When it comes to taboo topics, vaginal dryness is at the top of the list. Women will discuss their constipation, belching, vaginal odors and incontinence with their doctors, but studies confirm that if a doctor doesn’t bring it up (and they generally don’t), women are unlikely to themselves broach the topic of painful intercourse. Even close girlfriends rarely have that discussion: “Jenny, my vagina has been really dry lately. How’s your vagina?” And in spite of the fact that almost 50% of post-menopause women have difficulty with, or have abandoned sex as a result of dry, thin vaginal walls, relatively few women take steps to help their vaginas.
You would think that there is nothing out there to alleviate the problem, but there are a number of good options that can help. Silicone-based lubes, long-acting moisturizers, and local vaginal estrogen products all make sex more pleasurable, or in some cases, simply make it possible. In spite of this, only 7% of women who would benefit get a prescription that will help them. Most never fill the prescription.
The truth is, many of my patients tell me they are reluctant to use vaginal products for a variety of reasons including that they find them to be it is messy or inconvenient. But here’s something I didn’t know and my patients have never revealed: In many instances, women are ashamed of the need to use a product to alleviate dryness.
According to sexual health expert Dr. Michael Krychman, they don’t want their partner or husband to know they are not as naturally moist and sexy as when they were twenty. The ReVIVE Survey research, soon to be be published in the Journal of Sexual Medicine, showed that 81% of women who use local vaginal estrogen ensure some privacy or have a “secret ritual” behind a closed door to insert or apply the product so their partners don’t know they are using it. Most women, however, use nothing and simply grit their teeth and endure painful sex, or go into avoidance mode.
Well ladies, cheer up – there is now another option. As I predicted (yes, you heard it here first!), ospemifene, a daily oral pill to alleviate vaginal dryness has just been approved by the FDA. This pill is not estrogen, but is classified as a SERM, or selective estrogen receptor modulator. Ospemifene specifically targets vaginal tissue and has been shown to alleviate painful intercourse due to vaginal atrophy. Ospemifene does not affect breast tissue, but can stimulate the tissue that lines the uterus. There is no evidence that it will increase the risk of uterine cancer, but of course any woman, whether she takes ospemifene or not, should evaluate any postmenopausal spotting or bleeding. Women with breast cancer are advised not to use it, not because there are likely to be problems, but because it hasn’t been tested in women with breast cancer.
Ospemifene is not a magic bullet, and many women will still need to use a lubricant or a long acting vaginal moisturizer, but since only 7% of the 32 million women who need the help are getting it, another option is a welcome addition.