At present, gynaecology and/or sexology professionals continue to visit a large number of mature women who complain of discontinuation of their genitals and sexual apathy. Most of the time these women are derived by GP, as they have pruritus or itching in the vulvovaginal area and urination-related discomfort.
This causes repeated visits in primary care and controversies in its handling, by the way in which it is presented, by the intensity and frequency with which it occurs. For years we repeated the classic concept of health as defined by the WHO, “health is a state of complete physical, mental and social well-being, and not just the absence of disease or disease.”
Vaginal dryness in mature women
If we establish a parallelism, we can define vaginal health as ” the self-perception of genital well-being at the different stages of life, which implies a psycho-emotional balance and a periodic, satisfying sexual activity; and not only the absence of vulvovaginal conditions”.
It is necessary to explain to women some essential aspects of the anatomy and functioning of the genitourinary apparatus.
Vaginal homeostasis should be understood as those self-regulatory mechanisms necessary to maintain consistency in the composition of the native vaginal flora that is primarily represented by lactobacillos. This homeostasis helps us to ” understand the vagina as a full organ of life in constant adaptation and renewal throughout the life cycle of the woman”.
A healthy and balanced vagina is the key element for not experiencing local symptoms such as pruritus, itching, changes in vaginal flow, microsangrad, and coital pain; and other psychoemotional symptoms such as anxiety, mood swings, insecurity, and anger due to the recurrence of physical symptoms.
Enjoy a good vaginal health allows women to have a satisfying sex life with countless benefits, physical, psychoemotional and social.
Factors that alter the normal balance of the flora or vaginal microbiota can be both internal and external.
Here are the highlights: age of the woman, menstruation, eating habits and hygiene and inadequate, contraceptive method used, hormonal changes during pregnancy, the postpartum period and menopause symptoms, frequency of sexual activity, taking antibiotics or drugs used against cancer.
Diagnosis of vulvovaginal atrophy or dryness
The first is to conduct a full interrogation about the state and functioning of the female’s genital and urinary organs, as well as to ask about the sexual life today. It is important for the woman to pay attention to her body and recognize the symptoms of genital discomfort.
The attention of the mature woman should always include genital examination to evaluate the condition of the vaginal mucosa. During reviews gynecological are still many women with atrophy, vulvovaginal. Atrophic vaginas are dry, pale, fragile, rigid, smooth, painful and if they could speak they would say with complete certainty: pay attention to me!
Are usually seen in addition, signs of irritation of the vulva and changes in the anatomy of the vulva, such as loss of trophism of the labia majora, reduction of the labia minora and concealment of the glans clitoris.
They are often found different types of prolapses genitals or descent of pelvic organs such as the bladder, the uterus, the rectum, and sometimes eversion of the mucosa in the urethra.
All of the clinical findings described may be accompanied by genital secretions, smelly, erosions, vaginal, increased the friability in the cervix that bleeds on contact, and in the vagina that prevents a proper exploration. Involuntary leakage of urine, postcoital cystitis, and recurrent urinary infections also deserve our attention.
Another resource for assessing the degree of vaginal atrophy is the realization of cervical cytology or Pap smear. We will observe an increase in the cells in the deep or basal layers, a predominance of parabasal cells and a decrease in the superficial ones. Fluctuations in the native vaginal flora and the presence of opportunistic pathogenic micro-organisms.
Treatment of vaginal dryness
The vagina is a genitosexual organ that requires specific care throughout the life cycle of the woman and even more during the climattery.
Specifically during menopause, estrogen deficiency leads to thinning of the vaginal wall. This results in different symptoms such as lower lubrication, varying degrees of dryness, pruritus, pain during penetration, postcoital bleeding, erratic urinary symptoms and early urinary incontinence presentations.
The vagina suffers the most noticeable changes of atrophy; it loses its rugged folds, decreases its elasticity and therefore increases its fragility with direct affect on sexuality. Most postmenopausal women who have vaginal dryness live it in silence, with resignation; they think ” that’s what it touches by age.”
Only one in four women with moderate and persistent symptoms of atrophy will seek specialized medical attention. The first option to resolve this condition is to go to the trusted pharmacy and after testing different moisturizers without the expected improvement, the decision is made to go to the gynecologist
In cases where atrophy has progressed and deteriorated sexual life, consideration should also be given to Sexological counselling. Currently, it is best to make a joint gynaecological approach during the annual gynaecological review.
Treatments to improve vulvovaginal atrophy are varied and should always be indicated by the specialist. Each woman needs personalized treatment to relieve genital discomfort, improve the quality of life and enjoy a pleasant sexuality.