Understanding and treating intimate dryness

This is the external part of your genitals. There is no such thing as a NORMAL vulva! The goal is to be comfortable with your vulva. People unfairly talk about "big" and "small" lips when we should say outer lips and inner lips, so as not to imply that the "small" lips are necessarily hidden by the "big" lips. The most important thing is that your vulva is comfortable and always slightly moist.

The vulva can have a slight odor, thanks to pheromones! It's a good thing! Don't try at all costs to mask this odor. If it bothers you, talk to your midwife or your doctor. Intimate hygiene soaps are just marketing! You can wash with whatever you like as long as you only wash the area where, in theory, there is hair. Rinse with clear water and dry gently.

It is a canal made up of a mucous membrane and a muscular layer, measuring 9.6 cm on average. It can stretch under the effect of arousal. It must always be well moist to be comfortable. It is home to our army of defenses: the Lactobacilli that make up the Döderlein flora. The secretions produced by the walls of the vagina serve its self-cleaning system! It is therefore pointless to wash the inside of the vagina during your daily wash.

It is a large muscle that closes the lower part of our abdomen. It is made up of several layers. It works like a trampoline: it can contract when it rises and relax when it lowers. It should be known to everyone! It is used to hold in, of course, but most of the time it should be supple and well relaxed, otherwise it can be the cause of pain such as difficulty inserting a tampon, pain during intercourse with penetration…

• Transudate fluid: Passage of serum through the vaginal mucosa following local hemodynamic changes: it is the vagina "sweating", a sign that it is working well.
• Cervical mucus: Secreted from inside the cervix, translucent, with the look and consistency of raw egg white; variable abundance, at its maximum at ovulation under the influence of estrogens; mechanical action through an outward flow: plug / flushing effect; chemical action: antibacterial barrier.
• The secretions have a natural acidity that explains the discoloration of underwear. Systematic use of panty liners is not recommended.
• Be careful if the secretions become thick, white, foul-smelling, or come with discomfort or pain, itching… You should consult a healthcare professional.
• Wash the vulva with water or with a normal soap or a soap with a physiological pH (that is, acidic < 5), once a day, dry gently, and don't hesitate to put sweet almond oil on your vulva if it is sensitive. No need for wipes, vulvar deodorant… You should be comfortable in your vulva. Vulvar mantra: happy vulva, silky vulva!

"The microbiota is a community of micro-organisms living in a given environment. The urogenital microbiota is in fact made up of several microbiotas, all interconnected with one another. The vaginal microbiota, the best known, is made up mostly of lactobacilli in healthy, non-menopausal women. The urogenital microbiota also includes the urinary microbiota, the endometrial microbiota and the perineal and vulvar microbiota. The whole is connected to the gut microbiota and interacts with the microbiota of the sexual partner. In the case of recurrent urogenital pathology, a comprehensive approach to the patient is necessary.

A balanced urogenital microbiota is dominated by estrogen-dependent lactobacilli. It is estimated that there are about 40% potentially pathogenic agents within the microbiota, which can develop when changes disturb its balance. They can thus cause infections, vaginal dryness, dyspareunia, changes in the endometrium but also prematurity, miscarriages, IVF failures and possibly cancers.

The factors of imbalance of intimate comfort are many: courses of antibiotics, tobacco, a drop in estrogen levels at menopause or postpartum, frequent changes of partner, diabetes, overweight, obesity, chronic stress, immunosuppression, not to mention poor hygiene practices…

In any situation at risk of imbalance of the urogenital microbiota, it is advisable to use specific strains of the vaginal microbiota, mainly lactobacilli. When antibiotics are taken by a woman at risk of candidiasis, probiotics should be advised rather than the systematic preventive prescription of antifungal pessaries. Indeed, antibiotics can cause yeast infections but also bacterial vaginosis, for which antifungals will have no effect. Specific probiotics for the vagina can be given orally during and for at least one week after the end of the antibiotic treatment. Recent studies have shown that Saccharomyces yeasts, well known for their effectiveness on the gut microbiota, can also be active at the vaginal level.

In case of recurrent infections, daily or split intake of probiotics for at least three months, with gradual discontinuation, can be advised provided that other risk factors such as tobacco, lack of physical exercise and stress are eliminated or reduced…

Probiotics are not magic. They should not become automatic but rather be given for particular indications. Formulas combining probiotics and herbal medicine can be interesting, for example in case of frequent urinary infections, while also treating the other causes such as constipation, digestive problems and poor or unsuitable hygiene. Hence a personalized approach to the patient.

As estrogen levels fall at menopause, the changes in the urogenital microbiota show up as vaginal dryness and pain during intercourse… Probiotic-based preparations, given as courses 2 to 3 times a year, in the pre-menopause period, around 45-47 years old, give good results. A woman who has enough vaginal lactobacilli from the beginning of menopause will have 10 times less dryness and 4 times less pain compared with a menopausal woman without lactobacilli. We can therefore prepare for menopause with probiotics and vegetable oils such as evening primrose or borage!

A common phenomenon, vaginal and vulvar dryness are a taboo subject. Yet it would affect more than one woman in six at different times in her life. More common during menopause, it increases vulnerability to gynecological infections and can disturb the sexual harmony of the couple. Solutions to intimate dryness exist, so know how to react for your intimate comfort!

We speak of intimate dryness (vaginal dryness or vulvovaginal dryness) when the vagina or the vulva is not properly hydrated. Vaginal dryness / can disturb the balance of the vaginal flora. The physical and psychological experience is far from trivial. Vaginal lubrication comes from the vaginal transudate and the cervical mucus, depending on the cycle. Vulvar lubrication comes from the cyprine secreted by the Skene and Bartholin glands. It is therefore possible to suffer from vulvar or vaginal dryness, or both.

Pain during intercourse is present in 85% of patients suffering from dryness, as is a drop in sexual activity (83%). As a result, 57% of women feel that this disorder has been or is the cause of serious problems in their relationship. Here again, patients over 40 are more affected. Among women who do not treat it, more than 5% have stopped having intercourse. Very common, vaginal dryness affects at some point in their lives 25% of women before menopause and 30% to 55% after. Vaginal and vulvar dryness nevertheless remains a largely taboo subject, often hidden from doctors, gynecologists and midwives. That is a shame because this condition can be managed very well.

Vaginal secretions come from glands located at the entrance of the vulva and from a vaginal transudate. The glands secrete a slightly "viscous" fluid every day that serves to rid the vagina of dead cells and other impurities or germs. Vaginal secretions form, so to speak, a self-cleaning system for the uterus and the vagina (dead cells…). At the level of the vulva, more precisely in the muscle that helps the vulva contract, the Bartholin glands produce a stringy, colorless fluid that contributes to the hydration of the vagina and the inner lips. Arousal and pleasure trigger the lubrication of the vagina ahead of sexual intercourse.

To diagnose intimate dryness, the doctor or midwife will try to find out more about the patient through a medical interview: the symptoms described by the patient and how she feels (absence of natural lubrication, feeling of dryness, daily discomfort, friction from clothing, vulvar itching…)

Then by carrying out a clinical and gynecological examination (absence of vaginal and vulvar secretions and moisture). They may also take a vaginal sample to check the good quality of the vaginal flora.

• Burning
• Irritation or local inflammation
• Vulvar itching: it is rather a vulvar symptom, it is rare to have vaginal itching. There are not many itch receptors in the vagina. If a woman feels the urge to scratch, the problem comes from the vulva. And the vulva is skin. It can therefore suffer from dehydration, loss of lipids, irritation caused by unsuitable soaps, dry eczema.
• Redness of the external genital organs
• Appearance of small fissures

This intimate dryness can cause a greater sensitivity to infections and have repercussions on the couple's life, since it can lead to pain during intercourse (dyspareunia), even a decrease in libido, and affect their quality of life.

During certain periods of life, the vaginal mucosa changes and becomes more fragile. It can lose elasticity and lose its moisturizing and acidifying quality as well as its self-cleaning capacity.

• Hormonal causes: Menopause, hormonal changes and finally pregnancy.

Next, the main suspects are psychological factors, vaginal infections, stress and medical treatments, but also a means of contraception. Other causes exist, however: smoking, alcohol or unsuitable intimate hygiene can affect lubrication.

Menopause is defined by the end of ovarian function, resulting in an estrogen deficiency responsible for the well-known clinical signs. For hormonal reasons, menopausal women are the first to be affected by vaginal and vulvar dryness. In addition, 40% of women taking hormone replacement therapy, HRT, would experience vaginal dryness.

• In the case of dry syndrome: it occurs when the secretions of the body's mucous membranes are not optimal. It thus leads to a set of manifestations: dry eyes, lack of saliva, dryness of the bronchi or the skin… Vulvar dryness can also be observed.

It is sometimes caused by taking medications (low-estrogen contraceptive pills, antidepressants, anti-allergy medications, acne treatments, diuretics…) or certain autoimmune diseases, such as Gougerot-Sjögren syndrome (antibodies attack the body's glands).

• In the case of skin disease: lichen, eczema, psoriasis can affect different areas of the body, including the vulva.
• Vulvodynia, which shows up as burning sensations in the vulva leading to reflex muscle hypertonia.
• Intimate laser hair removal aggravates vulvar irritation and vaginal dryness / . Not only does laser hair removal of the genital area burn the hair bulb, it also destroys the sebaceous glands. Yet these glands produce the hydrolipidic film that moisturizes and protects the skin of the vulva. On the one hand, intimate laser hair removal alters this film, and on the other, it removes the little "cushion" of hair that protects the vulva from friction, a source of irritation.
• All medications or substances that dry out the mouth and tongue are likely to dry out the vaginal mucous membranes, such as antihypertensives or acne medication (like Roaccutane).

Herpes outbreak, eczema, psoriasis, vaginal yeast infection (be careful, a major difference is the presence of abundant discharge in a yeast infection, which is not the case with vulvar dryness).

• The very first thing to do is to talk about it. Talking will first allow you to release the stress that this discomfort causes.
• If the discomfort occurs only during intercourse, an intimate lubricant will be enough to relieve you, consider a hyaluronic acid-based lubricant.
• If the discomfort continues throughout the day, a simple lubricant will not be enough. The best thing would probably be to make an appointment with your gynecologist or a midwife, who will prescribe a suitable treatment. In the meantime, or if the discomfort is bearable, regularly apply a cream for the intimate area ( Rebalancing Moisturizing Intimate Gel) or a vegetable oil (sweet almond, jojoba, evening primrose, borage). They are often enriched with soothing plants. You can reinforce their effect by getting lubricating pessaries at the pharmacy, often plant-based, or evening primrose oil capsules that you can place intravaginally. Also consider specific probiotics for the intimate area, taken orally.
• Good hygiene: washing the vulva once a day, in the shower, is enough. Using soaps internally is not advised, as they dry out the fragile mucous membranes. Opt for a mild cleansing solution or simply wash with clear water, taking care to dry the area well (by patting rather than wiping too vigorously!). No vaginal douching!!
• A corticosteroid-based cream in case of eczema or psoriasis.
• A cream based on female hormones (especially for menopausal women).
• To treat intimate dryness, you must avoid certain risk factors that can cause it, which, in most cases, will bring the level of hydration back to normal.
• Laser: Certain cancer treatments have a very harmful impact on the vaginal mucosa, to the point of causing unbearable pain. For these women, who cannot take hormones and are insufficiently relieved by other methods, it has recently become possible to stimulate the mucosa with a vaginal laser (Mona Lisa laser). The sessions are expensive (€300 or more), but their effectiveness is remarkable when the indication is well established.
• Plants to soothe irritation:
  • Aloe vera, anti-inflammatory and moisturizing, is found in many preparations.
  • St. John's wort oil can be used as a local application, morning and evening. "It is nourishing, healing, anti-inflammatory, pain-relieving, antibacterial, antifungal and antiviral".
  • Hyaluronic acid: This molecule occurs naturally in the dermis and the epidermis. It soaks up water and protects tissues against drying out. Hyaluronic acid creams and pessaries are enough for mild vaginal dryness. They plump up the mucosa and give it back its suppleness. "Some studies show that after a certain time, hyaluronic acid leads to re-epithelialization of the mucosa". In other words, the simple act of moisturizing encourages a slight regrowth of the mucosa.

Discover our intimate mist, a mist specially designed to refresh, moisturize and relieve intimate discomfort while helping to preserve a healthy intimate flora. A practical mist format to keep in your handbag, ideal as a replacement for intimate wipes.

To prevent vaginal dryness, it is important to have good local hygiene, but not too frequent, and not to use molecules that are too harsh. Alcohol, tobacco and other substances should be avoided, and wearing underwear made of non-aggressive materials such as cotton is recommended. You also need an excellent lifestyle to chase stress out of your daily life. Sexual intercourse should also take place after good lubrication of the vagina, either natural or with the help of lubricants.

First of all, you should know that the vagina is self-cleaning and does not need to be cleaned from the inside. Vaginal douches are therefore ruled out, although fortunately they are practiced less and less. External washing nevertheless remains essential and strongly influences the balance of the urogenital microbiota. Indeed, the reservoir of lactobacilli, which guarantee the good health of the vagina, is located in the rectum. When vaginal lactobacilli decrease, the lactobacilli move via the skin of the perineum from the rectum to the vagina. If antiseptics are used daily or during infectious episodes, there is a high risk of a decrease in physiological vaginal colonization, leading to a risk of infections becoming persistent. In addition, the movement of the lactobacilli is made easier by the hydrolipidic film on the surface of the skin. Washing too often with water or with soaps and shower gels that are "too harsh" damages this endogenous hydrolipidic film and leads to dryness of the mucous membranes.

Once a day is enough, as long as you rinse well and dry this area well. Women who wash after every urination or bowel movement should be warned, because too many washes have a harmful effect in the long run. For optimal hygiene, avoid washing with unsuitable products such as shower gels or classic soaps, like Marseille soap, which are too harsh and drying. It should be remembered that this area is specific, sensitive and fragile. The intimate hygiene product must therefore respect the natural hydration on the one hand and the local microbiota on the other. Thus moisturizing and superfatted products are particularly suited to this anatomical area. Good hygiene is learned from a very young age by little girls, who can imitate their mother by using the same products as she does.

Article written by Camille Tallet, midwife and osteopath, specializing in gynecological pain. She is president of the association "Périnée Bien-aimé", which brings together healthcare professionals to raise awareness of vulvar pain and its treatments.

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