nlm.nih.gov/b...
  • Wyndham CH, Morrison JF, Williams CG. Heat reactions of male and female Caucasians. J Appl Physiol. 1965;20(3):357–64.
  • Mehta J, Thompson B, Kling JM. The female athlete triad: It takes a team. Cleve Clin J Med. 2018 Apr;85(4):313-320. doi: 10.3949/ccjm.85a.16137. PMID: 29634467.
  • Lester J, Pahouja G, Andersen B, Lustberg M. Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue. J Pers Med. 2015;5(2):50-66. Published 2015 Mar 25. doi:10.3390/jpm5020050
  • https://www.breastcancer.org/treatment/side_effects/vaginal_dry
  • https://www.youngsurvival.org/learn/about-breast-cancer/statistics
  • Aguirre RMH, González MH, Hernández MP, Gutiérrez CDCA, Guevara MÁ. Observing baby or sexual videos changes the functional synchronization between the prefrontal and parietal cortices in mothers in different postpartum periods. Soc Neurosci. 2020 Aug;15(4):489-504. doi: 10.1080/17470919.2020.1761447. Epub 2020 May 13. PMID: 32402224.

Dr. Deborah Saltman is a family medicine practitioner and has done fellowships of family practices and public health boards. In 2004, Dr. Saltman was awarded the Order of Australia (AM) for services to women’s health and medical education.