Papaya Dryness

Are you feeling fresh squeezed?

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This week’s article is juicy!

I’m going to let you in on a well-guarded secret. My college friend, Audrey¹, who I’m still friends with, somehow discovered that if you whisper the word “papaya” into a man’s ear, it drives him wild.

I think it’s the combination of the pursed lips, the tiny puffs of air, and the wetness of the word. Raise your hand to your mouth and practice saying it. You’ll see what I mean. We loved it so much we started substituting the word “vagina” for “papaya.”

Not So Fresh Feeling

The first thing I need to say on this topic is that vaginal dryness doesn’t just affect us in the bedroom. The internet would have you believe that it’s all about sex all day, every day. It’s not. It’s about walking, sitting, being on a Peloton, working, driving, riding horses, exercising, and getting through the day comfortably. Kudos if you can do all of those things in one day.

Vaginal dryness causes sensations in your vaginal area and is a clue that vaginal changes are starting. This can begin in perimenopause. The physical changes causing these sensations may or may not be visible. Your doctor can help you confirm this.

The terms vaginal dryness and vaginal atrophy are part of a collection of issues that fall under an umbrella term named the Genitourinary Syndrome of Menopause (GSM)². The term vaginal atrophy is a little dated and is being replaced by GSM (see the same footnote 1 below).

GSM can cause some pretty unpleasant experiences and embarrassment. It also causes women to feel isolated because no one wants to talk about it. But, as you’ll see in a minute, it’s very common.

What does vaginal dryness feel like?

Vaginal dryness can be mild to intense. It may not catch your attention initially, but usually progresses across the menopause transition and menopause once it starts.

The Menopause Society Position Statement “The 2020 Genitourinary Syndrome of Menopause” says GSM affects approximately “27% to 84% of postmenopausal women”; however, “it’s likely been underdiagnosed and undertreated.”

My The Menopause Society-certified GYN says all women at some point develop vaginal issues related to menopause. Dr. Mary Jane Minkin, a leading menopause expert, says on webinars that it’s about 80%.

I always say this, and it’s especially true here: please see a physician if you’re experiencing the below issues. I learned at The Menopause Society meeting that some conditions have similar characteristics to the symptoms below. Your doctor can rule out other issues or infections and provide treatment if needed.

Your vaginal dryness may feel like one or multiple of these sensations or issues:

• Itching

• Dry sensation

• Burning

• Irritation

• Inflamed (and may look red)

• Sensation of heat

• Discomfort

• Bleeding after sex, bleeding after wiping with rough toilet paper (don’t cheap out on the good stuff)

• Vaginal infection-like symptoms

• Vaginal changes can also happen in the urethra and cause more frequent trips to the bathroom or frequent urinary tract infections (or feeling like you have one)

• Painful sex

• Lack of natural lubrication during arousal

• Lack of pleasure sensations

🎤 I love a good abbreviation, but I’m “forced” to say vaginal dryness because VD is something totally different.

Where can I feel these symptoms?

• Vagina

• Labia

• Whole vulva (which is the whole area on the outside)

• Urethra

• Clitoris

• Perineum

• The skin around your anus

My discomfort was so subtle, and I had lived with it for so long that I didn’t realize it was an issue. It was just a mild irritation that came and went and didn’t really impact me, or so I thought. More details will come later in the article.

Why is this happening?

The fluctuating hormone levels in perimenopause and the declining hormones overall through the menopause transition and menopause cause changes in our vaginal and urinary systems. I don’t like to blame one hormone over another because they work together, but estrogen helps keep things healthy down below.

Changes that can occur in Genitourinary Syndrome of Menopause ³

• Thinning of the vaginal wall and labia (the outer and inner lips)

• Loss of flexibility and accordion-like folds called rugae. You want your vagina to be flexible, not stiff like a plastic tube.

• Narrowing of the vagina

• Reduced blood flow to the vagina

• Shortening of the vaginal canal (is your guy or toy hitting up against your cervix more frequently?)

• The crevice around your cervix becomes more shallow

• Reduced blood flow, reduced sensation, and a reduction in the size of your clitoris

These are some pretty significant changes that can affect our comfort and our pleasure.

What Can I Do About This?

What’s the difference between lube and moisturizer?

Lubrication is helpful during sex to keep friction under control. Without lubrication, both natural or over-the-counter, sex would be painful.

Moisturizers help hold in moisture and can help keep tissue plump. Moisturizers are used as a part of your daily care routine and not for sex.

!!! Before using any new product, do a spot check. We may become very sensitive during perimenopause, and some inactive ingredients can be irritating. I personally am sensitive to aloe vaginally, so I have to make sure that the product doesn’t have any in it.

The Periprofessional’s Totally Unscientific Way of Testing Lubricants

I apply some lubricant on the back of my hand and use the other hand to rub it as fast as I can for a minute or so. If I develop irritation, it’s a no-go. I found one that doesn’t irritate me, so I just stick with that one now. I just hope they never change it or stop selling it.

Should I see a doctor about this?

I would! Other things can mimic vaginal irritation, so you want to make sure you aren’t dealing with any of those things like lichen sclerosis, a bacteria or yeast vaginal infection, or a UTI. I would also recommend not waiting until things become a bigger problem. I know it’s a hassle sometimes, but it really is in your best interest to have it checked.

Treatment Options

You don’t have to live with the pain and discomfort of vaginal dryness. There are plenty of options that can help, including prescription and over-the-counter.

• Vaginal Estrogen

• Vaginal Moisturizers

• Other Medical Options

• Keeping Busy in the Bedroom

• Other recommendations

Vaginal Estrogen

The most common treatment for moderate to severe vaginal dryness or atrophy is prescription vaginal estrogen. This is locally applied and stays local to the area of the vagina, vulva, and urethra. Local vaginal hormones are used to help repair the tissue and can also help prevent UTIs as well as reduce the frequency of bathroom trips. These are available as:

• Estradiol estrogen vaginal cream

• Conjugated equine estrogen vaginal cream

• Estradiol vaginal suppository

• Estradiol vaginal ring (called E-String, not to be confused with the systemic vaginal estrogen ring called Femring).

You and your doctor can decide which delivery method is best based on your medical history, symptoms, and preferences.

Although hormone therapy (HRT) *may* help with GSM symptoms, many women need the addition of local vaginal estrogen to combat symptoms. Follow this link if you want to watch my entertaining, well-educated, and extremely supportive urologist talk about Vaginal Estrogen 101. This link will bring you to her Instagram Live for patients.

If you’re concerned about cream messiness or have questions about how to use it, listen to Perry’s interview with Dr. Rachel Rubin (urologist & Sexual Medicine specialist, who is, in my opinion, the queen of explaining how to use vaginal estrogen cream so that it’s not messy, awkward, or uncomfortable. This link will bring you to YouTube.

My story: It was my urologist who begged me to start treatment even though I wasn’t showing physical signs of vaginal GSM. I was having off-and-on irritation that made me feel like I had to go to the bathroom all of the time and made sitting uncomfortable. I didn’t know that what I was experiencing was vaginal dryness because everything I read about it was about sex and I didn’t feel dry. She said once changes get severe enough, it’s hard to repair the damage, and treatment can also help prevent urinary tract infections as all of the tissue heals and becomes juicy again. Apparently, female anatomy is all connected.

I didn’t want to start on some old lady crotch cream, but I took the prescription anyway. A few weeks later, I felt very irritated, so out of desperation, I tried it. After 2 months of being on it, I wish I had started sooner! I hadn’t noticed how bad it was until I got better.

Vaginal Moisturizers

Another popular treatment is to use hyaluronic acid vaginal moisturizer, but according to The Menopause Society guidelines mentioned in the footnotes, they work just as well as non-hyaluronic acid vaginal moisturizers.

These are over-the-counter and readily available for purchase (usually on shelves, not behind the pharmacy counter, but that may vary). You may have to test a few to see which one you like the best. This is best for mild vaginal dryness.

Other Options

There are other hormonal and non-hormonal treatments and procedures that may help, but it’s best to discuss them with your physician. I’m not as comfortable discussing these, but my urologist is a good resource with a ton of information on various topics on Instagram and YouTube. I think there are a few vaginal rejuvenation procedures that she does if you want to learn more. Her link is above called “Vaginal Estrogen 101.”

Keeping it Spicy

I know sex may be the last thing on your mind right now, but the old saying “use it or lose it” applies here. Sex (either with yourself or a partner), helps keep things moist and juicy (or maybe that’s just something men tell us lol). It helps bring blood to the area. But I wouldn’t recommend sex as your first step if you’re experiencing discomfort in or out of the bedroom. Fix the issue first, and then consider whether this is something you want to be a part of your life. Any vaginal discomfort is going to affect your libido.

Other Recommendations

Being gentle with our female parts when undergoing distinctive changes becomes super important now. I’ve even had cheap toilet paper tear me up and cause bleeding (don’t stay at the Hyatt Regency in Chicago - their toilet paper has weird ridges on it that make wiping very uncomfortable.) Also, be careful when toweling off after showers, and be gentle.

General vaginal hygiene guidelines are to use gentle soap on the outside area where your pubic hair is, if needed. The inside of your vagina is like a self-cleaning oven and doesn’t need soap, but you can use water on your vulva for a fresher feeling. Douching is also not recommended in general.

We can become sensitive to laundry detergents that we’ve used for years when our vaginal tissue changes, so look for gentle, non-scented laundry detergents and skip the fabric softener or perfumed products on your underwear or menstrual products. I wash my underwear separately from my clothes using a fragrance-free and gentle laundry detergent.

Change out of wet clothes and underwear as soon as possible.

You Don’t Have to Live with Papaya Dryness

I hope I’ve shed some light on why you may not be feeling so luscious down below and have given you some hope to feel better. You don’t have to live with papaya dryness and the uncomfortable sensations or disruptions to your sex life.

You’ll be amazed at what a difference feeling better vaginally will make on your mood, your libido, and your energy levels through perimenopause. It will be one less thing you’ll have to worry about.

Be well, stay cool…

Disclaimer, Content Use Policy, Privacy Policy

1. That’s her real name, and she gave me permission to mention it. She loved the idea of sharing this in my newsletter. She’s a lot of fun!

2. I love fun facts - The Genitourinary Syndrome of Menopause (GSM) was previously called vaginal atrophy, but The Menopause Society recognized that vaginal atrophy didn’t include the urinary problems that can also arise from fluctuating and declining hormones. This caused some confusion in the medical world, so in 2014, in Chicago, they came up with the new term that it is today. It’s taken 10 years for it to be a more commonplace place. They also recognized that women don’t like the term atrophy and vagina together.

All of the symptoms that fall under the category of the Genitourinary Syndrome of Menopause are recurrent UTI, urinary frequency or urgency, urinary leaking, pain with urination, vaginal dryness, decreased lubrication, diminished orgasm or arousal, and pain with sex. www.rachelrubinmd.com

3. For a really great picture of the changes and where I pulled the information from for this section, visit https://jamanetwork.com/journals/jama/fullarticle/2614191. The artist, K. Bucher is brilliantly talented. I don’t know if he/she/they are proud of being a medical artist, but this is really a work of art.