Vaginal dryness impacts more than 50% of women experiencing menopause, and there are a range of options at your disposal to increase lubrication.
While it might not be the most common conversation around your social circles, menopause dryness is a suprisingly common menopause symptom, and it can have serious impact on sexual intimacy, relationships, and body confidence.
Here’s why your vagina is on the dry side during menopause and what you can do to alleviate your symptoms with hormone therapies or accessible over-the-counter treatments.
Why you’re experiencing vaginal dryness
If you’re experiencing menopause and have been wondering why your vagina feels drier than normal, decreased estrogen is the usual suspect.
When this hormone drops in menopause, it can lead to many unwelcome symptoms such as hot flashes, mood swings, night sweats—and vaginal dryness. This is because estrogen is responsible for maintaining your vagina’s lubrication, elasticity, and thickness. So, a lower level of estrogen can lead to thinning, drying, and inflammation of your vaginal walls, often referred to as vaginal atrophy.
This dryness can take on various forms, and women describe it as burning, itching, or feeling less lubricated during sexual activity. Further irritation can also occur as your vagina becomes less acidic and loses some of the bacteria used to fight against infections.
Managing your vaginal dryness
There’s a range of options to help you manage your dry vagina and increase lubrication. It may take some trial and error before you find what works best for you, but speaking with your doctor about your symptoms is the first step.
Hormone replacement therapy (HRT)
HRT has always been a go-to multi-tasker for women experiencing menopause as it can provide relief from a range of symptoms, including hot flashes, irritability, insomnia, and achy joints, as well as vaginal dryness, pain, and discomfort.
Estrogen is the hormone most commonly prescribed to improve dryness symptoms.
In fact, researchers found that one-third of women will experience atrophic vaginitis (causing dryness, itching, irritation, and vaginal pain during sex) without an estrogen replacement. It has been shown that applying estrogen locally to your vagina will relieve dryness symptoms, while also having a favorable effect on urinary tract infections (UTIs), vaginal surgery, and incontinence.
Estrogen therapy is available by prescription, and you will need to speak with your doctor about which one is right for you.
Oil-based suppositories: this type of estrogen therapy is inserted into your vagina for at least two weeks every night.
Vaginal ring: a vaginal ring needs to be inserted as far into your vagina as possible, and it can last for around three months.
Estrogen cream: this cream is spread topically inside your vagina and around the opening.
Estrogen tablet: this dissolving tablet is inserted into your vagina via an applicator for you to absorb the estrogen internally.
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While lubricants won’t treat your vaginal dryness, they will decrease the discomfort you experience during intercourse. The advantage of over-the-counter lubricants is they are easy to access and readily available for most people.
The American College of Obstetricians and Gynecologists (ACOG) suggests you skip oil-based lubricants as these are more likely to cause irritation and can make condoms less effective. Instead, try either a silicone-based or water-based lubricant, keeping in mind that water-based lubricants won’t last as long.
Additionally, avoid colored, flavored, or warming lubricants, which could be irritating if your dry vagina feels sore and inflamed.
ACOG recommends speaking to your healthcare provider if irritation and pain during sex don’t improve after trying lubricants for two months, or if any new symptoms have appeared.
Applying a vaginal moisturizer around and inside your vagina may provide you with welcome relief from dryness, and easeburning or itching.
Unlike a lubricant, an internal moisturizer is inserted directly into your vagina to help build vaginal tissue and make it feel thicker and more elastic.
A simple non-hormonal internal vaginal moisturizer may contain adhesive ingredients that allow the cream to attach to your dry cells and deliver continuous moisture over three days before you need to reapply. If you have been using a vaginal estrogen cream as part of an HRT plan, it’s best if you don’t apply it on the same night as a moisturizer.
If preferred, an external moisturizer applied to your vulva will help soothe dryness on the outside. If you tend to wear panty liners or sanitary pads, these can contribute to vulva dryness, and adding a skin protectant cream like Aquaphor or Desitin will help seal in moisture for extra skin soothing and protection.
Your sex life gone dry
Many women experiencing menopause say their sex life has all but disappeared, with vaginal dryness and painful intercourse going hand in hand.
Alongside decreased vaginal blood flow that leaves you feeling less lubricated during menopause, women’s testosterone levels also fall gradually with age, which can lower libido.
And then there are the symptoms not related directly to vaginal dryness but still generate a “domino effect” on your sex life heading south—think hot flushes, disturbed sleep, fatigue, and mood swings.
While the impact of losing interest in sex varies between individuals, for women who are concerned about symptoms getting in the way of sexual intimacy, you may be caught in a negative pain cycle.
Here’s what might be happening: a symptom like vaginal dryness is causing you pain during intercourse. For some women, this can trigger anxiety just thinking about it. With sexual intimacy becoming fear-based, associating sex with pleasure has now disappeared from your mind. The pain cycle then becomes you fear sex, you avoid sex, and you get frustrated with yourself (and your vagina). This can make it more likely sex is going to hurt even more.
To break out of this cycle, women’s health advocacy Jean Hailes advises focusing on your physical symptoms first, such as finding treatments for vaginal dryness, with the idea being that the fear of painful sex can subside if you are less triggered by painful physical reactions during intercourse.
If sex is still a no-go area for you, even after implementing solutions like lubricants or HRT, there are other strategies to try, including:
- turning your attention to relaxation exercises
- seeking expert guidance from a pelvic floor therapist who can arm you with practical strategies and techniques for relaxing your pelvic floor
- speaking with a psychologist or sex therapist.
Keeping quiet about vaginal dryness
Whether your vaginal dryness is impacting your sex life or you’re trying to manage painful sensations as you go about your day, women have been reluctant to seek solutions, let alone speak up about this common occurrence.
Alarmingly, of the more than 50% of women who experience vaginal dryness during menopause, most don’t share their concerns with their healthcare providers. And less than 4% of affected women are actively using any proven therapies, such as vaginal estrogen tablets or moisturizers.
The Wrap Up
Vaginal dryness is a common symptom for women experiencing menopause. It can feel painful and uncomfortable, with associated burning or itching sensations. This menopause symptom can make sex particularly problematic for women, who may find they’re trapped in a pain cycle and have begun to fear sexual intimacy. To ease vaginal dryness, women can try a range of doctor-prescribed estrogen therapies, as well as over-the-counter options like lubricants and moisturizers.