Exploring Common Vaginal Health Concerns for Women
Vaginal health constitutes a crucial component of holistic well-being for women, but it is not always easy to talk about. Many women experience issues such as vaginal dryness, laxity and urinary incontinence, but these can evoke feelings of social awkwardness or shame when communicating with healthcare providers.
You need not feel embarrassed or ashamed about experiencing all these problems as they are natural aspect of the female life cycle that will affect most women at some point.
Let us explore the causes of these conditions one by one:
1. Vaginal laxity/ looseness
Vaginal delivery
This is a common phenomenon after vaginal delivery, especially if you have a big baby or undergone forceps delivery. The vagina is naturally designed to expand during childbirth, then contract and return to its original shape afterwards, thanks to the collagen tissue that composes its skin. However, there are limits to this natural elasticity. The vagina will eventually lose its resilience over time after repeated stretches and tears of underlying dermal tissues as baby passes through the birth canal. The pelvic floor musculature serves as a critical support structure for the vagina. However, the process of childbirth can significantly weaken these muscles, leading to vaginal laxity.
The degree of vaginal laxity is contingent upon various factors, namely the cumulative and escalating number of vaginal deliveries, the size of newborn, employment of forceps during delivery and trauma associated with each subsequent childbirth.
Vaginal laxity causes discomfort and the emergence of excessive vaginal folds causes further distress. Furthermore, it results in a diminished capacity to experience pleasure during sexual intercourse, which may culminate in a reduction in sexual desire, compromised sex life and have negative impact on relationships.
Aging
As we age, our bodies gradually lose collagen, a ubiquitous protein that serves as a fundamental building block, imparting structural support to various tissues. Regrettably, this diminution of collagen affects the integrity of vaginal tissues, causing vagina to become loose over time.
Hormonal changes
Physiological decline in the production of estrogen can result in gradual attenuation of vaginal thickness and elasticity. Consequently, the vaginal canal and the adjacent tissues enveloping the vaginal aperture experience loss of strength and structural integrity, culminating in a state of vaginal laxity.
Genetic
Genetics play a role in determining the overall structure and composition of the vaginal tissues. Some women may have a genetic predisposition to laxity due to differences in the collagen and elastin fibers that make up the vaginal walls. If someone has a genetic variation that affects the production of function of these proteins, it could contribute to the development of vaginal laxity. For example, a mutation in the COL3A1 gene, which encodes for type III collagen, has been associated with pelvic organ prolapse.
Is vaginal laxity equal to pelvic organ prolapse?
Pelvic organ prolapse is a condition in which the pelvic organs, such as the bladder, uterus, or rectum, descend or bulge into the vaginal canal. Pelvic organ prolapse can occur due to weakened or damaged pelvic muscles and connective tissues, often as a result of childbirth, aging, obesity, or chronic coughing.
Vaginal laxity can contribute to pelvic organ prolapse by reducing the strength and support of the vaginal tissues, which can lead to the descent or bulging of the pelvic organs. Conversely, pelvic organ prolapse can also cause or worsen vaginal laxity by stretching and weakening the vaginal tissues. As the pelvic organs descend or bulge into the vaginal canal, they can put pressure on the vaginal tissues and cause them to stretch or tear, which can result in vaginal laxity. However, not all cases of vaginal laxity are related to pelvic organ prolapse, and not all cases of pelvic organ prolapse are related to vaginal laxity. Each condition can occur independently or be caused by a combination of factors.
Does frequent sexual intercourse cause vagina to become loose?
This is one interesting and common misconception that I would like to address. In fact, sex does not have a lasting impact on vaginal tension.
When a woman is sexually aroused, your pelvic floor muscles relax, allowing for penetrative sex. After intercourse, the vagina returns to its usual shape and tension. There is no scientific evidence to support the idea that regular sex can cause the vagina to become loose over time.
2. Vaginal dryness
Vaginal dryness can cause discomfort during sexual activity, as well as itching and irritation. It can be caused by:
Hormonal changes
The primary reason behind vaginal dryness is the decrease in estrogen levels, especially after menopause. Estrogen is responsible for sustaining normal vaginal lubrication, tissue elasticity and acidity, which ensure the healthy condition of vaginal tissue.
Medical conditions and medications
Vaginal dryness can also be caused by specific medical conditions such as Sjogren’s syndrome or cancer patients undergoing chemotherapy. Additionally, some medications such as antihistamines and antidepressants can have vaginal dryness as a side effect.
3. Stress urinary incontinence
Stress incontinence is a condition characterised by the leakage of urine when coughing, laughing or any form of physical exertion. This can be a stressful and disruptive condition that can have a negative impact on one’s quality of life. It can be caused by a variety of factors, including:
Aging
As we age, pelvic floor muscles that support the bladder weaken, leading to urinary incontinence.
Childbirth
Your bladder is supported by your pelvic floor muscles. After delivery, most women have weakened pelvic floor muscle due to the stretch and tension and damage from vaginal laceration, hence resulting in urinary incontinence.
Extra pressure on bladder
Conditions that put extra pressure on the bladder, such as being overweight or obese and chronic coughing can lead to urinary incontinence.
In the past, these conditions which often arise as a result of childbirth, were regarded as inevitable and deemed an acceptable consequence of giving birth. In the 1940s, Dr Arnold Kegel introduced a simple yet effective solution- Kegel exercises- named after him, to help women who were experiencing urinary incontinence after childbirth.
Kegel exercises, also known as pelvic floor exercises, are a type of exercise that involves contracting and relaxing the pelvic floor muscles that support the bladder, vagina, uterus and rectum. Kegel exercises can be done by both men and women, and they can be performed discreetly anytime, anywhere. The first step in doing Kegel exercises is to identify the pelvic floor muscles by stopping the flow of urine midstream or by imagining that you are trying to stop yourself from passing gas. Once you have identified the muscles, you can then begin contracting and relaxing them for a few seconds at a time.
Kegel exercises have numerous benefits, including:
- Improved bladder and bowel control
- Increased sexual satisfaction and improved orgasmic potential
- Reduced risk of pelvic organ prolapse
- Enhanced blood flow to pelvic region
- Improved recovery after childbirth
Restoring Confidence with Vaginal Laser Therapy
As technology continues to evolve, more sophisticated and efficient solutions have emerged to address common vaginal health concerns. Among them is vaginal laser therapy, utilising Erbium YAG Petit Lady Laser, which offers a more effective treatment option.
How does it work?
This laser works by delivering laser energy directly to the vaginal tissue, heats the tissues and deliberately induces controlled damage to the vaginal tissues. The induced trauma prompts the body’s inherent healing response, which involves the production of collagen. The augmented collagen production, in turn, leads to the rejuvenation, thickening and tightening of vaginal wall, and improved function like lubrication.
Benefits of vaginal laser:
1. Improves vaginal lubrication
Vaginal laser therapy can help to increase blood flow to the vaginal area and stimulate the production of collagen and elastin, which can improve vaginal lubrication and reduce vaginal dryness.
2. Reduces vaginal laxity
Vaginal laser therapy can help to tighten and tone the vaginal tissues, which can reduce vaginal laxity and improve the appearance and sensation of the vaginal area.
3. Enhances sexual function
By increasing vaginal lubrication and improving the tightness of the vaginal tissues, they can potentially enhance sexual function and satisfaction due to reduced pain and increased sensitivity.
4. Treats urinary incontinence
Vaginal laser can improve mild to moderate urinary incontinence as collagen remodelling helps to support bladder neck and urethra.
While vaginal laser treatment can improve the tightness and elasticity of the vaginal tissues, it is not typically recommended as a primary treatment for pelvic organ prolapse. Instead, treatment options for pelvic organ prolapse are aimed at addressing the underlying weakness or damage to the pelvic muscles and connective tissues.
What to expect during the treatment?
The procedure typically takes less than 30 minutes to complete. After proper cleaning, specialised laser probe will be inserted into the vagina, and laser energy will be delivered to the vaginal tissue. There are 360 degrees probe that targets the whole vagina for vaginal rejuvenation, and 90 degrees probe to treat stress urinary incontinence. Patients find it painless and generally well-tolerated.
Who can get vaginal laser treatment?
Not all women are good candidates for vaginal laser treatment. Women who are pregnant, have active vaginal infection or undiagnosed vaginal bleeding should not undergo the procedure.
Hormone Replacement Therapy (HRT)
Apart from vaginal laser, hormonal therapy can also help reduce vaginal dryness. Hormone replacement therapy (HRT) is a treatment option for vaginal dryness that involves the use of hormones to restore estrogen levels in the body. As mentioned previously, estrogen is a hormone that plays crucial role in maintaining vaginal health, including the production of vaginal lubrication.
As women age and go through menopause, estrogen levels decline, which can cause a range of symptoms, including vaginal dryness, itching and burning. HRT can be an effective wat to alleviate these symptoms by supplementing the body’s natural estrogen production.
HRT can be administered in different forms, such as pills, patches, creams, or vaginal rings. Vaginal estrogen preparations, such as creams, tablets, or rings, or specifically designed to treat vaginal dryness and can provide quick and effective relief. These preparations work by delivering estrogen directly to the vaginal tissues, which helps to increase vaginal lubrication and thickness of the vaginal lining.
While HRT can be effective in treating vaginal dryness, it is important to note that is may also be not suitable for everyone. Women with history of breast cancer, blood clots, or liver disease, for instance, may not be able to take estrogen. Additionally, HRT can have some potential side effects, such as bloating, breast tenderness and nausea.
Why is my genital area getting darker?
Aging brings about many changes to our bodies, some of which are expected, while some you may not notice or anticipate. One such change is the alteration in the colour of the skin around your genital area.
The skin in the genital and anal areas of both males and females often appears darker than other parts of the body. This so-called hyperpigmentation is a common occurrence, especially in individuals who have gone through puberty.
There are several reasons why intimate areas can appear darker than other parts of your body:
Friction and inflammation
Friction caused by tight clothing or physical activity can cause the skin to thicken and darken over time, as increased friction leads to melanocyte hyperactivity and pigmentation. Inflammation or irritation caused by waxing, shaving or other forms of hair removal can result in darkening of the skin. The skin folds in the groin area can also undergo a process called keratinisation due to constant rubbing or trauma, which results in thicker and darker skin in those areas. Inflammation caused by rubbing against skin or infections can also lead to postinflammatory hyperpigmentation.
Hormonal changes
The cells responsible for producing melanin in the skin, called melanocytes, are especially sensitive to hormones. As such, hormonal changes during puberty, pregnancy, or aging can cause the genital area to darken gradually. Estrogen is one of the hormones that can result in increased pigmentation. This explains the darkening of areolae and nipples as well during pregnancy.
Aging
You will probably notice genital area gets darker with time. This is because as we age, our skin experiences more years of repeated trauma and hormonal changes.
Several medical conditions can also cause darkening of genital area, including:
Acanthosis nigricans, which is a condition that causes thickening of the outer layer of skin resulting in a discolouration of brown-to-black, typically around the neck, armpits and groin area. Acanthosis nigricans is most commonly associated with diabetes and insulin resistance, but rarely it can be a sign of internal malignancy. Hormonal disorders or use of certain medications like systemic glucocorticoids and oral contraceptives.
Addison disease, also called adrenal insufficiency, is an uncommon illness that can cause hyperpigmentation in certain areas of the body. Hyperpigmentation can occur due to the stimulant effect of excess adrenocorticotrophic hormone (ACTH) on the melanocytes to produce melanin.
Obesity is associated with darker genital area as excess weight can cause areas of the skin to darken due to friction and rubbing.
Fortunately, hyperpigmentation at the genital area can be improved with laser that targets pigment. Laser works by targeting the pigment in the skin cells and breaking it down with heat energy. This process is known as selective photothermolysis and is effective at removing unwanted pigmentation without damaging the surrounding tissue.
While laser therapy can effectively treat hyperpigmentation in the genital area, it is imperative to consult a doctor for thorough investigation if this condition is accompanied by other symptoms that suggest an underlying medical condition. In such cases, treatment of the underlying medical condition should be prioritised.
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