Vaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Vaginal dryness is a hallmark sign of vaginal atrophy (atrophic vaginitis) — thinning and inflammation of the vaginal walls due to a decline in estrogen.
A thin layer of moisture coats your vaginal walls. When you're sexually aroused, more blood flows to your pelvic organs, creating more lubricating vaginal fluid. But hormonal changes associated with your menstrual cycle, aging, menopause, childbirth and breast-feeding may affect the amount and consistency of this moisture.
Vaginal dryness may be accompanied by signs and symptoms such as:
- Itching or stinging around the vaginal opening and the lower part of the vagina
- Pain or light bleeding with intercourse
- Urinary frequency or urgency
- Recurrent urinary tract infections
When to see a doctor
Vaginal dryness affects many women, although they frequently don't bring up the topic with their doctors. If vaginal dryness affects your lifestyle, in particular your sex life and relationship with your partner, consider making an appointment with your doctor. Living with uncomfortable vaginal dryness doesn't have to be part of getting older.
Conditions that contribute to vaginal dryness include those below.
Decreased estrogen levels
Reduced estrogen levels are the main cause of vaginal dryness. Estrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining and an increased risk of urinary tract infection.
Estrogen levels can fall for a number of reasons:
- Menopause or the transition time before menopause (perimenopause)
- Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy
- Surgical removal of your ovaries
- Immune disorders
- Cigarette smoking
Some allergy and cold medications contain decongestants that can decrease the moisture in many parts of your body, including your vagina. Anti-estrogen medications, such as those used to treat breast cancer, also can result in vaginal dryness.
In an autoimmune disease called Sjogren's (SHOW-grins) syndrome, your immune system attacks healthy tissue. In addition to causing dry eyes and dry mouth, Sjogren's syndrome can also cause vaginal dryness.
The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated.
If your primary doctor is a family doctor or general practitioner, he or she may refer you to a specialist (gynecologist) to evaluate your condition.
What you can do
- Ask if there's anything you need to do in advance, such as limiting food or fluid intake to prepare for diagnostic tests.
- Prepare a list of symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Make a list of your key medical information, including other conditions for which you're being treated, and the names of any medications, herbs, vitamins or supplements you're taking.
- List questions you want to ask your doctor and be prepared to jot down the answers.
For vaginal dryness, some basic questions to ask your doctor include:
- What's causing these symptoms?
- Are there other possible causes for my symptoms?
- What kinds of tests do I need? Do these tests require any special preparation?
- Is this condition temporary or long lasting?
- What treatments are available, and which do you recommend?
- Are there any alternatives to the treatment you're recommending?
- Do you have any brochures or other printed material that I can take with me? What websites do you recommend?
Don't hesitate to ask questions during your appointment anytime you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Be ready to answer them so that you'll have time to go over points you want to focus on. Your doctor may ask:
- What vaginal symptoms are you experiencing?
- How long have you experienced these symptoms?
- Do you still have regular menstrual cycles?
- How much do your symptoms bother you?
- Are you sexually active?
- Does the condition limit your sexual activity?
- Do you use scented soap or bubble bath?
- Do you douche or use feminine hygiene spray?
- What medications, herbs or vitamin supplements do you take?
- Have you tried any over-the-counter moisturizers or lubricants?
Diagnosis of vaginal dryness may involve:
- Pelvic exam. Your doctor visually inspects your external genitalia, vagina and cervix and inserts gloved fingers into your vagina and rectum to feel (palpate) your pelvic organs for signs of disease.
- Pap test. Your doctor collects a sample of cervical cells for microscopic examination. He or she may also take a sample of vaginal secretions to check for signs of vaginal inflammation (vaginitis) or to confirm vaginal changes related to estrogen deficiency.
- Urine test. If you have associated urinary symptoms, you'll provide a urine sample to be analyzed for urinary conditions.
In general, treating vaginal dryness is more effective with topical (vaginal) estrogen rather than systemic estrogen given orally or by skin patch. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal, especially if a low dose is used.
Vaginal estrogen doesn't decrease testosterone levels — important for healthy sexual function — the same way oral estrogen can. Vaginal estrogen therapy may also reduce the risk of urinary tract infections.
Talk with your doctor about what dose and what product is appropriate for you. Vaginal estrogen therapy comes in several forms:
- Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it.
- Vaginal estrogen ring (Estring). A soft, flexible ring is inserted into the upper part of the vagina by you or your doctor. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months.
- Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet into your vagina. Your doctor will tell you how often to insert the tablet.
If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest systemic estrogen, along with a progestin if you have not had your uterus removed (hysterectomy). Systemic estrogen can be given as pills, patches, gel or a higher dose estrogen ring.
Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you. If you have a history of breast, ovarian or cervical cancer, vaginal estrogen therapy may still be an option, but discuss the risks and benefits with your doctor.
Consider using a lubricant or moisturizer
Before, or in addition to, using vaginal estrogen therapy, talk with your doctor about over-the-counter products, such as those below, to help remedy vaginal dryness.
- Lubricants (Astroglide, others). Water-based lubricants can keep your vagina lubricated for several hours. Choose products that don't contain glycerin. You apply the lubricant to your vaginal opening or to your partner's penis before intercourse.
- Moisturizers (Lubrin, Replens, others). These products imitate normal vaginal moisture and relieve dryness for up to three days with a single application. Use these as ongoing protection from the irritation of vaginal dryness.
Before using complementary or alternative treatments, such as vitamin therapies or products containing estrogen, talk to your doctor about the product's safety and effectiveness.
Pay attention to sexual needs
Occasional vaginal dryness during intercourse may mean that you aren't sufficiently aroused. Make time to be intimate with your partner and allow your body to become adequately aroused and lubricated. It may help to talk with your partner about what feels good. Having intercourse regularly also may help promote better vaginal lubrication.
Avoid certain products
Avoid using these products to treat vaginal dryness because they may irritate your vagina:
- Vinegar, yogurt or other douches
- Hand lotions
- Antibacterial or fragrant soaps
- Bubble baths or bath oils
Also avoid using scented or perfumed products, including toilet paper and detergents.
Dec. 21, 2012
- Bachmann G, et al. Clinical manifestations and diagnosis of vaginal atrophy. http://www.uptodate.com/index. Accessed Oct. 31, 2012.
- Casper RF. Clinical manifestations and diagnosis of menopause. http://www.uptodate.com/index. Accessed Oct. 31, 2012.
- The North American Menopause Society. The 2012 hormone therapy position statement of The North American Menopause Society. Menopause. 2012;19:257.
- Bachmann G, et al. Treatment of vaginal atrophy. http://www.uptodate.com/index. Accessed Oct. 31, 2012.
- Fox R, et al. Treatment of dry mouth and other non-ocular symptoms of Sjogren's syndrome. http://www.uptodate.com/index. Accessed Oct. 31, 2012.
- Frequently asked questions. Women's health FAQ072. Your sexual health. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq072.pdf?dmc=1&ts=20121214T1150341035. Accessed Oct. 31, 2012.
- MenoNote: Vaginal dryness. The North American Menopause Society. http://www.menopause.org/publications/educational-materials-for-women/menonotes. Accessed Oct. 31, 2012.
- Vaginal and vulvar comfort: Lubricants, moisturizers, and low-dose vaginal estrogen. The North American Menopause Society. http://www.menopause.org/for-women/-em-sexual-health-menopause-em-online/effective-treatments-for-sexual-problems/vaginal-and-vulvar-comfort-lubricants-moisturizers-and-low-dose-vaginal-estrogen. Accessed Oct. 31, 2012.
- Cano A, et al. The therapeutic effect of a new ultra low concentration estriol gel formulation (0.005% estriol vaginal gel) on symptoms and signs of postmenopausal vaginal atrophy: Results from a pivotal phase III study. Menopause. 2012;19:1130.
- Frequently asked questions. Gynecologic problems FAQ028. Vaginitis. The American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq028.pdf?dmc=1&ts=20121214T1156584804. Accessed Oct. 31, 2012.
- Marnach ML (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 6, 2012.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 3, 2012.