Treating Dry Vagina Syndrome
Symptoms of the perimenopausal and postmenopausal years common to the midlife of women are dryness of the vagina and other mucous membranes, including the mouth and eyes. Lower levels of estrogen may be the culprit, but sometimes the dryness is also because of an allergic response to perfumes or dyes. For some women this dryness can be partially remedied through using eye drops and a vaginal lubricant when needed, but most other women will require additional treatment. Further, those who have Sjögren's syndrome, a poorly understood autoimmune disorder, with symptoms of extreme drying, will experience a disease that is far more prevalent and difficult to treat than previously thought.
In the United States today, the average age at menopause is 52 and our life expectancy is 80. This means many women will live 30 or more years after menopause. Starting with the perimenopausal period the walls of the vagina become thinner and produce fewer secretions. Vaginal lubrication with sexual excitement occurs more slowly. As the amount of estrogen decreases, the vagina becomes less acidic, causing women to be more susceptible to vaginal infections, including yeast. In over 40% of women changes are significant to the point of feeling dryness and irritation, known as Dry Vagina Syndrome (DVS). Sjögren's is estimated to affect more than four million people in North America, but a good estimate of the incidence is unknown because no uniformly accepted diagnostic criteria are employed in medicine, and the condition is not considered life threatening.
The Immune System and Dryness
The vagina, like the other mucosal openings of the body, is richly endowed with a superficial immune system known as the secretory immune system. Most often we think of the immune system as working internally in our bloodstream, however the majority of our immune system cells and molecules are located on the surface of our bodies in the mucous membranes. Therefore the immune system of the vagina and other mucous membranes, working through secretions from the exocrine glands, ordinarily protects us against allergy, inflammation, and infectious disease, thus protecting the vagina and other parts of the body, such as the eye. Exocrine glands produce secretions that are rich in IgA antibodies, cytokines, and growth factors. These glands also contain white blood cells, including lymphocytes, plasma cells, T cells, B cells, and macrophages. The exocrine glands also produces molecules that prevent our own immune systems from attacking the mucosa and eyes.
In those with autoimmune diseases, however, the very processes that protect the vagina and the eyes are not held at bay by the immune system and become imbalanced, resulting in a kind of hyperactive immune response, and accounting for the symptoms of Sjögren's syndrome. Autoimmune disease produces autoantibodies, and one or more autoantibodies may be produced by a person's immune system when the system fails to distinguish between "self" and "non-self" proteins. Autoantibody production is thought to occur because of a genetic predisposition combined with an environmental trigger,such as a viral illness or a prolonged exposure to certain toxic chemicals
Secretions and the film they produce play a critical role in the vagina's defense against bacteria and allergy. Alteration, deficiency, or loss of the film significantly increases the susceptibility of the vaginal surface (or any bodily mucosal surface) to desiccation (dryness) and subsequent infection, because the antibodies and other immune cells cannot sufficiently coat the vagina. The same problem occurs in the eye, which is why women with Sjögren's experience vaginal irritation, dry eyes and dry mouth. In the eye, contact lenses worn with insufficient tears can result in corneal ulceration, perforation, and even blindness.
In addition to the immune system components, vaginal secretions also contain a series of hormones, including estrogens, prolactin, and testosterone, which explains why changes in hormone levels can affect the function of the secretory glands. Moreover, vaginal secretions contain a series of immune system modulating mediators such as prostaglandin E2, histamine, and leukotrienes, all of which are part of the eicosanoid chain that participates in the inflammatory response.
Dry vagina syndrome is characterized by a decreased immunoglobulin A (IgA) in the vaginal secretions. In this syndrome, patients develop antibodies against immune proteins in their own vagina. This results in a dry, inflamed vagina.
During perimenopause, changes in hormone levels can trigger autoimmune problems in susceptible individuals. Given that the immune system is influenced by hormonal levels, a woman who is predisposed to autoimmune problems may experience an exacerbation of her disorders. Perimenopause may unmask an underlying autoimmune disorder such as Sjögren's for the first time.
Endocrine fluctuations associated with perimenopause may significantly increase the levels of antibodies and other immune factors in the vaginal secretions. Immune components in the vaginal film may decrease or change because of illness, environmental factors, and poor diet.
Women and Autoimmune Disease
Autoimmune diseases are strikingly common in women, and Dry Vagina Syndrome is often associated with autoimmune diseases, such as rheumatoid arthritis, polymyositis, scleroderma, and lupus. In these diseases, the very system that is supposed to protect you begins to attack your body. At least 50 percent of women with rheumatoid arthritis have concomitant symptoms of Dry Vagina Syndrome, and it is conservatively estimated that at least four million women in North America have an advanced form of Dry Vagina Syndrome.
Let's consider why so many women suffer from autoimmune disorders? First, women's hormones affect the immune system differently from men's hormones. Stress is another factor and is physically associated with changes in the hypothalamic–pituitary axis of our brains, which can affect the immune system, and hence mucous membrane function. The hypothalamus and pituitary gland have direct nerve connections to lacrimal glands, and also the salivary glands in the mouth. Hormones also directly affect the conjunctivae, thyroid and adrenal gland function, as well as the immune system. Most importantly, both the sympathetic and parasympathetic nervous systems are connected to lacrimal gland function and thus affect secretion levels. The stress women feel relative to family, belonging, measuring up, and safety and security in the world can also result in an immune system that functions improperly. Because our thoughts and activities affect our sympathetic and parasympathetic nervous systems, it is not difficult to see how chronic stress can exacerbate Sjögren's and other autoimmune diseases, especially at midlife, when there are so many difficult life changes.
Sjögren's syndrome lies at one end of the continuum of symptoms (including decreased tear production, decreased saliva, joint aches, fatigue, Raynaud's phenomenon, decreased respiratory secretions, dry nose, dry throat, vaginal dryness leading to painful intercourse, and dry skin) with a simple, mild case of dry vagina at the other. Correctly diagnosing dry vagina can be a challenge, because there are no uniformly accepted criteria across this continuum.
Causes OF Dry Vagina
The exact cause of Dry Vagina Syndrome is unknown, but if we consider results for the more severe forms some mechanisms are apparent such as viral agents and hereditary factors. In the most severe form, Sjögren's is the result of B cell hyperactivity and increased circulating autoantibodies that affect mucous membranes directly. In such a case autoantibodies are directed against the vaginal mucosa, salivary ducts, thyroid gland cells, and gastric mucosa. And because all immune cells in our bodies have hormonal receptors on them, it's not uncommon for women with a tendency toward immune system dysfunction to have symptoms triggered by the hormonal perturbations of perimenopause.
The key treatment for Dry Vagina Syndrome is to replace the moisture your body is lacking because of DVS. Some recommended treatments are detailed below.
1. Topically applied cytokines and growth factors have been shown to help increase the secretions, rebuild the thickness, and reduce inflammation of the vaginal mucosa membranes. A product is now available from BioRegenerative Sciences, Inc. of San Diego, California (www.bioregenerativesciences.com) that has been demonstrated to help increase lubrication, rebuild the mucosa membrane, and reduce inflammation of the vagina. Simple topical application of the product to the vagina is all that is required.
2. If your dryness is a reaction to a substance that you are allergic to, an allergen, you may have to do a little detection to pinpoint the culprits. Two common allergens are the fragrances and dyes in laundry detergent and toilet paper.
3. Check for environmental factors in the home and workplace: Poor air quality or sick building syndrome (SBS) can be significant contributors to oculovisual discomfort.
4. Use a superfatted hypoallergenic soap with no dyes or fragrances—one that is nonalkaline and pH-balanced.
5. Honey -- hydroscopic (water-drawing), will moisturize and heal an inflammed vagina. Apply directly where needed.
6. When you have sex on a regular basis, you naturally make more lubrication. Continuing sexual activity is an important in preventing the thinning and drying effects of menopause on vaginal tissues
7. Try Traditional Chinese Medicine (TCM): TCM can build what's known as kidney yin and liver yin, which is associated with replenishing moisture. Anyone who is well-trained in TCM will know which herbs to prescribe to help restore the balance between your yin (vital fluids) and yang (vital energy and heat). This method will help every dry area of the body. Be patient because TCM often requires several weeks or months to work.
8. Include soy foods in your diet daily. One serving per day.
9. Ingest Omega-3 essential fatty acids (EFAs) in your diet. Unfortunately, many women who consume a diet lacking in Omerga-3 fatty acids throughout their twenties and thirties end up with dryness when they begin menopause; their bodies are essentially "dried up" from lack of EFAs.
10. Reduce your stress: The key to lasting relief is to address underlying stress, because stress always exacerbates any problem. Reduce stress through exercise, meditation, cognitive behavioral therapy, yoga, and full breathing.
1. Goldman, M., & Hatch, M. (Eds.) (2000). Women and health (pp. 740–752). San Diego, CA: Academic Press.
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