La sècheresse vaginale
INTRODUCTION
La sécheresse intime se manifeste par une diminution des sécrétions vaginales, touchant 46% des femmes au cours de leur vie (1). Cette sensation, fréquente et affectant des femmes de tout âge, résulte de la réduction ou de l’arrêt de la lubrification naturelle essentielle au maintien de l’humidité vaginale. Bien que la sévérité de ce trouble puisse varier, il est essentiel de comprendre ses causes, symptômes et options de traitement. En fournissant des conseils éclairés et des solutions adaptées, le pharmacien d’officine répond aux besoins des femmes cherchant à améliorer leur confort intime.
DÉFINITION
La sécheresse vaginale, se manifeste par une insuffisance ou une absence d’humidification naturelle du vagin. Les sécrétions vaginales, produites par les glandes cervicales et les glandes de Bartholin, jouent un rôle fondamental dans le maintien des conditions physiologiques optimales du vagin, assurant ainsi sa protection, son élasticité et sa texture douce. (2)
Le rôle clé de la lubrification vaginale se déploie à plusieurs niveaux. Tout d’abord, ces sécrétions contribuent activement à créer un environnement humide et légèrement acide, favorisant un équilibre microbiologique sain. En agissant comme un mécanisme de défense naturel contre les agents pathogènes, elles renforcent la protection du système vaginal, constituant ainsi une barrière essentielle contre les infections.
Au cours du cycle menstruel, ces sécrétions subissent des variations spécifiques. Leur composition est modulée pour faciliter ou entraver la mobilité des spermatozoïdes, particulièrement pendant la période d’ovulation. Par ailleurs, la lubrification générée par les glandes de Bartholin revêt une importance particulière en offrant une protection supplémentaire à la muqueuse vaginale, notamment lors des rapports intimes. (4)
CAUSES
Les causes de la sécheresse vaginale sont multiples :
– la ménopause : la diminution de la production d’œstrogènes et les troubles hormonaux entraînent un déséquilibre de la lubrification vaginale. (4)
– La grossesse : Au cours des trois premiers mois de la grossesse, il est possible que la femme éprouve une sécheresse vaginale temporaire, susceptible de se résorber dès que la région pelvienne reprend son afflux sanguin habituel. (4)
– L’allaitement : entraîne aussi une diminution des taux d’œstrogènes et de progestérone pouvant mener à une diminution de lubrification vaginale.
– Les contraceptifs hormonaux : La sécheresse vaginale est fréquemment observée comme un effet secondaire des contraceptifs hormonaux. Ceci est la conséquence du remplacement des hormones naturelles, œstrogènes et progestérone, responsables de la régulation de la production des sécrétions vaginales, par les hormones synthétiques présentes dans la contraception hormonale.
– La prise de certains médicaments comme : les antidépresseurs, les benzodiazépines, les traitements anti acnéiques, les anti-hypertenseurs, les vasoconstricteurs, les antihistaminiques, peut mener à une sécheresse vaginale dans environ 3 à 5% des cas. (5)
– L’hystérectomie: où l’utérus et les cellules productrices de sécrétions vaginales sont retirés, la sécheresse vaginale peut se produire.
– La chimiothérapie: induisant une ménopause chimique, peut également causer la sécheresse vaginale.
– Le nettoyage excessif du vagin peut provoquer la déshydratation.
– Le syndrome de Sjögren: qui est une maladie auto-immune, peut entraîner une inflammation des glandes, réduisant la production de sécrétions et provoquant la sécheresse vaginale.
– Le diabète : peut endommager les nerfs et vaisseaux affectant les glandes utérines et asséchant les muqueuses.
– Les infections vaginales : mycose vaginale
– La sclérose en plaques.
– La consommation de tabac en raison de l’effet vasoconstricteur engendré par la nicotine.(4)
– L’alcool : en raison de son impact déshydratant sur l’organisme . (4)
– Les malformations congénitales.
SYMPTÔMES
Les manifestations les plus fréquentes de la sécheresse vaginale comprennent :
• Gêne, sensibilité et douleurs au niveau de la cavité vaginale.
• Douleurs lors des rapports sexuels, pouvant résulter de la friction accrue due à la sécheresse.
• Démangeaisons, tant à l’intérieur qu’autour du vagin, souvent liées à une irritation de la muqueuse.
La carence d’humidité dans le vagin peut entraîner des perturbations de la flore vaginale, constituée des diverses bactéries qui résident naturellement dans cet écosystème. Cette altération de l’équilibre microbien augmente le risque de divers troubles gynécologiques, notamment la vaginite, les infections fongiques (mycose vaginale), et la vaginose bactérienne (déséquilibre bactérien).
TRAITEMENT
Il existe différentes approches pour soulager la sécheresse vaginale.
1. L’hygiène intime
Pour l’hygiène intime, des produits spécifiques adaptés, conçus pour traiter la sécheresse, offrent un confort supérieur par rapport aux solutions d’hygiène intime classiques. Leur distinction réside dans la présence d’agents hydratants spécifiques. Par exemple, certains contiennent des extraits d’olivier, d’aloe vera, d’avoine, de camélia, etc. Les formulations varient pour répondre aux besoins spécifiques, apportant un soulagement optimal. (3)
2. Le traitement hormonal
L’administration d’œstrogènes, sous diverses formulations telles que crèmes, ovules, suppositoires, anneaux ou gels, se présente comme un traitement efficace contre la sécheresse, particulièrement recommandé dans des situations avancées de cette affection.
Les œstrogènes agissent en stimulant la régénération cellulaire, en favorisant la vascularisation locale et en rétablissant l’équilibre hormonal au niveau de la muqueuse vaginale.(6)
3. Les hydratants vaginaux
Les hydratants vaginaux, qu’ils soient en crème ou en ovule, exercent une action sur le tissu vaginal en augmentant la teneur en eau des cellules constituant la paroi vaginale. Typiquement, leur application s’effectue de 2 à 5 fois par semaine à l’intérieur du vagin et au niveau de son orifice. L’acide hyaluronique, une molécule reconnue pour ses propriétés hydratantes, est fréquemment privilégié dans ces formulations.
De nombreux hydratants utilisent des composants naturels et bénéfiques tels que les extraits de bardane, l’allantoïne, la glycérine, l’huile de paraffine, l’extrait de grenade et l’extrait de racine de guimauve.
4. Les lubrifiants
Les lubrifiants ont pour objectif de rendre le vagin plus humide pour faciliter les rapports sexuels. Ils sont tous formulés à base d’eau et sont compatibles avec la plupart des préservatifs, diaphragmes ou spermicides. On trouve ainsi différentes catégories : les classiques, les hydratants, ceux à effet prolongé, et ceux spécialement conçus pour la ménopause.
• Les lubrifiants classiques : Ces produits sont destinés à être appliqués immédiatement avant ou, si nécessaire, pendant un acte sexuel afin de prévenir les dyspareunies. Ils servent à suppléer la lubrification naturelle, agissant instantanément, bien que leur effet soit temporaire. La composition de ces lubrifiants peut varier selon les marques. (3)
• Les lubrifiants hydratants : Ils présentent des propriétés hydratantes, notamment grâce à la présence d’acide hyaluronique qui a la capacité de retenir l’eau dans les cellules. L’action lubrifiante se prolonge dans le temps et ils ne peuvent être appliqués qu’une seule fois par jour. (3)
• Les lubrifiants hydratants “longue durée »: Ces lubrifiants sont utilisés pour traiter la sécheresse vaginale chronique, particulièrement observée lors de la ménopause, et présentent ainsi des propriétés hydratantes. En règle générale, une application de 2 à 3 fois par semaine est considérée comme suffisante. Certains produits comprennent un gel polycarbophile saturé en eau, doté d’un polymère adhérant à la muqueuse et libérant progressivement de l’eau sur une période de 3 jours. D’autres formulations intègrent des liposomes d’acide hyaluronique, assurant une action à libération prolongée.
• Les lubrifiants ( spécial ménopause): Ils contiennent des phyto-oestrogènes dans leur formulation. Il est essentiel de prendre en considération les contre-indications éventuelles, notamment en cas de tumeur oestrogéno-dépendante, comme le cancer du sein, ou en présence d’antécédents médicaux.
5. Le traitement (CO2, laser)
Certains médecins, proposent un traitement au laser à base de CO2 dans le but de stimuler et régénérer les cellules vaginales. Cette procédure consiste en l’utilisation du laser vaginal, où des impacts laser sont dirigés vers la muqueuse vulvo-vaginale, potentiellement induisant une stimulation de la production de collagène et un épaississement de la muqueuse. En plus du laser vaginal, d’autres approches telles que la radiofréquence vaginale et la photothérapie (ou photobiomodulation) peuvent également être envisagées.
6. L’homéopathie
L’homéopathie peut être envisagée comme une approche pour traiter la sécheresse vaginale. Des souches homéopathiques spécifiques sont réputées pour aider à soulager les symptômes, telles que :
• Folliculinum 5CH : Souvent recommandé pour atténuer la sécheresse vaginale, ce remède homéopathique peut être envisagé pour son potentiel à rétablir l’équilibre hormonal.
• Bryonia 5CH et Alumina 5CH : Utiles lorsque la sécheresse est particulièrement gênante et que la peau présente une sécheresse intense.
• Arsenicum album 5CH : En cas de douleurs et de brûlures soulagées par la chaleur, ce remède homéopathique peut être considéré.
• Natrum muriaticum 9CH : Indiqué en cas de sécheresse accrue après les règles ou si toutes les muqueuses sont sèches.
• Hepar sulfuris calcareum 9CH : Recommandé lorsque la sécheresse s’accompagne d’une inflammation.
• Sepia 9CH : Utile lorsque la sécheresse est associée à des troubles du cycle.
La posologie habituelle est de 5 granules, 2 fois par jour, mais elle peut être ajustée en fonction des symptômes et jusqu’à l’amélioration (6) , (7).
7. La phytothérapie
Dans le domaine de la phytothérapie, certaines plantes riches en phytoestrogènes, des hormones naturelles favorisant potentiellement la lubrification vaginale, incluent la sauge, le soja, le houblon, le lin, le dong quai, ou l’actée à grappes. Ces plantes peuvent être intégrées, que ce soit sous forme de gélules, de capsules, ou en infusion.
Des herbes comme l’achillée millefeuille et l’alchémille, reconnus pour leur rôle de régulation du système hormonal, peuvent également être utilisées. Le gattilier, en normalisant et en augmentant les niveaux d’hormones, s’avère également efficace dans la prévention de la sécheresse vaginale. Il est possible d’incorporer ces plantes dans son régime soit sous forme de gélules ou de tisanes, en fonction des préférences individuelles
8. L’aromathérapie
La sauge sclarée joue un rôle crucial dans l’équilibre du système hormonal, impactant ainsi la qualité de la peau et des muqueuses. Souvent qualifiée de « l’huile essentielle de la femme », elle peut être utilisée de deux manières principales:
• Voie orale : Une goutte de l’huile essentielle de sauge sclarée sur un comprimé neutre, à prendre une fois par jour pendant 21 jours. Cette routine peut être renouvelée au besoin après une pause de 21 jours.
• Voie locale, en massage : La sauge sclarée, diluée dans une huile végétale, peut être appliquée en petite quantité sur le bas-ventre et le bas du dos une fois par jour pendant 21 jours. Cette application peut également être renouvelée selon les besoins. (9)
Conseils et prévention
En tant que pharmaciens, nous assumons un rôle crucial dans la fourniture de conseils éclairés et de recommandations préventives. Ainsi, nous contribuons à guider nos patientes vers des habitudes et des choix de vie favorables pour prévenir la sécheresse vaginale. Voici quelques suggestions que nous pouvons partager en officine pour favoriser une santé vaginale optimale :
• Limitez les toilettes intimes : Il est recommandé de ne pas dépasser deux toilettes intimes par jour pour préserver l’équilibre de la flore vaginale.
• Choisissez des produits adaptés : Optez pour des produits doux au pH neutre lors des toilettes intimes, évitant ainsi de perturber l’acidité naturelle de la flore vaginale.
• Évitez l’usage fréquent de protège-slips et tampons : L’utilisation excessive peut contribuer à la sécheresse vaginale à long terme.
• Privilégiez des vêtements confortables : Évitez les vêtements trop serrés, qui pourraient provoquer des irritations. Les sous-vêtements en coton sont à privilégier.
• Encouragez une activité sexuelle régulière : Cela peut contribuer à améliorer la circulation sanguine des organes génitaux et à prévenir le risque d’atrophie.
• Gérez le stress : Le stress peut affecter la santé vaginale, donc encouragez des pratiques de gestion du stress et favorisez la confiance en soi.
• Protégez lors de la baignade : Appliquez légèrement une crème hydratante avant la baignade pour protéger contre les effets de l’eau chlorée.
• Compléments alimentaires : Suggérez l’utilisation de compléments alimentaires contenant des vitamines D ou E, connues pour contribuer à une meilleure santé vaginale.
RÉFÉRENCES BIBLIOGRAPHIQUES:
(1) Etude IFOP/Bayer® : L’impact des problèmes de sécheresse intime sur la vie sexuelle des Françaises en phase de péri-ménopause et de ménopause -Enquête réalisée sur un échantillon représentatif de 1402 Françaises (45-60 ans) dont 685 sont en ménopause ou péri ménopause.
(2) medinova formation destinée aux professionnels de santé “ maladie de la vulve- de nombreux troubles – un seule produit 2022
(3) LE MONITEUR, Les maux gynécologiques. Le moniteur des pharmacies. 2939
(4) FEREY D., Conseils en pharmacie. Edition Maloine, 2011, pp. 247-9
(5) Magazine américain Prevention, édition de février 2023
(6)Astrea Pharmacie (Magazine sur la santé suisse), édition de juin 2021 consacrée notamment aux sécheresses vaginales
(7) SAYOUS D-J. Le grand livre de l’homéopathie. Edition Eyrolles. 2012
(8)QUEMOUN A-C. Ma bible de l’homéopathie. Quotidien Malin, 2013. 544 p.
(9) GROSREY-LAJONC N. Naturo-famille : 100 petits maux de la vie quotidienne traités par les plantes. Albin Michel, 2014. 306 p.
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Hickey lectures different attorneys nationwide and has authored over 30 papers on trial techniques and damage law.
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