"Hormones do play a large role in sex drive," said Nisha McKenzie, PA-C, IF, CSC, Grand Rapids OB/GYN and Director of the Center for Women's Sexual Health. "Both estrogen and testosterone function to help libido in women."
And both estrogen and testosterone levels fall during menopause. "Estrogen has over 400 functions in our body," said McKenzie. "Imagine all the things, big and little, that can change when estrogen stops being produced by the ovaries with surgical or with natural menopause."
The vagina and opening of the vagina have estrogen and testosterone receptors. When hormones are depleted, the tissue becomes less elastic, less robust and dry—which can make penetration difficult and painful, if not impossible.
Bioidentical hormone replacement therapy could help.
McKenzie notes bioidentical hormone replacement therapy is often misunderstood, due to inaccurate reporting from the results of the 2002 Women's Health Initiative Study. While bioidentical hormones—hormones produced in a lab, rather than by the body—cannot be truly identical to your body's natural hormones and—like most treatments—come with health risks, supplementing hormones are effective in treating vaginal dryness and pain.
Bioidentical hormones are available commercially as well as by compounding pharmacies in oral, gel, injectable, pellet or patch formulations. McKenzie notes that hormone therapy should be initiated within five to 10 years of menopause, and it's worth a discussion with your gynecologist.
Bioidentical hormone replacement therapy is not the only option for treating vaginal dryness or pain, and there are other factors, other than aging and menopause, that affect vaginal health.
"Any woman who carries a pregnancy to term will show changes to their pelvic support," said Andrea Wolfe, M.D., Plastic Surgery Associates and Grand Pearl Spa. The effects can include anything from leaking—or nearly leaking—urine, to unsatisfying or painful intercourse.
Women should always discuss their options with a trained provider notes Dr. Wolfe, who outlines two alternatives to bioidentical hormone therapy:
The hybrid laser system increases collagen activity, which serves to tighten the vagina as well as give it tensile and elastic strength. It also increases blood flow to the tissues and activates the natural production of vaginal lubrication.
O-shot is a painless procedure in which a Platelet Rich Plasma (PRP) shot is directed under the neck of the bladder, to increase the collage support. PRP is also injected to increase clitoral nerve endings and blood flow.
"If women have deficiencies in their hormone levels, they will find optimization of these levels will also help to reverse these changes in their sexual health," Wolfe said.
Written by Cassie Westrate, staff writer for West Michigan Woman.