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Sometimes Love Hurts - And Why it Doesn't Have to

Updated: Jun 14

Over half of postmenopausal women report sexual dysfunction. Recent studies have postulated this number to be even higher as many women are reluctant to report symptoms such as lack of desire and/or discomfort due to vaginal tissue changes. While there are many additional aspects to a relationship outside of the bedroom, researchers point to the importance of a healthy sex life as a key marker for a happier, healthier life. As the average life expectancy lengthens, odds are most women will live 20-30 years past menopause. What does this mean for the majority of postmenopausal women?

Couple kissing in front of a barb wire fence with a field

A woman entering menopause experiences a wide range of hormonal fluctuations, but estrogens, in particular, affect vaginal health. Low levels of estrogens are known to be associated with a decrease in blood flow and lubrication; it is less known that they also play a role in maintaining a healthy pH. Estradiol is a proliferative hormone and helps maintain thickness and suppleness of tissues. Estradiol also plays a role in maintaining the pH of vaginal tissue. As vaginal epithelial cells shed and die, they release glycogen which is hydrolyzed to glucose. Glucose is then further broken down into lactic acid by lactobacilli which contributes to an optimal pH. When estradiol production slows and vaginal epithelial cells thin, the sloughing process diminishes and the pH rises, resulting in lower levels of protective lactobacilli and the potential for growth of pathogenic bacteria. This can result in an increase in vaginal infections and/or inflammation, contributing to discomfort and lack of desire.

The good news is that these changes are reversible. Estradiol and estriol creams are safe and effective treatments that can be applied intravaginally, and are a better choice than vaginal lubricants and moisturizers due to their ability to restore the integrity of the tissues. Current research is exploring complimentary treatments to estrogens, including the addition of lactobacilli for restoring vaginal pH, treatment for vaginal atrophy, and preventing recurrence of bacterial vaginosis. There is even research that demonstrates the positive effects of topical vitamin D treatment on vaginal atrophy.

Women don’t have to suffer in silence anymore.


Gupta, P., Özel, B., Stanczyk, F. Z., Felix, J. C., & Mishell, D. R. (2008). The effect of transdermal and vaginal estrogen therapy on markers of postmenopausal estrogen status. Menopause, 15(1), 94-97. doi:10.1097/gme.0b013e318148b98b

Lommen, E., & Mead, J. H. (2013). Estriol; the ‘Good’ Estrogen Advances and Updates in its Clinical Uses. Journal of Restorative Medicine J Restorat Med, 2(1), 45-52. doi:10.14200/jrm.2013.2.0103

Mac Bride, M. B., Rhodes, D. J., & Shuster, L. T. (2010). Vulvovaginal Atrophy. Mayo Clinic Proceedings, 85(1), 87–94.

Shen, J., Song, N., Williams, C. J., Brown, C. J., Yan, Z., Xu, C., & Forney, L. J. (2016). Effects of low dose estrogen therapy on the vaginal microbiomes of women with atrophic vaginitis. Sci. Rep. Scientific Reports, 6, 24380. doi:10.1038/srep24380

Unlu, C., & Donders, G. (2011). Use of lactobacilli and estriol combination in the treatment of disturbed vaginal ecosystem: A review. Journal of the Turkish German Gynecological Association J Turkish German Gynecol Assoc, 12(4), 239-246. doi:10.5152/jtgga.2011.57

Yildirim, B., Kaleli, B., Düzcan, E., & Topuz, O. (2004). The effects of postmenopausal Vitamin D treatment on vaginal atrophy. Maturitas, 49(4), 334-337. doi:10.1016/j.maturitas.2004.02.008

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