Vaginal Dryness After a Hysterectomy: Things Nobody Talks About
Note: If you don't like the word vagina, I probably wouldn't read this blog. 😂
Vaginal dryness was one of the first symptoms I experienced after my hysterectomy, and honestly, I had absolutely no idea how much of an issue it could become.
It started with thrush just a few weeks after my hysterectomy. And when I say thrush, I mean THRUSH. I genuinely had no idea it could be that bad. I was around three weeks post-op and was convinced I had some kind of major infection, so I rang the doctors and basically demanded that I come down immediately. It turned out to be thrush, they treated it and thankfully it went away.
From then on, though, I spent the next six months being ridiculously prone to it. Yay me.
The reason this can happen after a hysterectomy, particularly if your ovaries have also been removed and you've gone into surgical menopause, is the sudden drop in oestrogen. Oestrogen helps keep the vaginal tissues healthy and maintains the vaginal environment, so when levels drop, things can become much drier and more irritated and you can become more prone to problems such as thrush or urinary symptoms.
For me, introducing a topical oestrogen cream helped enormously and things eventually settled down.
My vagina actually hurt when I walked
That was my second big symptom.
Yep. Just WALKING.
I was 31 and walking around with, honestly, the driest vagina imaginable. 😂
I mentioned it to my GP as one of my surgical menopause symptoms and, around this time, prasterone pessaries had just become an option for me. They're a small pessary that you insert into the vagina and, after an initial period of daily use, they're generally used a few times a week depending on what your doctor recommends.
For me, they made a huge difference to the dryness.
I don't get it anywhere near as badly now, but I do sometimes randomly think, “Oh my God, my vagina is dry.” And then I know it's probably time to use my treatment again.
Yes, sometimes you need lube
I also find that sex toys can make me feel drier, and sometimes I need lubricant. And honestly? Who cares.
It doesn't mean anything is wrong with you. It doesn't mean you don't fancy your partner. It doesn't mean you're not turned on. Sometimes your vagina is just dry!
I use a water-based lubricant because I seem to react to other types and they can actually make me feel even drier.
I also went through a phase of using coconut oil. I found it felt really nice when I was particularly dry, although it isn't suitable for everyone and it's not compatible with latex condoms, so do your own research before trying it.
Then my vagina changed again
Around six years into my surgical menopause, the dryness reared its head again, but this time it wasn't quite the same.
I was struggling with sensitivity.
It wasn't necessarily that I felt incredibly dry. I just couldn't really feel anything.
And I wanted something to make everything feel a little more... well... juicy?!
I started using a vaginal oestrogen tablet as well. I'm told it's a more potent local treatment, although if I'm being completely honest, I'm not sure I noticed a dramatic difference myself.
And that's something I think is important to say: we don't all respond to these treatments in exactly the same way. What works brilliantly for one woman might not work for another.
What about HRT?
I have tried oestrogen topic cream and also Prasterone Pessaries. Both have helped but I really love the Prasterone Pessaries. They are little oily capsules you put inside and it just solves the issue.
A lot of vaginal creams and pessaries come with applicators and, personally, I don't use them. I find them fiddly. Getting the cream into the applicator, getting the right amount, cleaning the applicator so you can use it again... honestly, impossible. I much prefer using my finger to apply cream or insert a pessary, and then washing my hands afterwards.
Obviously, follow the instructions for your particular medication and ask your doctor or pharmacist if you're unsure, because not every product is used in exactly the same way.
But personally, when my vagina is already really dry, the last thing I want to do is poke a plastic tube up there. I think I have trauma from pulling out dry tampons back in the day. 😂 And while we're on the subject of applicators...WHY ARE WE STILL USING SO MUCH PLASTIC FOR THIS?!
I have a drawer full of them and I genuinely feel guilty every time I throw one away. I keep thinking there must be some sort of art project I could make with them. Maybe a giant uterus? If anyone has any ideas, let me know. 😂
What about if you've had cancer?
This is a really important one.
Lots of women experience vaginal dryness and other menopausal symptoms after cancer treatment, and some are understandably nervous about using anything containing oestrogen.
I'm not a doctor and this is absolutely something you need to discuss with your own healthcare team, particularly if you've had a hormone-sensitive cancer.
However, local vaginal oestrogen is absorbed differently from systemic HRT and, because the doses used locally are very small, it may be an option for some women who have had cancer. Whether it's appropriate depends on your individual cancer history and treatment, so please don't take my experience as a recommendation to use it without speaking to your doctor or specialist.
There is also increasing research and discussion around how best to manage genitourinary symptoms in women after cancer treatment, so please don't just assume you have to suffer in silence.
Ask the question.
What if you don't want to use hormones?
There are also non-hormonal treatments available. I get lots of messages from women in the Rayse community asking about these and I've tried a few myself. Personally, I don't find them as effective as vaginal oestrogen for my symptoms, but that doesn't mean they won't work for you.
If you're avoiding HRT or local oestrogen, it's absolutely worth speaking to your pharmacist or doctor about the non-hormonal options available and finding something that works for you.
And what about sex?
I have a whole other blog about sex after a hysterectomy, but I want to say this here because I think it's important: Don't be embarrassed if you need lube.
Seriously. Needing lubricant does not mean you're broken. It doesn't mean you're not attracted to your partner. It doesn't mean you aren't enjoying sex. Sometimes you just need a bit of help. And if sex is painful, don't just put up with it. Pain is a reason to speak to your doctor.
What should you wear?
For years, I stopped wearing knickers. Honestly, sometimes now I still forget to put them on. 😂 When things were particularly sore or irritated, I found that going without underwear and wearing loose trousers helped me enormously. I would avoid tights and tight leggings like GPs avoid prescribing the right HRT. 😆
I'm not saying everyone should stop wearing knickers. But if you're having one of those days where you feel itchy, dry or sore, it might be worth giving yourself a bit of breathing room. And if you wear underwear to bed, you could try sleeping without it and see if that feels more comfortable. I love a trackie trouser, wide-leg baggy trousers or, if I'm at home, pyjamas.
I'm rarely properly dressed and if I am I am probably dressed like boy. 😂
An example of the kind of trosuers I wear now - am I wearing knickers? No one knows!
Please don't suffer in silence
This is the serious bit.
Vaginal dryness is nothing to be ashamed of. But it is also something you shouldn't feel that you just have to put up with.
What many people now call genitourinary syndrome of menopause (GSM) can include vaginal dryness, irritation, burning, discomfort during sex and urinary symptoms. It can become more troublesome over time if it's not treated, which is why it's worth talking to your GP or menopause specialist when symptoms start.
And please don't be embarrassed about saying the words. “my vagina is dry.” or “sex is painful.” or “I'm sore when I walk.”
Your doctor has heard it before.
I recently had a friend who'd had a baby tell me she couldn't wear anything tight because she felt sore and itchy and didn't know what to do. I told her to speak to her GP because hormonal changes, including those associated with breastfeeding, can contribute to vaginal dryness and irritation.
She did, was prescribed oestrogen cream and felt better pretty quickly. That's exactly why I think we need to talk about this stuff.
Because women shouldn't have to quietly suffer for months or years because they're embarrassed to say the word vagina.
Seven years into surgical menopause...
I'm now seven years into surgical menopause and, thankfully, I feel like I have this pretty well under control. If you've followed me for a while, you'll know I'm a little bit slapdash with my HRT sometimes, and I absolutely don't recommend copying me on that one. Consistency is important.
Personally, I've used a combination of treatments at different times, including vaginal oestrogen and prasterone, depending on what I've needed. My doctor won't actually prescribe me all three at once anyway. 😂
The important thing I've learned is that vaginal health is part of menopause care too. It's not an embarrassing extra or something you have to accept because you're getting older. And it's certainly not something you should feel ashamed to talk about.
So there we go. My very open and honest account of having a dry vagina after a hysterectomy.
I really hope this has helped someone and if you've been quietly suffering with dryness, soreness, painful sex or urinary symptoms, please don't suffer in silence.
Go and talk to your doctor. ❤️
TO SUM UP
Speak to your GP about oestrogen cream or Prasterone Pessaries
Stop wearing tight trourers
Even with cancer, it’s worth discussing this with your GP
Be careful as over the years it can get worse, and it needs to be treated
Lube during sex is nothing to be ashamed off - find the right one
Rachel
