Use It or Lose It: Fact or Fiction About Vaginal Lubrication?

If you’ve read enough of my past blogs, you’d think the whole world is experiencing dry, painful intercourse — and that without the benefit of a great lube, a local vaginal estrogen, ospemifene (a non-estrogen oral medication), or a CO2 laser treatment, women are doomed to a destiny of sandpaper sex or no sex. But that’s not the case.

Before menopause, the majority of women don’t require anything other than the occasional lubricant. Post-menopause, only about half of women have lubrication trouble.

So what separates the two groups: Good genes, good diet, or good luck?

When it comes to vaginal elasticity and lubrication, a number of factors besides estrogen and age have a role. Certain medications have a negative impact, for example, and women who’ve never had a vaginal delivery are more likely to have vaginal tissue that becomes dry. Other contributors to a lack of lubrication are inadequate blood flow to the vaginal walls due to the normal aging process, a medical problem such as diabetes, and cancer treatment.

Another factor beside age, medical problems, and luck is the value of regular use.

Vaginal Lubrication and Regular Intercourse

Regular stimulation of vaginal tissue helps maintain blood flow, which in turn increases lubrication and elasticity. And that’s where “use it or lose it” comes into play.

Women who have had a long sexual hiatus are more likely to experience vaginal dryness than women who are regularly having intercourse.

So what’s a woman to do when she’s between partners, or has a partner who’s out of business, to keep her tissue from drying up?

In many cases, the changes destined to occur from lack of use are preventable. You may have to get creative and be consistent about stimulating blood flow. Regularly inserting a dildo or a vibrator should help maintain vaginal lubrication and elasticity. And just like going to the gym, you will probably enjoy it once you get started!

Of course, if your vaginal tissue is already very thin and dry, a little repair work may be in order in the form of a prescription product like vaginal estrogen. One of the most common questions I get when I prescribe a local vaginal estrogen is, “How long will this treatment be necessary?”

In general, my answer is “forever,” because once the treatment is discontinued, the vagina will become thin and dry again. But in my experience, for many women who have had a long hiatus, a local vaginal estrogen repairs the situation and they maintain vaginal elasticity by regular stimulation — they don’t need to continue using a prescription.

So if you have no pain, but alas, no partner, stimulate with a device to keep things good to go. Use it or lose it.

Eliminating Sandpaper Sex with Laser Treatments

Not only can you laser your face smooth, laser your pubic hair away, and laser off regrettable tattoos — now you can also laser your vagina

Not only can you laser your face smooth, laser your pubic hair away, and laser off regrettable tattoos — now you can also laser your vagina

In spite of the many safe options to treat what I’ve dubbed sandpaper sex, only 7 percent of affected women use a prescription product that goes beyond what a lubricant or a long-acting moisturizer can do to alleviate dry, painful intercourse.

There are a number of reasons that this number is so low:

  1. Many women are not distressed by the inability to have intercourse; they think it’s not important enough to treat.
  2. Some women don’t want , or can't afford,  to use a pharmaceutical product on a regular basis.
  3. Many women, despite reassurances, are concerned about side effects from local vaginal estrogen or Osphena tablets.
  4. Often, a woman’s physician advises against using local vaginal estrogen. 

If you fall into the first category, you probably stopped reading this article already. But the other categories are a different story, and those women either abandon sexual activity altogether or put up with the pain. In fact, in a of sexual behavior in more than 3,000 postmenopausal women, 73 percent admitted they silently endured painful intercourse to please their partner.

But there’s a new solution for women who prefer not to use estrogen or have been advised to avoid it: vaginal laser treatments, a new non-estrogen option to treat vaginal dryness and thinning.   You read that right. Not only can you laser your face smooth, laser your pubic hair away, and laser off regrettable tattoos — now you can also laser your vagina.

How Laser Treatment for Vaginal Dryness Works

The Mona Lisa Touch is an FDA-approved medical carbon dioxide (CO2) laser that delivers controlled energy to both the surface and the deeper layers of vaginal tissue to stimulate your cells to make more collagen. The result is restoration of lubrication and elasticity that had vanished as a consequence of menopause, surgery or cancer treatments.

The laser treatment involves three five-minute sessions performed in a doctor’s office, spaced six weeks apart. No anesthesia is required, and most women report feeling only gentle vibration while a slender laser probe is in the vagina.

Women in a recently presented clinical trial reported that after the treatment, they had significantly less dryness, pain, and irritation, along with a dramatic improvement in sexual pleasure.

So what are the downsides of vaginal laser treatment? Really only two things.

First, there have been no long-term studies on the procedure, though it’s unlikely to have long-term adverse effects. And second, it’s hard to say how long the results will last. After the initial three treatments, the manufacturer recommends one treatment every year to maintain the results.  Vaginal laser treatment has been used both here and in Europe in over 25,000 women. In clinical studies, the overwhelming majority of women are pleased with the results.

The main problem is that medical CO2 laser treatments for vaginal dryness are expensive and not covered by insurance: Three treatments are in the neighborhood of $3,000. If the results last for years, clearly the procedure is worth it, but you still have to come up with the cash. One woman told me the choice was between pleasurable sex for a year, or a vacation in Florida for a week. She chose sex for a year.

Whether you choose a local vaginal estrogen, Osphena (ospemifene) tablets, or vaginal laser treatment, there is no reason to grit your teeth and endure painful sex — or avoid sex altogether. Mona Lisa should not be the only one smiling.

Click here for more information about this treatment