This post was written by H&W instructor Allison Ariail PT, DPT, CLT-LANA, BCB-PMD, PRPC, who will be presenting Pelvic Floor Level 2B in Houston at the end of February.
Dyspareunia, or pain during or after intercourse, can be very upsetting and frustrating to a woman. One cause of dyspareunia is vaginal dryness. As estrogen levels decrease, the vaginal tissues can have less moisture, elasticity, and become thinner. This not only can affect postmenopausal women, but also post-partum women, and women who are on estrogen-blocking medication due to cancer or for treatment of fibroids. One of the common and effective treatments for this vaginal dryness includes estrogen creams, or hormone replacement. However, what does a woman do if she is not able to use an estrogen cream, due to an estrogen receptor positive cancer? One possibility is hyaluronic acid. Hyaluronic acid is a substance naturally found throughout connective, epithelial, and neural tissue. You may be more familiar with hyaluronic acid as the substance injected into joints for osteoarthritis. However, there have been some recent published studies comparing the use of hyaluronic acid to estrogen replacement.
In 2011, Ekin et al. published a study comparing the use of hyaluronic acid vaginal tablets with estradiol vaginal tablets. Two groups of postmenopausal women with atrophic vaginitis were studied. One group used estradiol vaginal tablets (n=21) for 8 weeks, while the other group used hyaluronic acid tablets (n=21) for 8 weeks. Outcomes consisted of the degree of vaginal atrophy, vaginal pH, vaginal maturation index, and a self-assessed 4-point scale. Both groups had relief of vaginal symptoms, improved epithelial atrophy, decreased vaginal pH, and increased maturation of the vaginal epithelium. The group on estradiol did have greater improvements, however, it was determined that the hyaluronic acid vaginal tablets was effective enough to be considered an alternative treatment for those who wanted to avoid the use of a local estrogen treatment.
In 2013, Chen et al. published a study comparing the use of hyaluronic acid gel to estriol cream. Women were randomized into two groups, using the hyaluronic acid vaginal gel, or the use of estriol cream (n=72 each group) for 30 days. Outcome measures included a visual analog scale for vaginal dryness, and three other vaginal symptoms. Also measured were lab tests of the vaginal micro-ecosystem, vaginal pH, vaginal US, and incidence of adverse events. Results showed both groups had improvement without a statistically significant difference between the groups.
These two studies show that hyaluronic acid may be an alternative to hormone replacement. This is good news for women who suffer from vaginal dryness and cannot use hormone replacement therapy, or even localized hormone replacement therapy due to the use of anti-estrogen medications! The improvement of vaginal dryness can significantly improve dyspareunia symptoms for many women. To learn more about dyspareunia, as well as other causes of pelvic pain, join me in Houston for PF2B!
Chen, J., Geng, L., Song, X., Li, H., Giordan, N., & Liao, Q. (2013). Evaluation of the Efficacy and Safety of Hyaluronic Acid Vaginal Gel to Ease Vaginal Dryness: A Multicenter, Randomized, Controlled, Open?Label, Parallel?Group, Clinical Trial. The journal of sexual medicine, 10(6), 1575-1584.
Ekin, M., Ya?ar, L., Savan, K., Temur, M., Uhri, M., Gencer, I., & K?vanç, E. (2011). The comparison of hyaluronic acid vaginal tablets with estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial. Archives of gynecology and obstetrics, 283(3), 539-543.
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