Question: I wear a pessary, which gave me my life back. Are there options for dryness, as I find I am experiencing soreness when removing?
Answer from Dr. Daniel Gruber, urogynecologist from Sibley Memorial Hospital in Washington D.C., part of John Hopkins medicine.
A pessary is a silicone device typically that sits in the vagina, which the patient can remove themselves. There come in many shapes and sizes for. Below is an example of a couple of them; the one on the left is used for prolapse, whereas the one on the right is used for stress incontinence.
One option for dryness involves vaginal estrogen. Often after menopause, the vagina gets very dry because of lower estrogen, and the vaginal tissues are very sensitive to estrogen. Therefore, one of the replacements that we use is vaginal estrogen, which is topical. There are different types of formularies that you can use for topical estrogen. One of them is a cream, one of them is a ring, and another one is a vaginal pill. They all work very similarly in that they provide local estrogen to the vaginal tissues. This bulks up the vaginal tissues and makes it a better and thicker environment, and it gets the PH closer to premenopausal levels.
Vaginal estrogen also has a side benefit of decreasing the amount of recurrent bladder infections as well. Because it’s topical, it’s extremely safe, as very little gets absorbed into the bloodstream. In fact, it is so safe, that very often even patients with breast cancer can use it – even patients who’ve had estrogen positive breast cancers in the past.
Other things that some people prefer to use are certain types of oils, such as coconut or mineral oils. There’s no harm in using most of those things that might help with dryness, except they don’t help for the long term. It just will help while it’s being used, which can be perfectly fine as well.
Estrogen cream is usually the go-to that we prefer because it spreads out very nicely. For estrogen cream, I usually recommend using half an applicator, or even less. 2 grams are usually too much for most people, so 1 gram, or half the applicator, is usually plenty. This is typically done two or three times a week, but talk to your doctor about what’s best for you.