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Whether 29 or 89 Years old Here’s A Guide To Successful Vaginal Therapies

Women with a variety of vaginal issues from painful sex, to chronic infections, urinary tract infections, vaginal order, and incontinence can benefit from vaginal therapies. 

At Women’s Health Practice we have treated women from age 29-89 with success, and usually it means a uniquely designed combination therapy. 

Sorting out which vaginal therapy to use is complicated, and of course should be done with your personal evaluation and consultation. 

We recommend a plan to keep vaginal tissues healthy once any treatment course is complete. A treatment called Osphena may be the best way to improve long term health, and it’s an oral medication covered by many insurances.

Vaginal health for the average woman means: not getting infections, having comfortable intercourse, being able to be aroused and have an orgasm; vaginal health is also, to most women, about not having bladder symptoms, not having unusual discharge, and not having unusual odor. It is also important for young people to help preserve fertility and not jeopardize hormone levels or menstrual cycles.

Vaginal therapy decisions can be more complex than those features: vaginal health also means maintaining the pelvic floor, having a strong abdominal core, having functioning blood supply to the vulva and the vagina, maintaining skin health, and maintaining a youthful look and function to the tissue. Having regular sex, eating and sleeping well, getting the right nutrition and supplements, getting vaginal therapies, and proper treatments can do all of those things for best vaginal health!

Laser, radio frequency and pelvic floor therapies are all non-invasive, and at Women’s Health Practice we can design customized therapies that are best for you. These therapies can then be backed up by a unique longer term maintenance plan that will help you resolve your issues long term. 

For the FDA, and many physicians, vaginal health is treating sexual pain and vaginal atrophy for women age 40 and up, but that is not all these treatments are for. While it is true that virtually 100% of women will experience vaginal atrophy and require therapy as they age, it is also true that 100% of women have concerns many years before they are atrophic and to them vaginal health needs to be approached from the wellness aspect we approach cardiovascular health, the way we approach fitness and nutrition: preventative health.

While therapies cleared for use by the US Food and Drug Administration (FDA) abound in treatment of vaginal pain, atrophy and sexual pain due to atrophy, this approach has not begun to address what women are interested in which is staying healthy in the vaginal tissues. The lasers and heat treatments are not approved, so it’s important to understand the difference between approval and clearance, and what that might mean for insurance coverage and costs. 

There is important good news for those who want to treat vaginal pain with hormonal treatments, as there is a newly approved therapy that joins various estrogens and Osphena as a therapy for dysparunia. The FDA has approved prasterone (Intrarosa, Endoceutics Inc) to treat women with moderate to severe pain during sexual intercourse (dyspareunia) associated with menopause. Prasterone, a once-daily vaginal insert, is the first FDA-approved product containing the active ingredient prasterone, also known as dehydroepiandrosterone (DHEA), which is essentially a prodrug. It is thought to work by being converted to estrogen in the tissues. This step of conversion may be a better alternative or potentially an alternative to combine with other vaginal pain therapies.

In reality there are even other therapies that can be used, some women for instance would be treated by compounded testosterone creams, or medications to help improve nerve conductivity thus arousal and sensations through the area, and a positive impact on orgasm.

Consultation from experts is important for many reasons. The wrong spermacide, shaving creams and the wrong soaps can be offensive and simple fixes. Many women will say that laser hair reduction helped them avoid the complications and irritations they were experiencing from shaving that made sex less appealing.

Estrogen levels decline in vaginal tissues prior to the time of menopause, and then further as you get farther into menopause which may lead to both vulvar and vaginal atrophy (VVA) and contribute to pain during sexual intercourse. Women with vaginal pain, especially with hormonal therapies have to continue getting pap smears, as one of the side effects of these hormonal therapies could be newly abnormal discharge or an abnormal pap. For women wanting to treat vaginal health before they get to the stage of needing medication: that begins many years before menopause, and may involve preventative care with therapies such as MonaLisa Touch, ThermiVa or PRP therapy. Come to discuss options at Women’s Health Practice.


Suzanne Trupin, MD, Board Certified Obstetrician and Gynecologist and owner of Women's Health Practice, Hada Cosmetic Medicine, and Hatha Yoga and Fitness

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