What to do when your vagina is dry?

Vaginal Dryness Causes, Symptoms & Natural Treatment

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Vaginal Dryness, also known as vaginal atrophy or atrophic vaginitis, is a common and distressing condition which can affect women at any stage of their adult life, causing embarrassment, a sense of loss and, at times, extreme physical discomfort. Approximately 80% of women will experience vaginal dryness due to hormonal changes at some point in their lives.

A comfortable, naturally moist vagina which responds to sexual arousal with a surge of vaginal lubrication, can feel like a woman’s birth right. The loss of this, temporarily or otherwise, can come as a shock, and be capable of undermining a woman’s sense of her innate womanliness and desirability.

If you’d like to know more, download our complete guide on vaginal dryness by filling in the form on this page. You’ll receive a link to download a pdf file which contains all the information you need about the causes, symptoms and possible treatments for vaginal dryness.

What Causes Vaginal Dryness?

Vaginal tissue is kept elastic, comfortable and moist by lubrication which is created by glands at the neck of the womb and governed by the body’s production of estrogen. When the ovaries’ production of estrogen is disrupted, which can happen for a number of reasons, the change in lubrication can make the vagina feel itchy, dry and irritated.

The most common cause of a decrease in estrogen levels is the menopause. During this period, the body decreases its production of estrogen, leading to thinner vaginal tissue and fewer lubricating glands. However, menopause is not the only cause of vaginal dryness. There are a number of possible reasons which can affect hormone production:

  • Life events such as childbirth and breastfeeding
  • Hormone treatments such as HRT and contraceptives
  • Illness such as cancer and its treatments
  • Medications such as anti-depressants and hay-fever remedies
  • Reaction to substances such as nicotine and alcohol
  • Intolerance to preparations used in the vulvar area such as douches and harsh soaps
  • Deep emotional upsets.

What are the Symptoms of Vaginal Dryness?

Vaginal dryness can be identified by various symptoms:

  • Dryness, burning, stinging, swelling, chaffing and bleeding
  • Discomfort if the vulva is inflamed and sore
  • Pain when you have sex (e.g. dyspareunia)
  • Infection and discharge may be experienced. The normal vaginal mucus, acidity and tissue elasticity protect against vaginal and urinary tract infections. When these are reduced, so are the natural defences, and infection meets less resistance. If you feel you have an infection, like bacterial vaginosis, please seek medical advice
  • Itching provokes scratching, which aggravates the itching, which leads to more furious scratching – or to the intolerable effort of not scratching. The sensitive skin around the vulva when weakened is prone to damage, inflammation and itching.

5 Things That Can Cause Vaginal Dryness

  • Changes in hormones. One of the most common causes of vaginal dryness is a decrease in estrogen levels during menopause or perimenopause, after childbirth, or during breastfeeding, according to the American Congress of Obstetricians and Gynecologists (ACOG). Cancer treatments such as chemotherapy and radiation to the pelvis can also lead to low estrogen and a decrease in vaginal lubrication. “The vagina depends on estrogen for health,” says Irwin Goldstein, MD, director of Sexual Medicine at Alvarado Hospital and San Diego Sexual Medicine in California.
  • Medications. Allergy and cold medications containing antihistamines as well as asthma medications can have a drying effect inside the body and cause reduced vaginal lubrication, according to Dr. Goldstein.
  • Insufficient arousal. In some cases, vaginal dryness may be caused by a low libido or sexual problems with a partner. “If a partner has poor performance and early ejaculation, it can contribute to vaginal dryness,” Goldstein says.
  • Irritants. The chemicals in soaps, hygiene products, dyes, and perfumes may cause problems. “Many women have allergies to detergents and soaps,” Goldstein says. “There can be irritants on things like underwear or towels.” Other allergens can actually include lubricants and objects that may be placed in the vagina, he adds.
  • Anxiety. Psychological and emotional factors like stress and anxiety can also interfere with sexual desire and lead to vaginal dryness when normal vaginal lubrication does not occur. “When a woman is anxious, there is insufficient blood flow,” Goldstein says, “so she will have dryness.”

How to Prevent and Treat Vaginal Dryness

Treatment for vaginal dryness depends on the cause. Women who experience problems with vaginal lubrication because of hormonal changes can often benefit from estrogen therapy, according to ACOG.

In some cases, doctors recommend localized treatments like vaginal estrogen inserts. For other women, especially those who have symptoms such as hot flashes in addition to vaginal dryness, an oral medication or a skin patch that releases estrogen throughout the body is an option, according to ACOG. And, in some cases, both approaches can be used together to effectively treat vaginal dryness. “Local estrogen hormone treatments that are inserted into the vagina in the form of a ring, pellet, or cream can complement systemic medications that raise systemic levels of estrogen,” Goldstein says.

In addition to estrogen-based therapies, other approaches that may bring relief, especially from painful sex, include:

  • Lubricants. “There are a plethora of lubricants that can help vaginal dryness,” Goldstein says. They include silicone-based, oil-based, and water-based products, according to ACOG. Lubricants are usually used to make sex less uncomfortable rather than for long-term vaginal lubrication.
  • Moisturizers. Over-the-counter vaginal moisturizers can be an effective way to minimize vaginal dryness over several days with one application. Goldstein explains that “moisturizing agents help introduce water into the tissue of the vagina.”

Vaginal dryness is a common and frustrating condition, but there are ways to alleviate the discomfort. If a lack of lubrication is causing painful sex, be sure to talk to your doctor about all possible treatments.

— Additional reporting by Madeline Vann, MPH

For women, vaginal lubrication is an important part of sexual arousal. It readies the vagina for penetration, making it easier for the penis to enter and reducing any accompanying friction or irritation. Pain during intercourse is often caused by inadequate lubrication.

Lubrication usually occurs naturally, but some women become more lubricated than others. Lubrication can also be a matter of preference. Some women feel that sex is better when they are more lubricated.

Sometimes, especially after menopause, a woman experiences vaginal dryness. Her vagina doesn’t lubricate enough and intercourse becomes painful. A personal lubricant, usually available over the counter at a pharmacy or department store, can help. (There are several types of over-the-counter lubricants, each with advantages and disadvantages.)

It’s important for partners to understand the role lubrication plays in comfortable intercourse. Partners may need to openly discuss the best ways to ensure lubrication. Sometimes more foreplay is all that’s needed for a woman to become sufficiently lubricated. Other times, a personal lubricant may need to be applied during sexual activity. (The application could be part of foreplay, too.)

Women who experience painful intercourse are sometimes told that becoming more aroused will help. However, an April 2013 study in The Journal of Sexual Medicine suggests that this might not be the case.

Canadian researchers studied sexual pleasure and pain sensitivity in women. They found that when women were aroused or partially-aroused (immediately after sexual activity or after a 15-minute rest period), their genital pain sensitivity was higher than it was when the women were not aroused. In other words, the study subjects reported more pain when they were aroused.

This finding led the researchers to think more about lubrication as a way to protect against sexual pain by decreasing pressure on the genitals.

The researchers also theorized that focusing more on pleasure during sex may take women’s attention away from the pain. Women may find it helpful to tell their partners what, specifically, feels good to them.

More study is needed on both of these points, however.

Vaginal dryness makes sex uncomfortable — and it can make you avoid intimacy altogether, which is tough for you and your partner. But what can you do when sex becomes painful because of a lack of moisture?

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There are other options besides reaching for K-Y Jelly®. Even though this can help, it’s also important to understand why you’re experiencing vaginal dryness. Start by talking to your healthcare provider and getting a complete pelvic exam, especially if vaginal dryness is a chronic issue for you.

Normally, the vaginal walls are hydrated by a thin layer of clear, odorless fluid. Estrogen influences the pH of the vagina and vaginal secretions. Without enough moisture, vaginal tissue becomes fragile and has the propensity to tear. These fragile tissues can bleed, hurt and make intercourse less appealing.

These factors can most affect vaginal moisture levels.

  1. Hormones. Changes in vaginal moisture is most often tied to a decline in estrogen levels. Menopause isn’t the only reason for a drop in estrogen production. Breastfeeding and birth control pills can cause this.
  2. Medical treatments. A drop in vaginal moisture also can result from medications and treatments. These include surgical removal of the ovaries, anti-estrogen medications that treat uterine fibroids or endometriosis, chemotherapy treatment for cancer, and certain antidepressants. Douching can also cause problems with estrogen. Even medications taken for itchy eyes and runny noses (antihistamines) can decrease vaginal secretions.
  3. Duration of foreplay. Vaginal moisture is tied to arousal. It’s important to spend enough time with your partner enjoying different sensations outside of intercourse. The vagina responds to a variety of sensual parts of the body that can be caressed, including the lips, tongue, clitoris, toes, neck and breast. Cuddling also counts. It’s important for your partner to understand how much foreplay has a role for women during sex.

If you are experiencing a problem with vaginal dryness, there are a variety of treatment options your doctor may suggest. You may even try natural oils, such as grape seed, olive, sweet almond, sunflower or coconut. Understanding the cause of your problem can open up some other possibilities, too.

From the book Us! Our life. Our Health. Our Legacy. by Linda Bradley, MD and Margaret McKenzie, MD

Don’t ignore vaginal dryness and pain

The condition is treatable, although treatments likely won’t provide complete relief.

Published: March, 2019


Image: © vchal/Getty Images

Vaginal dryness occurs in women of all ages, but it becomes much more common after menopause. It’s estimated that the problem affects about half of postmenopausal women — most of whom, possibly as many as 90%, don’t seek treatment for their symptoms, which include not only dryness, but also irritation and pain during sexual intercourse.

The North American Menopause Society and the International Society for the Study of Women’s Sexual Health refer to this combination of menopausal symptoms, which are brought on by a drop in the body’s estrogen production, as genitourinary syndrome of menopause (GSM).

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Vaginal dryness is a symptom that I discuss with women every week. Typically, it isn’t the main reason that brings a woman to the clinic, but the topic comes up when we discuss other related subjects, such as painful intercourse or persistent pelvic pain. Understandably, the problem of vaginal dryness is more common in menopausal women. Vaginal dryness sometimes can be more distressing for younger women who are still menstruating, because it causes discomfort with daily activities or during sex.

Vaginal dryness can be impacted by a handful of factors. Estrogen probably is the most important hormonal influence on the health of the vulva and vagina. Low estrogen can contribute to dryness. Diet and the use of other medications also are important factors. You can expect any medications that cause dry eyes and dry mouth to have a similar effect on the vagina, as well. An interesting study in 2015 showed that a daily oral soy supplement could improve vaginal dryness.

Estrogen levels in the blood vary during the month and follow a common pattern for each menstrual cycle. For women not on hormonal birth control, levels are lowest in the days just before and after the start of menstrual bleeding. This low level sometimes can contribute to vulvar and vaginal dryness. Women on combination oral contraceptives containing both estrogen and progestin are unlikely to experience such dryness.

We don’t fully understand why some women develop uncomfortable symptoms, such as vaginal dryness, vulvar pain and itching towards the end of their menstrual cycle, while others have no problems. Most likely, there are additional factors that are made worse by the lower estrogen level expected at the end of the menstrual cycle. There are a lot of interesting theories and ongoing research into these symptoms.

Of course, I would encourage a woman to have a thorough discussion and exam with her provider to determine the most likely causes for these symptoms. An exam also will help ensure that less common, but more serious, conditions are not missed. Your provider will help you determine the best course of treatment. Many times, I meet women who, inadvertently, have made their symptoms worse by having tried multiple different creams or other home treatments before seeing their provider.

Here are a few things you can try to reduce vaginal dryness:

  • Consider using a lubricant designed to have the appropriate pH for the vagina.
  • Incorporate more soy into your diet, as well as an oral probiotic supplement that enhances vaginal health.

For vulvar sensitivity during the period, consider a low-oxalate diet during the week prior to the expected bleeding. Some have questioned the effectiveness of a low-oxalate diet, but it does seem to improve pain for some women; and, certainly, there is no harm in trying it for a few menstrual cycles.

Read about some ideas for a low oxalate diet, which also is used to reduce the likelihood of kidney stones.

Robert Lee, M.D., is a physician in the Obstetrics & Gynecology department at Mayo Clinic Health System – Red Cedar in Menomonie.

Dealing with Vaginal Dryness

The hormone fluctuations that begin in perimenopause bring about many physical changes. As estrogen and progesterone levels decline in late perimenopause and postmenopause, vaginal walls often become thinner, drier, less flexible and more prone to tears and cracks.

This can be particularly true for women who have never given birth or had only cesarean sections, as vaginal birth gives the walls a lasting stretch. Similarly, regular sexual activity helps maintain vaginal flexibility and pliability, presumably because it increases blood supply to the vagina and can also have a stretching effect.

Women who have thinning and inflammation of the vaginal walls — which many clinicians refer to by the term vaginal atrophy or atrophic vaginitis — may end up completely avoiding intercourse or other insertive sex because of discomfort.

The hormonal shifts of perimenopause may also result in less lubrication being produced, so it can take longer to become wet during sexual activity. Penetration may be uncomfortable or even painful, and can lead to irritation. If the tissue of the vaginal wall become very delicate, friction from sexual activity may cause bleeding.

Some prescription and over-the-counter drugs can cause or contribute to vaginal dryness. Antihistamines, for example, dry vaginal tissue as well as nose and eye tissues. Douches, sprays, and colored or perfumed toilet paper and soaps can irritate vaginal and vulvar tissues. There are also a variety of conditions, including vulvodynia, that can cause pain and/or irritation with insertive sex.

Vaginal dryness during sexual activity at any age may simply mean that you need more stimulation and maybe even to experience orgasm before penetration. Experiment with different types of stimulation to discover what feels best and is most arousing.

Here are some tips to relieve vaginal dryness and discomfort during sex:

  • Wait until you are fully aroused before penetration.
  • Lubricants such as Silk-E, Albolene, Astroglide, or Slippery Stuff are often helpful during sex. Vegetable oil is another option. (See: How to Choose a Lubricant for Pleasure and Safety.)
  • If dryness persists, try an over-the-counter vaginal moisturizer, such as Replens. It can be used one or more times a week, but not at the time of penetration.
  • Avoid scratching, which can irritate delicate tissues and lead to infections and further problems. (Itching is sometimes a sign of a yeast or fungal infection that needs treatment.)
  • Graduated dilators may be used to gently expand your vaginal walls and increase elasticity. Start with a small size, and work your way up.

If lubricants and other strategies are not sufficient, there are several other strategies to try.

Low-dose local (vaginal) estrogens, in very small amounts, are highly effective at relieving vaginal dryness. They can also restore thickness and flexibility to the tissues in the vulva and vagina.

Preparations include Estring (a Silastic ring that you insert like a diaphragm and leave in for up to three months), Vagifem tablets, and Estrace and Premarin creams. There is also Estriol, a bioidentical vaginal cream made by compounding pharmacies. These products have a localized effect, so far less estrogen gets into the bloodstream than occurs with oral or transdermal (patch) estrogen medications.

The ring delivers a minuscule amount of estrogen to the bloodstream, and the tablets send a little more, though the dose delivered in the tablet has recently been reduced. Regrettably, there are no long-term studies that demonstrate if even these small amounts of estrogens have risks, but they definitely improve the quality of life for many women.

If you use a vaginal estrogen cream, keep in mind that it can send a larger and somewhat unpredictable amount of estrogen into the bloodstream, depending how much is used and how often it is used. Most women initially require nightly treatment, but many women find that a dose smaller than what’s prescribed works fine, especially if they are sexually active.

Try using just enough to cover a fingertip and apply it to the opening of the vagina; the applicators tend to deliver a systemic dose of estrogen and deposit it higher than necessary. Estrogen cream should not be used as a lubricant for intercourse because it can be absorbed through a partner’s skin.

If you’re among the small number of women who have persistently sore breasts while using vaginal estrogen, try decreasing the dose to see if that will eliminate the soreness. If soreness persists, consult your health care provider.

Hormone therapy (HT) that includes systemic estrogen is also effective at relieving vaginal dryness. However, since low-dose local estrogens work well, it is typically not necessary to resort to systemic HT.

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