Vaginal dryness, itching, and burning, are often symptoms following chemotherapy among patients with breast and other hormonally-related cancers. Treatments that involve estrogens aren’t recommended for most patients with breast cancer due to concerns about possibly contributing to future disease or risk of recurrence. That leaves unanswered one question: What are non-hormonal options for managing vaginal dryness following breast cancer chemotherapy?
Although there are limited studies on the full effectiveness of non-hormonal treatments, still there definitely are encouraging options for this population, such as, vaginal moisturizing gel, sea buckthorn oil, vaginal pH-balanced gel, topical hyaluronic acid gel, as well as vitamin E vaginal suppositories. We anticipate future studies with larger populations to determine which non-hormonal approach will offer a solution to this vexing problem.
Several promising solutions to vaginal dryness are the following:
1) Sea Buckthorn Oil:
Sea Buckthorn Oil has a very high content of Omega-7, also known as palmitoleic acid. It supports mucous membranes, prevents them from becoming dehydrated, and may have beneficial effects for vaginal dryness. A randomized trial done in Finland showed that it did benefit this issue, improving what is explained as the integrity of the vaginal epithelium. The study had limitations — a small sample size and a 3-month study duration. Also, this research focused on postmenopausal patients. Future studies will need to determine if equally helpful for those with a premenopausal diagnosis.
Availability: Sea buckthorn oil capsules can be purchased online at Walgreens.com, GNC, or a Vitamin Shoppe store.
2) Vaginal pH-balanced gel
Low levels of estrogen lead to an increase in vaginal pH. Vaginal pH higher than 4.5 can lead to vaginal symptoms such as dryness, itching, and burning. By maintaining a pH lower than 4.0, there may be a decrease in vaginal symptoms and the chances of an infection. A trial was conducted to determine the effects of vaginal pH-balanced gel on vaginal dryness in breast cancer patients following chemotherapy. Patients were randomized into either the vaginal gel or placebo three times weekly for 12 weeks. The vaginal health index was evaluated with moisture, fluid volume, elasticity, epithelial integrity, and pH. The results showed dryness and dyspareunia decreased by the end of the study in the group with the pH-balanced gel. The study showed that vaginal pH-balanced gel was better than placebo in decreasing vaginal pH and relieving symptoms of vaginal dryness.
Availability: One easily purchased is RePhresh (http://www.rephresh.com/Products/), found at local pharmacies and comes as applicators pre-filled with the gel. Each application lasts for three days.
3) Hyaluronic Acid Vaginal Gel:
Hylauronic acid has hydrating properties and acts as a lubricant by releasing water molecules into tissue. A trial was done to evaluate the efficacy of vaginal hyaluronic acid gel compared to estriol cream for vaginal dryness in postmenopausal women. Patients in the study had a total of 10 applications over the course of a month. It was found that hyaluronic acid had similar results as the estrogen cream and showed clinically significant improvement in dryness symptoms. Availability: Hyaluronic acid gel products such as, Hyalo Gyn and Hyalofemme.can be purchased on the Intern
4) Non-hormonal vaginal moisturizing gel
Certain products containing a moisturizer can be used to relieve symptoms of vaginal dryness. A clinical trial compared one vaginal moisturizer, Replens, with an estrogen cream. After 12 weeks, both treatment groups had a significant improvement in vaginal dryness, with no significant difference between the groups.
Availability: Patients can locate these products at a pharmacy and examples include Replens Vaginal Moisturizer, Silken Secret by Astroglide, Moist Again, and K-Y Long Lasting. They’re effective by keeping the vagina moist through skin absorption. Available in single-use tubes with applicators; patients may find it helpful to use a sanitary pad in case of any excess non-absorbed gel.
5) Vaginal Lubricants
Patients may use vaginal lubricants to relieve vaginal dryness during sexual intercourse. Availability: Examples of these products found at local pharmacies include K-Y Jelly and Astroglide. Another product in this category found online is called “Yes” (www.yesyesyes.org). The organic lubricants are either oil or water based and contain the following ingredients:
a. Oil based: Prunus dulcis (Sweet almond) oil, Butyrospermum parkii (Shea butter), Helianthus annuus (Sunflower) seed oil, Theobroma cacao (Cocoa) seed butter, Cera alba (Bees wax), Natural Tocopherols (Vitamin E).
b. Water-based: Aqua (water), Aloe barbadensis (Aloe vera), Cyamopsis tetragonolobus (Guar Gum), Ceratonia siliqua (Locust Bean Gum), Linum usitatissimum (Flax extract), Phenoxyethanol, Potassium sorbate, Xanthan Gum, Citric acid
(Importantly: None of these have been found to be phytoestrogens)
6) Vitamin E vaginal suppositories
Vitamin E is an antioxidant that protects cells and tissues from free radical damage. It can act as a lubricant and may be used for women with vaginal dryness.
Availability: An example for purchase on the Internet is called Carlson Key-E Vitamin E vaginal suppositories. Patients can also simply puncture Vitamin E capsules and apply the oil to the vagina.
7) Coconut and olive oil
Patients can also use coconut or olive oil to provide lubrication to the vagina.
However, patients should AVOID using vinegar, yogurt, hand lotions, antibacterial or fragrance soaps, bubble baths or bath oils as they may further irritate the vagina.