Some women choose to age gracefully and do so beautifully. They embrace the silver hair, laugh lines and crow’s feet, seeing them as life’s great adventures played out for the world to admire.
And, as we all know, beauty is more than skin-deep.
As the skin on your face ages, so can the tissues of your vulva and in your vagina. (Is nothing sacred?) Loss of estrogen due to menopause can lead to a condition called vulvovaginal atrophy.
What the heck is Vulvovaginal Atrophy?
It’s not as scary as it sounds. Vulvovaginal atrophy is a broad term that applies to common changes to a woman’s vulva (the outer part of the female genital anatomy) and vagina (the inner canal of the female genital anatomy) during aging and menopause. Vulvovaginal atrophy can be particularly extreme when a menstruating person enters menopause abruptly. Abrupt or “iatrogenic” menopause occurs when a menstruating woman has her ovaries removed, undergoes chemotherapy or radiation to the ovaries, or uses anti-hormonal treatment as is common for some breast cancer types. Due to the drop in estrogen, women with vulvovaginal atrophy can experience vaginal dryness, irritation, thinning of the vaginal tissues and flattening of naturally occurring “rugae,” or the folds along the walls of the vagina that allow that the vagina to stretch and expand for things like childbirth, vaginal exams and sexual intercourse. This dryness, irritation, and thinning can make sex uncomfortable or downright painful. Estrogen products inserted into the vagina or rubbed on the vulva are a common and effective treatment (Santen 2015, Fernandes 2014), but many women want to avoid estrogen or are advised not to use it due to their cancer diagnosis. Many women with these symptoms suffer in painful silence because either they do not report their symptoms to a doctor or other health care professional or the doctor doesn’t ask.
Many people find over-the-counter lubricants and moisturizers helpful for vulvar and vaginal dryness and to reduce pain and friction with sex. Unfortunately, scientific data about and regulatory oversight of these products are limited. Like these other products, scientific evidence about the value of hyaluronic acid for treating vulvovaginal atrophy is also limited. Because most women don’t have full access to the medical literature, and you know we love a good study (#womenscientists), we decided to share with you some insights about hyaluronic acid from the scientific literature.
Discovered in 1934, hyaluronic acid is a naturally occurring substance in our bodies that works to conserve and protect water molecules in skin cells (Jokar 2016). For skin care, hyaluronic acid has been described as a “humectant,” meaning that it may function by helping the skin “lock in,” or retain moisture. Biochemists, dermatologists, ophthalmologists, rheumatologists, and orthopedic surgeons have been interested in whether this viscous (viscous=gooey) molecule can also function as a joint lubricant and play a role in wound healing.
What does hyaluronic acid have to do with vulvovaginal atrophy?
Its hydrating capabilities make hyaluronic acid an interesting solution for problems related to dryness of the vulva and vagina, especially for women who want to avoid estrogen or other hormonal products.
While there have been a variety of studies, some more rigorous than others, that aimed to evaluate whether hyaluronic acid works to treat vulvovaginal atrophy, the evidence is limited. Though two early studies (Jokar 2016, Chen 2013) found that hyaluronic acid may be just as effective as estrogen or estriol treatment, more research is needed. For example, many of the studies of hyaluronic acid include small numbers of women and few have looked at the effects of hyaluronic acid use in the vagina of women going through or recovering from cancer treatment. Further, many of these studies have used hyaluronic acid in combination with other products, which makes it difficult to determine whether or not improvements in women’s vulvovaginal symptoms were from hyaluronic acid or another substance (or even a combination of the two!). Last, the studies say very little about the possible risks or downsides of using hyaluronic acid. Evaluation for safety is a key component of research about new treatments. More work is needed to understand just how effective and safe hyaluronic acid is for the treatment of vaginal dryness.
Other researchers have looked into the use of hyaluronic acid to treat skin inflammation due to chest or breast radiation among breast cancer patients, but did not find benefit (Pinnix 2012). More evidence is needed to determine if hyaluronic acid might have any benefit for skin care during or after radiation therapy.
There is growing interest in hyaluronic acid as a non-hormonal alternative to treating vulvar and vaginal dryness, and a growing number of women are using hyaluronic acid products on their face and body. Some products used on the face, vulva or in the vagina can be absorbed into the bloodstream. As with any new regimen, it is important to talk to your doctor or other health care professional before using hyaluronic acid or other products to treat vaginal dryness. We want to look and feel good and we want safe products, which requires high quality research. The voices of women with vaginal dryness – and there are millions of women with this problem – are needed to advocate for high quality research to establish the safety and effectiveness of treatments.
It is also important to remember that painful sex commonly involves vaginal dryness, but dryness may not be the only problem. Vulvar dryness and thinning can also make sex painful; so can other correctable problems like vaginismus, arthritis, relationship problems, erection problems in a male partner. Luckily, WomanLab is here to talk about how to address those concerns too.
So let’s hear about it—have you talked to your doctor or nurse about using hyaluronic acid products? Are you currently using hyaluronic acid and want to tell us about it? Do you want to advocate for research in this area? Send us an email at firstname.lastname@example.org or tweet us at @WomanLab_. We look forward to continuing the conversation there!
Fernandes T, Costa‐Paiva LH, Pinto‐Neto AM. Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on sexual function in postmenopausal women: a randomized controlled trial. The journal of sexual medicine. 2014;11(5):1262-70.
Jokar A, Davari T, Asadi N, Ahmadi F, Foruhari S. Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women: A Randomized Controlled Clinical Trial. International Journal of Community Based Nursing and Midwifery. 2016;4(1):69-78.
Pinnix C, Perkins GH, Strom EA, et al. Topical Hyaluronic acid vs. Standard of Care for the Prevention of Radiation Dermatitis after Adjuvant Radiotherapy for Breast Cancer: Single-Blind Randomized Phase III Clinical Trial. International journal of radiation oncology, biology, physics. 2012;83(4):1089-1094. doi:10.1016/j.ijrobp.2011.09.021.
Santen RJ. Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels. Climacteric. 2015;18(2):121-34.
Photo by Nicolene Olckers on Unsplash
Edited by Chenab Navalkha