Some people think it’s something that just happens to older women “down there.” Not true. Dryness happens to women for various reasons besides age. But no one really talks about it. Even here, as we’re trying to segway into the conversation attempting to make it appealing for our readers. We had learned that a new product called Replens Moisturize Restore External Comfort Gel had recently entered the Canadian market. We wanted to know who this is for and had some questions.

We’ve been lucky enough to meet Dr. Marla Shapiro several times over the past few years to get insight into women’s health issues. She’s our go-to for answers as she’s always made us feel more comfortable about discussing what the eff is going on with our bodies.

AL: We’ll rush to the internet to see if we can match our symptoms to health topic and try to take care of things ourselves, but how do we know what’s right? 

Dr. Shapiro: Yes, there’s lots of information out there but I’m always concerned about false information. It’s sometimes hard to know if something is evidence based with science behind it as oppose to a claim that uses words like “natural” where we assume that it’s safe. In fact, natural does not always mean safe or effective. It’s become a very trendy way of marketing.

AL: Oh, we never thought of that.

Dr. Shapiro:  Somehow the way the industry “markets” has become the reality in general but often it’s not evidence of science and evidence.  For me, it’s very important for women to be educated  with information that’s validated, evidence based, and vetted before making decisions on what they are going to do for themselves.

When were talking about the vaginal area, you need something that works with the natural pH levels of the vaginal area. There are a lot of products out there that don’t and they could potentially do more harm than good, even “natural.” You want anything you use in that zone to be neutral.

For internal moisture you want to look for something that is more adhesive to stay on your cells. So, that’s different from taking care of external vaginal dryness. Women need to understand that the products we use on either sides must be for the right reasons. You need to understand what lubricants are for and what moisturizers are for.

AL: Is vaginal dryness something older women experience as part of menopause?

Dr. Shapiro: Actually, there are many young women I see who are athletes who get a lot of dryness and chaffing so a product like Replens, is something that’s ideal for them as well. Also, women who are going through hormonal changes and pre-menstrual times of the month, or side affects from birth control pills or other medications also may experience external dryness. Often women don’t make that link between the meds you take to be associated with this discomfort.

AL: Oh, yes that sounds familiar but you’re right, we never made that association. It never really comes up in discussion when we follow up with our doctors either. 

Dr. Shapiro: Surprisingly many women don’t ask the questions and I’m constantly reassuring women that your relationship with your healthcare provider has to be comfortable.

What has me concerned or aware is that now we are doing PAPS every three years. We start at age 21 for very good reason but that doesn’t mean that you, who gets a letter now from the government every three years to tell you it’s time to get a PAP done, it doesn’t mean that you should not be going and asking your healthcare provider for a check up anyway. Sure you don’t need an actually need a PAP smear every year but you can still ask for checks on other gynaecological concerns or just to make sure that everything is okay. It’s not just about your cervix. It’s not the only important part.

AL: Maybe we’re just too embarrassed to talk about it?

Dr. Shapiro: Isn’t that interesting? Just think, nobody talks about impotence anymore. We talk about erectile disfunction. When was the last time you heard the word ‘impotence’? The marketing spin on erectile disfunction has made it easier to talk about. Men are not embarrassed at all to go into their doctor’s office to ask about maintaining an erection anymore. It’s just normal.

But let’s talk about vaginal health. We did talk about vaginal atrophy for years but we got rid of the term because we realized that no one wanted to even say the word vagina and atrophy? Whoa. That does not sound good. There’s nothing sexy or validating about being told you’re atrophic. Wow.

The North American Menopausal Society and the International Society for Women’s Sexual Health are trying to figure out how we speak to women with more acceptable terms to get women to understand their bodies better. They should feel more comfortable initiating conversation whether it has to do with intimacy, partner relationships, or sexual health.

There are so many things that happen in that part of the body. We’ve done a much better job in opening up conversation about men’s health so far.

AL: Have people asked you if we should be eating anything or do anything to change our lifestyle to prevent dryness?

Dr. Shapiro: Great question. I always start with health and lifestyle. But the reality is depending on the age group that you’re in, women mid to late 40s who are starting peri-menopause, and then getting older  are starting to get estrogen deficiencies. Women already know about hot flashes and night sweats and think they can wait that out. The average is six to seven years and some women can wait it out even though there are safe and effective options, but it’s your choice if you want to wait it out.

The one thing the women don’t understand about vaginal dryness is the further you get on the continuum, you get more and more dry. It just gets progressively worse. For women who are in menopause, they have to realize that they stay there. To understand this is where you’re living now, you need to know that there isn’t anything really to lifestyle wise to help vaginal dryness. Change in lifestyle will help in other ways but not here. It’s really a function of estrogen deficiency. You can eat all the soy you want but it’s not going to help.

In terms of vaginal dryness I talk about what you can use locally and start with over the counter moisturizers. There are some women who would require locally prescribed vaginal estrogen options. But you’ll see external dryness in younger women as well. So, you have to ask the questions with your doctor.

Also, some women think they need to take probiotics to help keep the vaginal area healthy. Make sure you ask your healthcare provider about this as well because probiotics you take for your gut isn’t the same kind you need for your vaginal health. Our vaginal ecosystem is very different.

AL: Any myths? 

Dr. Shapiro: Lots! Where do I start?  For women between ages  35 to 45, typically are still on a regular menstrual cycle and can have vaginal dryness and issues related to that. They may also have issues related to intimacy discomfort and issues related to odor. This age group, in particular, have a sense that “if there’s an odor, then I must have an infection,” and then they think they’ll go and treat it on their own. I say to women in this situation, “if you know what a yeast infection truly is like, and you’ve had it before, then by all means, go ahead in treat it. And if it doesn’t clear, then come see me.”

Most women think if something is wrong down there, then they must have a yeast infection and they will automatically reach for those over the counter treatments. But actually about 50 to 70 per cent of what’s actually going on is bacterial vaginosis. Which is really an overgrowth of the bad bacteria versus the good which is what gives us unpleasant odor. In this case, you’d go to your doctor to get a medication to treat it.

But we need to back up and start thinking about  why it’s happening. Another myth is that it must be a sexually transmitted disease. Well, the fact  is that many times is the pH level, which is a very narrow range in the vaginal area, has too much alkaline so you get changes in the overgrowth of bacteria. By keeping the range at healthy levels, which you can do with a gel, you may even get rid of the odor. There’s a lot of scientific research of women using a pH balanced product is as good as me treating it.

Not every odor is an infection and not every infection is a yeast infection. Sometimes odor is just odor. It’s just your scent and there are other things you can do.

As we get older, another myth about vaginal dryness, and the thought because I still have a regular period, I can’t have vaginal dryness is not necessarily true. Estrogen levels are beginning to fluctuate and you may begin to experience vaginal dryness.

The myth that you just have to “put up” with vaginal dryness is that you really don’t have to put up with it. You can do something about it.

AL: It also affects your sex life. Ugh.

Dr. Shapiro: Vaginal dryness just doesn’t affect women. In an international study, women and men around the world have talked about how it also affects intimacy. Women aren’t interested because of their discomfort and don’t feel like initiating intimacy because it may be too painful. Men were equivocally impacted as well. We often don’t think about this. And actually it’s not just men and women partners. Whatever your relationship may be,  one partner may feel like they may be hurting the other and aren’t comfortable talking to each other about the discomfort.

But even though all women will experience vaginal dryness at some point in their lives, not all women will experience it with distress. But the myth is that all that matters is the pain associated with sexual intercourse. That’s not true. Sexual relations is not  the only reason we need to take are of vaginal dryness. Some women can experience pain even when urinating or swimming. It’s impacting their quality of life. And you know what? Guess how many women who experience distress with vaginal dryness seek treatment? Only 7 %. Because no one talks about it. Women need to discuss any changes that they notice and learn what to do.

AL: Ooof, overwhelming. What else can we do?

Dr. Shapiro: Yes, and there are so many important things to make sure are healthy like strong muscles and strong bones to support your body. We need to be aware of so much. Your cholesterol levels, your cardiovascular health, your blood pressure, etc., are so important and your doctor will discuss all that with you but you’ve got to put concerns like this on your list to discuss. Make that appointment. Write down whatever health concerns are on your mind  not just so you won’t forget but so you won’t feel like it’s insignificant. Your doctor will want to know if you’re concerned about something. Ask the questions.

Also, if you’re going to be proactive and try an over the counter product, please try a product that has science and evidence to support it. Some of my most respected colleagues at the North American Menopausal society have done these studies that give us the evidence to say these products are safe to use. Ultimately, know what it is that you’re using and if you’re not sure, don’t be embarrassed to ask.

Thank you so much Dr. Shapiro for your insight! You can find out more about Replens Moisturize Restore External Comfort Gel  here.