Meredith, a 45 year old woman who regularly listens to my radio show the CKNW Sunday Night Sex Show emailed me to ask about the differences between the hormone-free personal moisturizers Replens® vs. RepaGyn® . Meredith had tried Replens® for her vaginal dryness but was still experiencing pain with intercourse and she wondered if RepaGyn® might be a better choice for her, but didn’t know if there was any difference between the two products.
Given the variety of personal moisturizers available, it is so important that a woman chooses the right product for the right reasons. Knowing the ingredients of a personal moisturizer and how it works is one important aspect of optimizing treatment.
Whenever any treatment is not working, I recommend patients speak to their doctor about discontinuing use and/or switching to another option. In this case, both personal moisturizers that Meredith was inquiring about (Replens® and RepaGyn®) are over the counter, so Meredith is free to choose another personal moisturizer as neither requires a doctor’s prescription.
One of the key benefits of RepaGyn® (apart from being hormone free and providing long-lasting moisturization) is that it has the additional benefit of helping to promote healing of the vaginal mucosa (tissue). If the vaginal mucosa does not heal then Meredith may continue to experience vaginal dryness as she was while using Replens® which just provides the moisturization aspect. Healing the vaginal tissues is rather important because dry tissues can tear and bleed, something many women do not realize is happening.
My Recommendation for Meredith
I suggested that Meredith use a personal lubricant during intercourse, and I also recommended that she switch . Meredith took my advice and started using RepaGyn® for her vaginal dryness. Within two weeks, she noticed a difference in the degree of her vaginal pain with intercourse – she found it helpful to use a personal lubricant, as I had recommended, helping reduce friction to decrease sexual pain. By the end of two months, Meredith no longer required the use of a personal lubricant as her sex was as she said, “Pain-free once again thanks to RepaGyn®,” which she used (as directed) vaginally once daily at bedtime.
Final Thoughts
I took the opportunity to educate Meredith that if her vaginal dryness progressed to other symptoms such as post-coital bleeding, burning, itching, recurrent urinary tract infection, thin watery discharge and/or leakage of urine, she may require treatment with a low dose localized estrogen therapy. But for now, continuing with RepaGyn® was just what the “nurse” ordered to keep her going back to the bedroom.
When reading the information on RepaGyn I noticed it said not to use any other products in the vagina when using it. You recommended that Meredith use a personal lubricant along with the RepaGyn. I find this a bit confusing. Could you explain? Thanks.
Hi Janice,
Thank you for your question. Interactions with other products that are used in the vagina are not known;therefore it is always advisable to discuss the use of Repagyn with your doctor. Some women may use low dose localized estrogen for vaginal atrophy in addition to a vaginal moisturizer like Repagyn. In this case we recommend alternating the Repagyn with the low dose localized estrogen so if you take the low dose localized estrogen therapy on a Sunday and Thursday for example, it is advisable to use Repagyn on Monday, Wednesday and Friday for example. Keep in mind there may be a reaction to a lubricant that is used during sexual intercourse as well but if you are using Repagyn as directed, you are less likely to require a lubricant as Repagyn helps to relieve vaginal dryness and promote healing of the vaginal tissues. Thank you again for your excellent question! Maureen
Hi Janice, Thank you for your question. It is fine to use a lubricant during sex on opposite days of when using Repagyn. Thanks again! Maureen
I bought 2 packs of repagyn on my way into work and forgot them in the car. at 7 pm the temp was 22c. I noticed that the suppositories had lost some of their shape. are they still okay to use.
Hi Margaret, No problem! They are still OK to use. Just place your Repagyn into the fridge. The will typically mould back into ovule shape. Maureen
just saw your message thanks. talked to pharmacist and since he had no idea how hot it got inside the car he suggested I throw them out and get a new pack as they might cause irritation. I did buy new pack but never threw out the old yet. now i wont since they are still okay to use. putting in fridge at this time however wont do much for restoring shape. they did keep most of their shape. thank you . i was concerned they might have caused other problems
You are most welcome Margaret. There is no reason they would cause irritation because they melted a bit.Yes, they are ok to use. It is just as important to moisturize your vagina as it is your face. All the best, Maureen McGrath RN Women's Sexual Health Expert and Host CKNW Sunday Night Sex Show http://www.cknw.com/sunday-night-sex-show/
I understand there are only 10 capsules in a pkg. I see on the web site they are $27.00. How often are they inserted? I am a breast cancer survivor and taking Letrozole and I am experiencing severe dryness. Tried Replens but it just aggravated the problem. Anxious to try RepaGyn but I am having trouble finding it in Peterborough.
Hello Carol, For Vaginal Dryness, the recommendation is to insert one ovule into the vagina nightly for eight days in a row. Then continue to insert one ovule at night twice per week. Some women notice benefit after two weeks but the product optimizes by about two months. Repagyn is available Shopper's Drug Mart and many other pharmacies in Peterborough however you will need to ask the pharmacist for it directly. You many also order it on-line through pharm-ex direct. Here is the link! https://www.pharmexdirect.com/repagyn/en/ Best of luck to you!
I used Repagyn, and at night start feeling hotness inside all lower abdominal area. In the morning feeling tired!!!!
Hi Celia, This is the first that I have heard of the symptoms you describe after having taken Repagyn. Please contact the manufacturer BioSyent and to report this as an adverse event.
Here is the number: 1-888-439-0013 Thank you very much for your feedback. Maureen
Hi Maureen
Any suggestions for a total loss of interest in sex?
Married 21 years and have 3 children. Generally happy, working full time .i had my uterus removed 7 years ago and I am definitely going through menopause.
He is my soul mate and I love him but not interested in sex any more.
He is Very unhappy about this, I don't really mind too much so long as we have each other.
Any suggestions would be appreciated
Thanks
Hi Keri,
Loss of interest in sex for women is common, especially in long term relationships. The loss of sexual desire peaks between the ages of 35-65. You will want to treat your peri-menopausal symptoms whether like hot flashes, insomnia and/or vaginal dryness. Rule out any medical issue and ensure that your low sexual desire is not the result of a medication side effect. Fatigue is the number one reason for low sexual desire so if you are not sleeping enough or well, you will want to do something about that.
If you are experiencing vaginal dryness, you may wish to try a personal moisturizer like RepaGyn (ovule), Gynatrof (gel) JoyGel(contains coconut oil and yam) or a water-based lubricant like V-Love.
To increase sexual desire one needs to think about sex and talk about it. After all, the brain is the biggest sex organ. Access your sexuality and feminine power. Make sure you are physically active, working out and keeping trim. Spend some time with yourself exploring what feels good. Have you tried a vibrator? Fantasize. Buy some lovely lingerie. Make it playful. Maybe it is time to bring sex toys into the relationship. It is at this time of life that foreplay becomes very important. Wanting sex for women is not enough. It's very important for women to have successful foreplay because it takes a woman a longer time [than a man] to get up to the level of arousal needed to experience orgasm. Foreplay begins long before you get into bed. Try sexting your husband before he comes home from work or on your way up to bed. Zestra® is a topically applied medication, approved by Health Canada for women suffering from female sexual arousal/interest disorders. Its unique, patented and hormone-free formula is composed of active ingredients extracted from 4 plants recognized to increased blood flow and local sensitivity. Let me know if you would like to learn about my silver balls secret sexting sensation! Hope that helps!
Maureen
My doctor recommended VagiFem 10 mcg. I did some research on the internet and saw some side effects including weight gain and hair loss. When I inquired further, I was told that the suppository is ok and that the side effects were more for the oral version. I am still not sure about that. I am now thinking of trying RepaGyn instead. I wanted to know your thoughts of VagiFem vs RepaGyn. Thanks.
Hi Mary, Thank you for your note. Vagifem is low dose localized estrogen that does not cross into the systemic blood system. The side effects listed on the product monograph relate to the systemic estrogen used for other symptoms of menopause such as hot flashes and night sweats. They do not apply to low dose estrogen for the vagina because the dose of estrogen is so low and is more like a topical application of it. If a women has too much estrogen in her vagina then she is at risk for a yeast infection. Vagifem is prescribed for the treatment of vaginal atrophy sometimes referred to a urogenital atrophy which consists of one or more of the following symptoms vaginal dryness, painful sex, leakage of urine, burning, itching, recurrrent urinary tract infections, thin watery discharge and/or post-coital bleeding. Repagyn is a hormone-free personal moisturizer used for vaginal dryness. It is an over the counter treatment and does not require a doctor's prescription. It contains Hyaluronic acid which may help to repair vaginal tissues which become thin and dry when the estrogen receptors decrease in the vagina. Of course treatment depends upon your symptoms and it is a good idea to continue a dialogue with your doctor. Both treatments are lifelong therapy as this is the only condition of menopause that does not go away. Each takes about two months to optimize but you should notice some improvement after about two weeks. Vagifem is to be inserted vaginally daily at night for two weeks and then twice weekly on a Monday and Thursday. Repagyn is inserted nightly for 8 nights then 2-3 times per week. Hope that helps! Maureen
Hi Maureen
Several years ago I was diagnosed with vestibulitis (by a gynecologist). I too am an RN and have always wondered at the accuracy of that diagnosis vrs plain old vaginal dryness/atropy. Many treatments were tried, even surgery, and low dose estrogen suppositories. None were successful at eliminating the sharp burning pain at one specific area of the vestibule, always in the same spot, on penetration. In frustration, my husband and I have tried to 'make it work' other ways, but not a very satisfactory outcome for either of us. My new doctor recently suggested Repragyn, which I have used only for a week, and am keen to see if the outcome is a reduction (or even elimination!) of pain with penetration. I have used only seven nightly doses, and so far we have not had sex since trying Repragyn. I am hopeful, but am wondering if you have any thoughts on the use of Repragyn with 'vestibulitis' (IF that is indeed what is bothering me)?
PS Thank you for the great work you are doing on this site, with your feedback process, and with your radio talk show. Wonderful to see RNs accomplishing so much good, for others.
Ann
Hi Ann, Thank you so much for your lovely note and kind words. It is difficult to say whether or not Repagyn will work without my having examined you but it is worth a try as it is has hyaluronic acid to which helps to heal tissues. Yesterday in my office I saw a patient with an "area" as you describe, very painful upon penile penetration. It was an area of thin skin due to vaginal atrophy. She is 47 years old. For that spot as for many many other patients, I recommend using Desitin (a diaper rash cream) two or three times per day to act as a barrier from underwear, urine, toilet paper etc to protect and help to heal in addition to Repagyn. Regain is for vaginal dryness, not vestibulitis which can be a diagnosis of exclusion. Vaginal dryness/vaginal atrophy is extremely common. Hope that helps.
Hi, I have an odd situation. I am 38, and for 2 years have been struggling with on and off vaginal irritation. At first it seemed to happen 2-3 days after sex, but for the last 3 months it has been constant. I have been to several doctors throughout this time and have been tested for everything under the sun. I have been told I have vaginal thinning/atrophy. My Dr tested my estrogen and it is normal, no menopausal symptoms. I have searched online extensively and all I can find about atrophy is relating to menapause. No one knows what to do. I was prescribed premarin even though my estrogen is good, bc my Dr doesn't know what else to do. I don't want to fill this prescription. I have been considering an otc estriol topical in hopes that it will repair my easily tearing and constantly irritated tissue. Do you have any info on vaginal atrophy in younger women? No history of cancer, ovaries in tact. Not on bc. Any help would be appreciated.
Thank you so much for your question. Your situation is not odd just not well-recognized. Vaginal dryness associated with perimenopause (the years leading up to menopause) can occur as early as age 37 in women. Your systemic (blood)estrogen level is unrelated to estrogen in your vagina. Estrogen is the hormone regulator of the vagina. That said, Premarin Cream is indicated for vaginal thinning (of tissues) vaginal atrophy. Premarin is low dose and localized. Although some women report breast tendnerness with it's use, it generally does not cross over into the blood system. If you do experience any side effects you can try other low dose localized estrogen therapies such as a pill (Vagifem) or Estragyn Cream or a ring called an Estring. I would not consider an over the counter estriol topical as these generally are not tested and may have unreliable ingredients and dosing. Vaginal dryness, thinning, irritation may be the only peri-menoapausal or menopausal symptom women experience. Vaginal dryness/thinning/irritation occurs in upwards of 80% of women and can occur during and after pregnancy, during breastfeeding, peri-menopause, menopause and for women on certain medications like the oral contraceptive pill and anti-histamines. If you only have vaginal dryness and or/thinning of the vaginal tissues you can try a personal moisturizer. Repagyn is a hormone free ovule that is inserted into the vagina. The hyaluronic acid holds moisture and repairs tissues. Vitamin E keeps tissues youthful. Please keep in mind that any of these treatments (Premarin, Estragyn, Vagifem or Repagyn) takes two months to optimize. Hope this is helpful. Please message me again if you have any further questions. Thanks for your question.
I have read wonderful reviews of Gynatrof (gel). Many women in the USA seem to be ordering it from Canada. Why is it not available in the USA?
It is available in the US but I believe it is marketed under a different name. I will get back to you on that. Yes, it's a great product for women.
I have been told by doctors that vagifem does not cross over into the bloodstream and after using for vagifem for about 4 years I disagree with that assumption. Every time I took it I would get hot flashes, depression and nightmares and sometimes headaches....that stopped when I stopped taking it.
It is low dose and so low that it usually doesn't cross over. That said, anything is possible and nothing is guaranteed side effect free. Thank you for your email. Appreciate it. Maureen
And just to clarify that was not the oral.
There is no oral Repagyn. It is a vaginal suppository. Thank you, Maureen
I would also like to know if you can get Repagyn without any scent. I do not want to smell like an orange down there and personally find it a bit insulting that the manufacturers think our natural smell needs to be covered up with perfume (which is as well irritating to delicate skin)
You make some great points. Thank you for your feedback. Gynatrof is scent-free. Gynatrof is an all natural hormone-free gel that is approved by HC for the treatment of vaginal dryness. Best regards, Maureen
Hi. I am a healthy 24 year old. I was put on alesse by my gp as a method of contraception. About 1 month after using it I started to notice very painful intercourse. I was on alesse for about 2 and a half months. My gp recommended that I take a month off from the pill. I took a month off and the pain was only a little better. My gp decided to put me on lolo, seeing that alesse didnt agree with me. I was on lolo for 1 month and a bit. I had to stop taking it. The pain during intercourse has increased substantially. Not only do I have severe pain during intercourse, but the whole area surrounding my vagina feels inflamed and sore. I just purchased repagyn today and used my first capsule. Do you think repagyn will help me? I am desperate for the pain to stop. Thanks!
Hi Simone, Thank you for your query. The oral contraceptive pill certainly may lead to vaginal dryness. Repagyn indeed may help you but it won't help with the area surrounding the vagina (the vulva). It will take 2 months for Repagyn to optimize so don't give up too soon. Also there is a pain feedback loop that is activated once pain starts in that area because there are so many nerves. So whenever you engage in intimacy you may fear the pain, understandably so which may make it worse. That said, you may also try Gynatrof a non-hormonal personal moisturizer that is all natural and approved by Health Canada. You can also use that during sex. Gynatrof is a gel so you can rub that on the outer lips (vulva area). You can also insert via a plunger the Gynatrof. You could try coconut oil for the outer area as well. But internally, I would stick with Repagyn or Gynatrof and or both. If none of this works, you might try a non-hormonal IUD or if that isn't an option and you stay on oral OCP, you can speak to your doctor about low dose localized estrogen therapy, a topical treatment for vaginal dryness. Let me know how you make out. All the best to you, Maureen
Hi Maureen,
I'm 49 years old in full menapause. I don't like to take any medications and like to try and do things more naturally. Breast cancer runs in the family. The hot flashes, night sweats and vaginal pain is very uncomfortable. I started on vitex and told it likely won't help and was suggested I also take repogyn. The BHT ingredient concerns me as it raises a moderate red flag according to the health organization.
What are your thoughts about it
Hi Eva, If you are uncomfortable about it, there are other options that are truly naturally like olive oil or coconut oil. Hope that helps! Maureen
Hi, I am on Revlimid Maintenance for Multiple Myeloma, had a stemcell transplant 3 years ago and am 60 years young. The last year I have problems with vaginal dryness due to the Revlimid treatment (low dose chemo). I don't dare to take any type of hormone treatment because of the cancer but the dryness has gotten to the point that I don't want to have intercourse with my husband anymore because of the pain. Do you have any suggestions?
Your help would be greatly appreciated.
Hi Erica, There are a number of hormone-free options: Repagyn is a suppository and Gynatrof is a gel. Use them 2-3 times per week after taking daily for one week. These are over the counter options available at the pharmacy without a prescription. You may also try coconut oil. All the best, Maureen
I have suffered from vaginal dryness for two years and just started taking Repagyn. Just wondering if there is a certain time frame before resuming intercourse.
Hi Judy, Repagyn takes about 2-3 months to optimize when taken as directed, however many women start to feel better after a few weeks. It is different for every woman. If after a few weeks you try to have intercourse and it is still painful, then wait a few more weeks. You might also add a lubricant. Hope that helps. Maureen