Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?

Abstract

Vaginal dryness is a common condition that is particularly prevalent during and after the menopause, and is one of the symptoms of vulvovaginal atrophy/genitourinary syndrome of menopause. The impact of vaginal dryness on interpersonal relationships, quality of life, daily activities, and sexual function can be significant, but is frequently underestimated. Furthermore, barriers exist to treatment-seeking, and this condition is often underreported and undertreated. Greater education about vaginal dryness and the range of available treatments is essential to encourage more women to seek help for this condition. Personal lubricants and moisturizers are effective at relieving discomfort and pain during sexual intercourse for women with mild to moderate vaginal dryness, particularly those who have a genuine contraindication to estrogen, or who choose not to use estrogen. However, there is a distinction between lubricants and moisturizers, and notable differences between commercially available products. Women should be advised to choose a product that is optimally balanced in terms of both osmolality and pH, and is physiologically most similar to natural vaginal secretions. A series of recommendations for the use of vaginal lubricants and moisturizers, either on their own or in combination with systemic or topical hormone replacement therapy, is presented.

Keywords: Cytotoxicity; genitourinary syndrome of menopause; lubricant; moisturizer; osmolality; vaginal dryness; vulvovaginal atrophy.

Figure 1.

Osmolality (a) and pH (b) of a panel of personal lubricants and moisturizers available world-wide. Black bars represent hyperosmolar preparations that exceed the ideal osmolality threshold of 380 mOsm/kg recommended by the World Health Organization for a personal lubricant (most of which also exceed the real-world recommended threshold of 1200 mOsm/kg), and which therefore have the potential to cause irritation and/or damage to vaginal or rectal mucosa. In healthy adults, normal vaginal and rectal pH ranges are 3.8–4.5 and ∼7.0, respectively. Gray bars represent preparations that are considered outside of these thresholds. Osmolality and pH testing methods are described in the online Supplemental Material S1 (http://dx.doi.org/10.3109/13697137.2015.1124259).