Is There Such a Thing as a "Closing of the Vagina"? - Hystersisters Hysterectomy Article

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Is There Such a Thing as a "Closing of the Vagina"?

Is There Such a Thing as a "Closing of the Vagina"?

From the Ask a Doctor - Hysterectomy Related Questions Articles List

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Ask A Doctor

I am 45 years old and 9 years post-op, no cervix or ovaries, no HRT.

I visited my doctor to talk about vaginal dryness and uncomfortable intercourse. She told me that if vaginal dryness is left untreated, the vagina will eventually close up and I will either need a reconstructive surgery or result to be sexually inactive. She suggested vaginal HRT cream which I started using. Could any of the doctors elaborate on this because if vaginal closure is something as a long-term effect of hysterectomy, I think it needs to be discussed with the patient prior to the surgery. Thank you!

Answered by Susan Hunter, M.D.

Closing of the vagina due to lack of estrogen is called "agglutination." It is an uncommon thing and is seen mostly in cases of radiation therapy to the area, no estrogen therapy and no sex for years at a time. It usually can be reversed partially or completely just with estrogen therapy. (Interestingly it can also happen to little girls and sometimes toddlers before puberty and it is treated with estrogen cream then as well.) I have seen it a handful of times in my 20 year career. In your case a little estrogen cream will help the vaginal dryness, and intercourse will guarantee that will not happen to you.

Answered by Deborah Wilson, M.D.

You are correct, the subject needs to be discussed with the patient before the ovaries are removed, leaving the woman with no hormones.

It is true that without hormones the vagina loses it's elasticity and the diameter of the vagina shrinks.

So if ovaries are removed along with the uterus the subject of hormone replacement needs to be explored. If hormones are replaced, the vagina will not shrink.

Hormone replacement is a very controversial subject. There is much misinformation floating around and many women are fearful of hormone replacement, even bioidentical replacement.
For many women, these fears are unwarranted.

The frightening studies that have been done on hormone replacement were all done on Premarin (horse urine derived estrogen) and Provera (synthetic progesterone). Both of these hormones were given to the patients orally, which means that they passed through the liver.
Bioidentical hormones are different and so far no studies indicate that they carry the same risks, particularly if they are administered non-orally (gels, patches, sublingual tablets, or subcutaneous pellets).

Obviously, each patient needs to be evaluated individually, and some patients are not candidates even for bioidentical hormones, but many women do not have risk factors that prohibit them from taking hormones.

These women can benefit greatly by using estrogen and testosterone in some form. The vagina does not tighten, they can retain their sex drive and sexual responsiveness long into their later years, their skin looks better, and their bones do not deteriorate. Not to mention the absence of hot flashes, night sweats, insomnia, and depression.

There are many Gynecologists who are forward thinking regarding the subject of hormones, and I suggest that women locate a doctor who places value on maintenance of sexual function for menopausal women.

The responses in the "Ask a Doctor" articles are provided by M.D./Surgeons with credentials in their linked profiles. The HysterSisters.com staff thanks the doctors for their participation and reminds all readers to discuss their medical concerns with their personal physicians for specific information about their health choices, as this is in no way intended to take the place of members consulting with their own physicians.

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