THERAPUTIC GUIDELINES: Atrophic/Menopausal Vaginitis and Dryness Giovannina M. Anthony, M.D. “Atrophic Vaginitis” is a very common problem in post-menopausal women. The cornerstones of care and resolution aim to increase comfort during sexual intercourse and relieve dryness, primarily through rejuvenation of the vaginal tissues and providing moisture. It requires some effort and discipline, but the following steps will help. 1. First, avoid deodorant soaps. They are harsh irritants and should never be used in the vulvar area. Examples: Zest, Lever 2000, Irish Spring, Dial, Ivory, and Dr. Bonner’s. Moisturizing soap such as Dove is preferred and inexpensive. 2. Studies show that some women require an emollient only as treatment. I recommend Replens, which is available over the counter, or at multiple pharmacy websites, including drugstore.com. Replens is an emollient that provides moisture to the inside of the vagina, much like a lotion, but is NOT meant to be used as a lubricant. Emollients are completely hormone-free. 3. Lubricants decrease friction, and should be used liberally with sexual activity. They may be either water-based, such as KY and Astroglide, available in your local drugstore, or oil-based, such as pure coconut oil. Oils have the advantage of not drying out and becoming sticky, and many women prefer this. Water-based lubricants however are readily available and do not stain bedding. It is definitely a matter of personal preference. Refined coconut oil can be obtained at any grocery store, and is another great option. 4. Sexual activity alone, as often as possible, is vital to maintaining healthy vaginal tissues, preventing stenosis (closure of the vaginal opening), and stimulating the development of new blood vessels and hormone receptors. 5. If you don’t already have it on hand, purchase Aquaphor ointment at your local store. Apply to the vulvar tissues around the vaginal opening after intercourse and liberally throughout the day as needed. This emollient promotes rapid healing on a cellular level and is also very soothing to traumatized tissue. 6. Perineal massage, a technique utilized by pelvic floor physical therapists, may also be required. This type of massage can help eliminate the expectation of pain with intercourse, causing the pelvic floor muscles to contract. Once this occurs, the pelvic floor acts as a barrier to penetration and a pain cycle is created which exacerbates the problem. Your doctor will demonstrate perineal massage so you can involve your partner and incorporate this into your sexual practice. 7. Some women will need estrogen therapy directly to the vaginal tissues. This can be delivered with creams, tablets, or a vaginal ring. Follow the directions on your prescription for appropriate use of vaginal estrogen. The course is usually intensive at first, for 14 days, followed by 2 days per week thereafter. .