Vitamin D and Genitourinary Disorders in Menopausal Women: Part Two
Vitamin D and Genitourinary Disorders in Menopausal Women: Part Two
The low estrogen levels that follow menopause can also result in lowered sexual desire, decreased arousal, and an ensuing decline in sexual activity (obviously worsened if one is also experiencing painful intercourse due to dryness in the vaginal lining).
Now let’s look again at the idea that low estrogen results in lower levels of active vitamin D in menopausal women. This would lead us to conclude that vitamin D may also be helpful in treating these conditions, and indeed research shows “a link between low vitamin D levels and sexual dysfunction among postmenopausal women”. (Source)
Small clinical trials have determined that vitamin D supplementation can improve female sexual function, including increasing orgasm, sexual desire and satisfaction. Though most of these studies were done on premenopausal women, the effect should be the same for postmenopausal women since vitamin D receptors (VDRs) are present in the uterus and ovaries, and have a role to play sexual functions and hormone balance. In these studies a topical vaginal cream mixing vitamin D and E was used, and benefits were observed after 4 weeks of application. (More on this cream to follow.)
Further to the subject of orgasm: “The scores of desire, arousal, lubrication, orgasms, and satisfaction were significantly lower in women with anemia.” (Source) And: “Magnesium is essential for the female orgasm…and can also help with female orgasm difficulties”. (Source)
As well, I’d like to point out that a common over-the-counter medication can be an impediment to a healthy sex life. Antihistamines can cause sexual side effects including decreased sex drive, decreased vaginal lubrication, and difficulty orgasming. (Antihistamines can also cause erectile difficulties in men.) (Source)
(For more on the subject of supporting sexuality in women, see this article from MedicineNet: 23 Best Supplements for Female Libido)
One other thing vitamin D can do, which is proven comparable to what estrogen can accomplish, is to stimulate the production of the vaginal epithelium (lining), which in turn “helps regulate the microbial environment within the vagina, including pH levels and flexibility”.
Furthermore, one of the key functions of a healthy vaginal epithelium is to store glycogen, which is converted into glucose. Lactobacillus turns this glucose into lactic acid and acetic acid “effectively maintaining a healthy vaginal pH within the range of 3.5–4.5. However, this entire pathway can be disrupted when estrogen levels are low.” But, when we have sufficient vitamin D levels, this vaginal glucose balance is maintained due to vitamin D promoting glycogen storage in this area.
Now, since we have seen that for many of the concerns we are discussing, the medical treatment is to use a topical vaginal estrogen cream, perhaps we should see how vitamin D might work when used in a similar manner.
In one study, after four weeks of treatment with a vaginal cream containing 1000 IU of vitamin D and 100 IU of vitamin E (per daily application), subjects observed an improvement in vaginal burning, dryness, and itching. Since vitamin E has proven to be helpful when applied in this manner for the treatment of vulvovaginal symptoms associated with GSM, we can see why they chose to combine the two nutrients.
“The participants applied the cream daily for two weeks and three times a week for an additional 10 weeks.” (If such a cream were not available to anyone wishing to try this experiment, one could simply add a drop or two of Quick D to half a capsule of Vitamin E 200 IU, mixed into some aloe vera gel.)
In another study, vitamin D vaginal suppositories, without vitamin E, were given to women for a duration of 8 weeks. Results indicated an improvement in the vaginal epithelium, as well as a decrease in vaginal pH.
Among postmenopausal women, there is a relatively high level of bacterial vaginosis found in those with low vitamin D levels (below 20 nmol/L), “while the prevalence was much lower among women with a serum 25(OH)D concentration exceeding 80 nmol/L”. (For more information on vitamin D testing and how to understand the results have a read of this older newsletter of mine.)
In this case vitamin D works to support and enhance the immune system as well as helping the body to produce antimicrobial peptides. Particularly, vitamin D has been shown to stimulate the production of cathelicidin (a powerful antimicrobial that also inhibits fungi, parasites and viruses) in the urinary bladder.
Pelvic Floor Dysfunction
Many of the genitourinary problems in postmenopausal women are attributed to pelvic floor dysfunction (PFD). Such problems include difficulty in urination, dyspareunia (pain during intercourse), and vaginal prolapse.
In one study, women with PFDs who had symptoms including pelvic organ prolapse, overactive bladder (OAB), and urinary and fecal incontinence, were found to have lower vitamin D levels than otherwise healthy postmenopausal women.
Another study on postmenopausal women, in this case examining those with stress incontinence, showed a positive effect by having them use vaginal suppositories containing a combination of estriol and high-dose vitamin D. It took about six weeks for a reversal of symptoms to manifest. And yet another study decided to forgo the estriol and simply gave the subjects 50,000 IU of vitamin D per week for eight weeks. (Here it appears that the vitamin D was given orally not via suppository.) This approach also reduced the severity and frequency of OAB, urinary tract infections, and the need to get up at night to urinate.
Vitamin D receptors are found in the detrusor muscle in the bladder wall “thus, its insufficient level may impact bladder function and pelvic floor muscle weakness”.
Studies such as these do conclude that the optimal way to treat vulvovaginal symptoms is with the suppository form, ensuring that the vitamin D be absorbed into the vaginal epithelium. However, “while the findings are not consistently conclusive, they suggest that vitamin D supplementation, whether topically or orally, may offer benefits in improving vaginal symptoms and sexual function and potentially reducing the risk of UTIs”. (Primary Source)
If the VDRs are sensitive to estrogen and the estrogen has declined, there are two things one must do if any of the symptoms discussed are an issue. Naturally increase one’s estrogen levels safely, as mentioned earlier, with progesterone cream (not progestin which is synthetic) along with supporting adrenal health in order to keep the mother hormone DHEA at an ideal level. And take extra vitamin D to compensate for the body’s diminished ability to utilize previously adequate levels of D. Here I suggest you read my previous newsletters on Megadosing Vitamin D, if you have not done so already.
And, keep in mind that NutriStart now has a high dose version of Quick D, providing 2,500 IU of vitamin D per drop, making it easier to take higher doses, if one chooses that avenue, and something that would be suitable for use in creating a vaginal cream since the only other ingredient is organic sunflower oil which is safe to apply to skin and mucous membranes.