I Have Questions…

It is simply a fact of life, that all of our skin changes as we age. So too does the delicate mucosa tissue in and around the vagina. Hormones fluctuate, and lube becomes a necessity. But since that same process can make your skin more sensitive, reactive and subject to microtears, what you use  important. 

So we did what we do here at Zoomerist, we asked a doctor. Dr. Kirsten L. Smith is a gynecologist focused on pelvic floor health who works out of North York General Hospital in Toronto. She is a lecturer at U of T, and is also the director of the Feminine Rejuvenation Program at Toronto’s DLK on Avenue clinic. 

“Once estrogen leaves the area,” says Smith, “we see increasing weakness in pelvic tissues.” Pelvic floor health in general is something that just isn’t discussed enough in Canada, she says, unlike in some more progressive Western European countries. “We need to have more respect for women’s health issues.” Amen to that!

So what are the best lubes? First of all, she points out that there are vaginal moisturizers and then there are vaginal lubricants – which are solely for sex (of all formats). A doctor may suggest vaginal moisturizers for day-to-day use, to reduce discomfort and prevent and heal microtears. RepaGyn is the first product Smith mentions; these are suppositories  with no hormones or parabens, what it does contain is hyaluronic acid (one of the main moisturizing ingredients in face and body creams). Hyaluronic acid is naturally produced by the body, aiding in cell development, wound healing and regeneration. It also works as a moisturizer when applied externally to improve hydration and elasticity of skin. It is humectant – a substance that retains moisture – and is capable of binding over one thousand times its weight in water.

Smith also cites Gynatrof, which on top of being glycerin and paraben free has vitamin E, liposomes and hops plant extract. There is both a vulvar (the area directly outside the vaginal entrance) and a vaginal formulation, to relieve dryness, itching and burning. Replens is another brand the doctor recommends, designed to be applied every couple of days, it provides long-lasting moisture, which not only helps with the irritation of vaginal dryness, but means sex can be more spontaneous. 

Smith adds that “local estrogen therapy to the vagina, such as in pill/cream/ring format, which is safe in the vast majority of patients and essential treatment for vaginal dryness and irritation in addition to or instead of vaginal moisturizers.” 

Lubricants designed solely for sex come in water-based glycerin or silicone formulas. Generally water-based ones are better for sensitive skin, silicone and oil-based ones last longer but can damage sex toys and condoms. 

Meanwhile, externally, using moisturizers and lubes are great, says Smith, “but they are like eye cream on wrinkles: the cream doesn’t make the wrinkles go away.” In other words, lubricants will solve the problem temporarily, but you have to keep using them. There is a new treatment, which Smith performs at DLK that is a proactive treatment for vaginal atrophy, and it directly addresses dryness. “It is a minimally invasive laser,” she says, called LASER. “It is the gold standard for treatment and prevention of urinary incontinence and vaginal rejuvenation.” It is medical grade, she says, and as it is a laser directly inside the vagina, it is done by a certified doctor with safety training, not an aesthetician. Vaginal skin is protected by a type of speculum, a device that keeps the wand from touching the tissue.

“The laser increases the speed of local epithelialization (wound healing) rate of the vulvar skin and vaginal mucosa,” Smith says, “stimulating collagen, creating new blood vessels, improving local circulation and increasing the secretions and skin strength.”

Here are some other major benefits: improvement of mild to moderate incontinence, it has a tightening effect to counter vaginal atrophy, address flaccidity of the labia minora (because gravity works all over the body), and it can lighten hyperpigmentation.

Protocols are three treatments (depending where you go, average cost is from $1,500 a session) four to six weeks apart, with single follow up sessions annually or as advised by your doctor. It is painless, and takes 20 minutes or so. So yes, a big chunk of change as these new medical miracles tend to be, but those $35 bottles of vaginal moisturizer also add up. This might be the case where what you can get out of a treatment is much more priceless: a rebuilt sense of confidence and vitality along with a return to enjoyable, versus painful, sex.  

Always asking questions,

—Leanne Delap