Vaginal flora in the female body:
The vaginal flora is the naturally occurring colonization of bacteria in the vaginal area. The defense function against pathogens and the regulation of the vaginal region are among the most important tasks of the vaginal flora. In a healthy vagina, the number and composition of these protective bacteria are in balance. This diversity of bacteria (approximately 100 million germs per millilitre of vaginal secretion) is dominated by lactic acid bacteria, as these are best able to proliferate in the vaginal environment. The essential function of the lactic acid bacteria, or lactobacilli, is to convert the glycogens, i.e. multiple sugars, originating from the vagina into lactic acid. This lactic acid lowers the pH of the vagina, which in turn prevents other pathogenic germs from multiplying. In addition to lactic acid, lactobacilli also produce hydrogen peroxide, which also has an antibacterial effect on the vagina. Ideally, the acidic vaginal environment is in a pH range of 3.8 to 4.4.
Common risk factors:
The most common risk factors of vaginal imbalance are improper or lack of intimate hygiene, medication use, stress, and hormonal changes. Especially when there are fluctuations in women's hormonal balance, vaginal dryness can also occur.
When women enter the climacteric, or menopause, hormonal fluctuations occur in the female body. Among other things, the estrogen level decreases. As a result, the blood flow in the labia and vaginal areas decreases. This can cause the vagina to dry out.
Post-menopausal vaginal disorders:
According to a recent study published in the scientific journal JAMA Internal Medicine, nearly half of all women complain of bothersome vulvovaginal symptoms after menopause. In the multicenter, randomized, placebo-controlled clinical trial, 302 women were treated with either the estrogen estradiol (in tablet form), or a vaginal moisturizer several times a week for 12 weeks. A third study group received only a placebo gel throughout the study period. All of the women had bothersome vaginal symptoms. Among the most common symptoms were pain on vaginal penetration (60% of women), followed by vaginal dryness (21% of women). The result of this study showed that neither the estradiol tablets nor the vaginal moisturizer provided any additional benefits over the placebo study group. Basically, a placebo works around 30% of the time. In this case, the placebo worked better than expected, as there were no significant differences between the effects of estradiol, the vaginal moisturizer, and the placebo gel. According to lead study author Dr. Mitchell, the lubricating properties of the neutral placebo gel may be one reason. These may have helped treat the vaginal dryness. Accordingly, the mental state, which can probably influence the biological states in the body, should not be ignored.
A big taboo?
Although many women experience vaginal dysfunction, some are reluctant to discuss the vaginal or sexual condition with a doctor. Because of this, one study developed a questionnaire designed to improve the identification and diagnosis of such genital discomfort in women over the age of 45 during their annual doctor's visit.
Another study, published in the North American Menopause Society's Menopause Journal, evaluated the effectiveness of a self-report questionnaire that, among other things, assessed the impact of vaginal dryness in postmenopausal women on their well-being. 113 women fully completed the so-called Day-to-Day Impact of Vaginal Aging (abbreviated DIVA) questionnaire between October 2019 and February 2020. The vaginal discomfort diagnosis rates of women who completed the DIVA questionnaire were assessed and compared to the diagnosis rates of women who did not. The result showed that women who completed the questionnaire during the period showed a diagnosis rate of 37.2%. Women who did not complete the DIVA questionnaire showed a diagnosis rate of only 10%. In post-menopausal women, the diagnosis rate with questionnaire was 44.2% and 8.5% without questionnaire.
There are very many different reasons for vaginal dryness. Stress, hormonal changes, excessive or insufficient intimate hygiene or as a consequence of other diseases can cause vaginal dryness. Therefore, it is important not to be afraid to consult a gynecologist if you feel that your vagina is too dry.
Mitchell CM, Reed SD, Diem S, Larson JC, Newton KM, Ensrud KE, LaCroix AZ, Caan B, Guthrie KA. (2018) Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms: A Randomized Clinical Trial, JAMA Intern Med.
Mastroianni J, Thompson JA, Shifren JL, Zuckerman AL, Pereira K. (2020): Improving the identification of genitourinary syndrome of menopause through the utilization of the Day-to-Day Impact of Vaginal Aging questionnaire. Menopause, The North American Menopause Society.
Huang AJ, Gregorich SE, Kuppermann M, Nakagawa S, Van Den Eeden SK, Brown JS, Richter HE, Walter LC, Thom D, Stewart AL. (2015) Day-to-Day Impact of Vaginal Aging questionnaire: a multidimensional measure of the impact of vaginal symptoms on functioning and well-being in postmenopausal women. Menopause; 22(2):144-54. doi: 10.1097/GME.000000000281. PMID: 24983271; PMCID: PMC4280352.