Vaginal Health: Solutions for Symptoms
"What’s the big mystery?
It’s my vagina not the Sphinx.”
- Sex in the City
Vaginal health is a subject rarely talked about, yet an increase in distressing vaginal symptoms is common in menopause. While the main culprit is a decrease in oestrogen levels, there are many ways to overcome symptoms and have a happy vagina.
I focus on 2 issues here, and these form part of the vaginal rejuvenation protocol that is included in the Modern Menopause Program. The rejuvenation protocol additionally has advice on how to moisturise the vagina, how to choose the right lubricants (which add and seal in moisture) and which ones to avoid, and how to recover from vaginal atrophy and plump up the vagina which can put an end to painful sex (without using hormones). If you would like to find out more about the Modern Menopause Program please visit here.
So let’s get to it: vaginal health depends on several factors, and here I will focus on:
preventing dryness and keeping the vagina lubricated, and
maintaining a healthy environment and preventing vaginal infections.
1. Vaginal Dryness
Vaginal dryness is defined as a reduction in lubrication of the surface of the vagina. It can occur at any age, and is very common in menopause. Dryness can cause discomfort, as well as itchiness and painful sexual intercourse. The main risk factor is a reduced oestrogen level, and prescription medications and various medical conditions can contribute as well (see below).
Risk factors for vaginal dryness:
Reduced oestrogen availability
Postpartum status, breast-feeding
Premature ovarian failure
Surgical removal of one or both ovaries
Other medical conditions
High blood pressure
Diabetes (types 1 and 2)
Neuropathies, especially autonomic neuropathy
Any condition that affects the skin including psoriasis, lichen sclerosis, Sjögren syndrome
Anti-histamines and decongestants
Anti-oestrogen therapy for chemoprophylaxis
Anti-oestrogen therapy for endometriosis or fibroids
Progesterone predominant oral contraceptives
Dehydration, including alcohol intake
Use of douches, extremely hot baths, or strong detergents and dehydrating soaps
Use of highly absorptive tampons
Use of male condoms with insufficient external lubricant
Lack of sufficient arousal before vaginal penetration
The lubricating fluid in the vagina consists of ultra filtered blood which is composed of water and proteins. The vagina doesn’t have any glands, so the fluid is pushed out to the vaginal surface by blood pressure in the tissues. Flow of the lubricant is therefore reliant on a healthy blood flow, which is reliant on a signalling messenger called nitric oxide (NO).
NO is produced when there is friction or sexual arousal. NO dilates blood vessels allowing blood to flow more quickly to the genital area. It is the same chemical which is increased by Viagra, helping men get erections. The production of NO depends on the availability of a protein called L-arginine, and is increased by oestrogen.
L-arginine is found in meat, seeds and some vegetables:
Turkey breast - 1.7g per 100g
Shrimp - 1.8g in 100 g
Beef - 1.5g per 100g
Tuna - 1.4g per 100g
Cod - 1g per 100g
Chicken breast - 1g per 100g
Pumpkin seeds - 6.9 g in 1 cup
Walnuts - 4.5 g in 1 cup
Lentils - 3.7 g in 1 cup
Spinach 1g per 220g
How much L-arginine do you need to maintain healthy lubrication? I usually recommend at least 1 gram per day. L-arginine can also be found as a supplement, but requires practitioner guidance for assessing suitability and the correct dosage.
One of the issues with NO is that it can be toxic in an environment where there is inflammation - not just in the vagina, but overall in the body. To keep inflammation down, follow a low carbohydrate, nutrient dense diet with minimal processed food. This will have a positive effect on blood vessels and on the availability of NO.
Raise nitric oxide via exposing your skin to UVA from the sun’s rays in the early morning and late afternoon (as opposed to UVB which is required to raise vitamin D).
Vitamin D, which is involved in the synthesis and bioavailability of NO. You can check you vitamin D level with a blood spot test from on-line labs, including: http://www.vitamindtest.org.uk/. With my clients I aim for a serum level of 125 nmol/L. For women with more pronounced menopausal symptoms, I aim for a serum level of 150 nmol/L. The initial dose is 2000IU per day, with regular checks every 2-3 months.
Ginko biloba, which supports NO in several different ways. Ginko should be used cautiously with anti-coagulants like Warfarin, non-steroidal anti-inflammatory drugs like aspirin, or high intake of garlic.
2. Maintaining a Healthy Vaginal Environment
The vagina has its own ecosystem, which brings to mind how apt the phrase ‘lady garden’ is. In my imaginary garden there are variety of wonderful plants, which keep the weeds and other nasties at bay. In the vaginal ecosystem, these wonderful plants equate to families of beneficial bacteria that keep the natural system in balance.
One of the most important family of bacteria is Lactobacillus. Lactobacillus keeps the vaginal pH low by producing lactic acid, which in turn, prevents less vagina-friendly yeasts, bacteria, and other organisms from getting a foothold and causing problems. Members of the Lactobacillus family also help to keep the vaginal wall healthy by promoting mucus production thus providing a protective barrier against other bacteria, yeasts, and viruses including HIV.
What’s the connection to oestrogen? Oestrogen promotes the release of a sugar called glycogen from the vaginal walls. Glycogen breaks down to glucose which is used by Lactobacilli to produce lactic acid. Certain strains of Lactobacillus also produce hydrogen peroxide which repels unfriendly vaginal flora such as Candida, E. coli and Gardnerella vaginalis.
Factors that can increase the risk of imbalance in the vaginal flora include:
Frequent sexual intercourse
At menopause, oestrogen levels decrease and glycogen production in the vaginal walls comes to gradual and complete halt. When Lactobacilli have nothing to feed on and so their numbers dwindle, allowing pH to rise - causing a more alkaline environment. This leads to colonisation by faecal flora and other pathogens, resulting in a loss in the quality of vaginal health.
Replacing glycogen as a food source for Lactobacilli is the therapeutic intervention for avoiding vaginal infection and inflammation. One source of prebiotic sugars that can take the place of glycogen is honey. Honey can naturally moisturise tissues and feed beneficial bacteria so that they crowd out vaginal pathogens. For my clients, I recommend that they take a small dab of set pasteurised honey, apply it to the vaginal wall daily and then use as needed. Like moisturising your face - only lower - and on the inside.
Adding probiotics that maintain the health of the vagina can also be of great benefit. I like Women’s Probiotics from Optibac, and usually recommend 2 capsules per day. One client reported that not only did her vaginal symptoms normalise, but that her pubic hair became lush and regained its colour from being grey. If you would like to buy them, you can take advantage of my 10% practitioner discount at the Natural Dispensary on-line, using the code SAND10: https://naturaldispensary.co.uk/products/For_Women_90_s-17520-0.html.
Reduce inflammation by following a low carbohydrate diet rich in nutrients: good fats (olive oil, coconut oil, butter, avocado), high quality protein, and high in vegetables (with fruit in moderation).
Focus the diet on L-arginine foods to promote the production of NO.
Consider testing vitamin D level and supplementing if necessary.
Consider Ginko biloba as NO enhancer.
Consider women’s probiotics to reseed beneficial bacteria.
Expose your skin to sun in the early morning and late evening to make NO.
Consider applying a small dab of pasteurised honey to the vaginal walls. This will serve as food for beneficial bacteria.
I hope you find this article useful, I will be updating it as new information comes to light.
PS. Don’t forget: this article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment and should never not be relied upon for specific medical advice. Every woman experiences the menopause differently and if you would like specific advice, I recommend that you get in touch and join the Modern Menopause Program which will be personalised to your specific symptoms: a thorough assessment of your health will provide vital insights and allow me to create the perfect health plan for you.