Title: Vaginal dryness-An unspoken sorrow of menopause and beyond

Biography:

Prof Shaikh Zinnat Ara Nasreen is now working as Professor and Head of Obs/Gyne department in ZHSwomen medical college & Hospital, Dhaka. She obtained MRCOG in 2000 and FRCOG in 2012 from Royal College, UK. She got her FCPS from BCPC and MPh from NS University Dhaka. She has more than 50 publications. She is secretary General of BMS, Joint Secretery of OGSB. She is also CAMS Representative IMS, and honorary Secretary General RCOG Representative Bangladesh.

Abstract

Vaginal dryness may be the problem at any age but it occurs more frequently in women beyond menopause. 1 in 3 menopausal women suffers from vaginal dryness. The repercussion of these symptoms on quality of life needs treatment otherwise it becomes progressive. Intercourse becomes very painful (47%) leading disharmony in women’s life. Dyspareunea affects all the domain of female sexual function and associated with GMS. Irony is women are reluctant to share the problem, get embarrassed, suffer silently and feel ashamed without knowing restorative treatment. So doctors need to be proactive in asking this issue.

Estrogen withdrawal in menopause causes thinning, narrowing,loss of elastic- collagen tissue, shrinkage of blood supply, decreases lubrication of vagina and dyspareunia. Diagnosis is straight forward. Investigations are done only to exclude the other causes. Treatment includes; General measure, Non hormonal therapy, Hormonal therapy, Alternative therapy. General Treatment includes maintenance of optimum bodyweight, regular exercise and quitting smoking. Nonhormonal therapy- Antidepressant, Gabapentine, SSRI, SNRI, SERM and Soya black cohosh, tafu, flaxceed all are also helpful. Probiotics, Vit D, Bioidentical Hormone, moisturizers are being used.-Hormonal therapy is evidence based. Systemic estrogen is not sufficient to ameliorate of vaginal atrophy but local therapy is very helpful for symptoms relief. Ospemifene, DHEA, testosterone are effective, but Laser is most promising. Botox, G-shot are coming up. There is significant unmet need for medical treatment of vaginal dryness. Women complain but that is just tip of iceberg, we need to break the ice of unspoken sorrows of vaginal dryness.