Hurricane Irma blew in more than just 70 mph winds. It blew my body into hot flashes and vaginal dryness. It’s hard to tell whether it was amazing timing or my heightened emotional state that pushed me over the edge.
Although I’ve had readers write to me for years about their vaginal dryness, I never experienced it until now. WOW, my compassion factor has went up to level 469! It is definitely a sex drive killer. It’s hard to get excited about sexual intimacy when it hurts.
What’s the deal with vaginal dryness?
It’s all about hormones.
Vaginal dryness is a consequence of the diminished amount of the hormone, estrogen, either due to ovary removal, menopause, or unusual ovarian failure. I fall in the menopause camp.
Hormones are a part of the endocrine system which regulates most of the functions in your body. Hormones are like email instructions sent through the bloodstream from an endocrine gland to a receiving gland or organ. Your body uses over 50 types of hormones. Hormones tell the glands to manage things like the fluid level in your tissue, how your skin reacts to the sun (creates a suntan), how efficiently your body burns calories and uses fat stores, your immune system, digestion, and sex/reproduction.
In this post, we are most interested in the sex hormones estrogen, progesterone, and testosterone. Sex hormones not only direct reproductive capabilities and keep reproductive organs healthy, they also are involved in creating the feelings of sexual interest, sexual arousal, and climax.
Vaginal dryness explained:
The vagina has three layers:
1. the internal mucosal layer,
2. the intermediate muscularis layer, and
3. the external adventitial layer.
All three layers are able to accept messages from estrogen. They have estrogen receptors.
Estrogen is a major regulator of growth and function of the three layers of the vagina. Estrogen tells the tissue to create fluid which keeps the birth canal plump, smooth, and supple, among other things.
With the decrease of estrogen, the tissue may:
1. thin (from approximately 10-20 cell layers to only 3-4),
2. lose collagen (for elasticity) and
3. lose the ability to stay hydrated.
Vaginal tissue, without as much estrogen, can become fragile, easily susceptible to irritation and bleeding from only minimal trauma.
If you suffer from this side of effect of estrogen loss, I’m here to tell you it can be managed successfully with the help of your doctor. (Disclaimer: I want to help you think about some things, but I am not a medical professional.)
One effective and traditional means of easing vaginal dryness and sexual pain is to get a prescription for estrogen replacement from your doctor. The basic mechanism of this oral medication is that it dissolves in your digestive tract, is uploaded into your blood stream, and finds its way to revive your vaginal health. There is also a topical cream and vaginal insert that releases estrogen.
However, there is another way if you want to avoid manufactured molecules.
Recent studies on vaginal dryness have revealed three exciting findings.
After menopause, the dry tissue in your vagina can be changed by medicinal suppositories inserted into the vagina without affecting what is in your blood stream. In other words, the tissue of your vagina comes in contact with the medicine, the medicine helps the vaginal cells return to health and no medicine gets into your blood stream. This process is called intracrinology. It greatly reduces the chance of having a negative side effect because the medicine is not your blood stream. The medicine doesn’t come into contact with any other part of your body.
“As strong support for the mechanism of intracrinology, recent randomized and placebo-controlled studies have shown that all the signs and symptoms of vulvovaginal atrophy can be rapidly improved or corrected by local administration of DHEA without systemic exposure to estrogen,” Labrie, F. (2013). Multiple applications of intracrinology in clinical medicine, Endocrine Abstracts (31)2.
“To illustrate the marked differences between classical endocrinology that distributes hormones to all tissues of the body through the bloodstream and the science of intracrinology, whereby each cell of each peripheral tissue makes a small and appropriate amount of estrogens and androgens from the inactive precursor dehydroepiandrosterone (DHEA), DHEA being mainly of adrenal origin. Because only the inactivated sex steroids are released in the blood, influence in the other tissues is avoided,” Labrie, F., Bélanger, A., Pelletier, G., Martel, C., Archer, D., Utian, W. (2017). Science of intracrinology in postmenopausal women, The Journal of the North American Menopause Society (24)6, 702-712.
If I’m reading this last quote correctly, your cells will only make as much estrogen from the DHEA as they need.
DHEA (dehydroepiandrosterone) is an “inactive hormone precursor” or building block that is produced by your adrenal glands. DHEA can turn into either androgens (like testosterone) or estrogens depending on which cell it comes into contact with. A vaginal cell will create estrogen.
You can think of DHEA like flour. Flour is a building block in baking. It can become cupcakes or cookies depending on what you add to it.
Findings support DHEA is able to revert estrogen deprived vaginal tissue into healthy supple, pain-free tissue through the process of intracrinology discussed above. According to a 2017 study, the DHEA action was limited to the vagina. Blood levels of all sex steroids in the menopausal participants inserting DHEA suppositories were “maintained within normal values of menopause, thus protecting the uterus and most likely other tissues [from being affected]” Labrie, F., & Martel, C., (2017). A low dose (6.5 mg) of intravaginal DHEA permits a strictly local action while maintaining all serum estrogens or androgens as well as their metabolites within normal values, Hormone Molecular Biology and Clinical Investigation (29)2.
After the age of 30, your adrenal glands produce less and less DHEA. By the time you hit menopause, you are producing about 60% less than you were at 30. At menopause, not only have you lost the ovarian estrogen, you’ve also lost some estrogen building block.
Third finding – DHEA may increase sexual function!
According to a 2009 study, DHEA inserted vaginally can have significant positive affect on 4 areas of sexual health:
3. orgasm, and
4. minimizing pain during sexual activity.
In a placebo, double-blind study involving 200 menopausal participants all four domains of sexual dysfunction were positively addressed by intravaginal DHEA with no interaction on the brain or other tissue in the body. This was confirmed through blood analysis.
“By a local action in the vagina, DHEA applied daily at doses at which serum steroids remain well within normal postmenopausal values exerts relatively potent beneficial effects on all four aspects of sexual dysfunction,” Labrie, F., et al. (2009). Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women, Menopause: The Journal of The North American Menopause Society (16)5, 923-931.
With anything there are pros and cons. It is important to take opposing viewpoints into consideration. It helps to understand the good/bad of an issue and make an informed decision.
Most opposing viewpoints for DHEA use are in regards to taking it by mouth. When you take it by mouth, DHEA flows through your blood stream and affects your entire body. At the end of this article are 4 negatives about DHEA.
The crux of the studies I’ve pointed to show the benefit of DHEA when administered intravaginally. Dr. Labrie concludes that because blood serum levels are not affected with intravaginal DHEA, side affects are nearly non-existent.
If you take DHEA orally, this WebMD article lists of side affects and risks. Also, here is a personal account of oral DHEA use and what she found to be negative about it: DHEA and worrying side affects.
Another factor that isn’t exactly an argument, but could be troubling, is most of the current data was collected by the same lead scientist, Dr. Fernand Labrie. When it comes to intracrinology, I could find very little outside of this one doctor’s work, although the different studies had different teams working with him. His studies were published in credible journals that are peer reviewed. This means he followed protocol for the scientific method which is supposed to limit the bias of research.
My personal experience
Three months ago, I chose to use 25 mg of intravaginal DHEA daily. My results are pleasing. With the advice of my compounding pharmacist, I merely used a regular capsule not a special suppository.
I waited three months to write about this to see if I had any side effects. I have not experienced any. The side effects of DHEA are very similar to taking too much testosterone, acne, lowered voice, and mood swings.
In conjunction with the DHEA, I have been applying olive oil. Olive oil is an old remedy for vaginal dryness. It is not inserted vaginally. It’s applied daily to the perineal area (between the vagina and anus). I feel the two are working well together, helping me regain what was starting to be lost. Intimacy is once again very comfortable with a nice conclusion.
Even though it is a relief that my sexual health is so much better, there is still tenderness if not enough preparation is made (foreplay) before we try to proceed. If that happens to you, just back up a step or two and give more time to let your erectile tissue become more fully aroused. I cannot say that I am back to pre-menopause levels, but pretty darn near!
Here is one last article I highly encourage you to read. It references over 70 scholarly articles and is a very thorough treatment of DHEA. It outlines all the different ways DHEA can affect your body. Since it is a hormone building block, it affects more than just sexual function. DHEA Therapy.
If you have dealt with a cranky vagina, DHEA is worth considering. However, I highly encourage you to do your own research! Talk to your doctor. (Some doctors may not be aware of this research, so take the studies to them.)
For more information on finding answers to menopause related sexual issues, please see Female Sexual Dysfunction by my good friend, Chris, at the Forgiven Wife.