An Overview of Vaginal Dryness

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Vaginal dryness (atrophic vaginitis) can occur at any time during a woman's adult life, but it is most common during perimenopause, menopause, and when a woman is breastfeeding. Vaginal dryness may result in intermittent or constant discomfort, and it can cause sex to be painful. Usually, it can be treated with over-the-counter remedies or rethinking some self-care practices, but vaginal dryness can also be a sign of a health problem requiring medical attention.

Causes

The most common cause of vaginal dryness is the decreased production of estrogen, as the hormone plays a role in maintaining lubrication both during sex and at other times. This dip reliably occurs as a result of:

  • Childbirth
  • Breastfeeding
  • Perimenopause
  • Menopause

That said, there are other possible reasons for vaginal dryness. These may cause the issue on their own or compound the effects of lowered estrogen.

Lifestyle

Several things you may do as a matter of routine that may cause vaginal dryness include:

Excessive alcohol consumption can also have this effect.

Medical Problems and Treatments

Systemic conditions such as pituitary disease, ovarian or uterine conditions, or removal of the uterus or ovaries through surgery, can alter estrogen levels, causing a variety of symptoms, including vaginal dryness. Sjögren's syndrome, an autoimmune inflammatory disease, is also commonly associated with vaginal dryness.

Sometimes, medical treatments such as chemotherapy or radiation therapy can cause dehydration, which may cause vaginal dryness.

Symptoms

It may seem odd to explore the symptoms of vaginal dryness, since dryness itself is the logical calling card of the condition. But there are others that can arise, which you may not immediately associate as being connected to this issue. They include:

The symptoms are most likely to occur during or after sex and can last up to several days after intercourse. However, symptoms can occur intermittently, even without sex a precipitating factor.

Many of these symptoms can also be caused by other conditions, such as sexually transmitted infections, urinary tract infections, and inflammation. Usually, infections cause urinary frequency and urgency, vaginal discharge, or foul smell, in addition to the symptoms that overlap with those of vaginal dryness.

Diagnosis

In working to discover the reason for your vaginal dryness, your doctor will consider factors such as your age, habits, and any other symptoms you may be experiencing.

When a medical condition is the cause of vaginal dryness, your doctor is likely to recognize this possibility because such concerns are usually associated with other symptoms that are often more noticeable than vaginal dryness itself.

For example, Sjögren's syndrome can also cause joint pain, dry eyes, and dry skin. The hormonal fluctuations that can occur as a result of ovarian or uterine conditions may manifest with symptoms that are similar to those of menopause such as menstrual irregularities, breast soreness, or weight changes, in addition to vaginal dryness.

Generally, hormone levels and diagnostic testing, such as ultrasound, can distinguish the conditions.

If you have symptoms of vaginal dryness before you have reached the age of perimenopause, which typically does not begin before age 45, you should see your doctor. Symptoms of vaginal dryness can also overlap with symptoms of infection, so it is best to have your doctor identify and treat an infection if you have one.

Treatment

There are several prescription and non-prescription treatments that can help improve symptoms or treat the underlying cause of vaginal dryness. Your doctor may suggest one or more, depending on your circumstance.

Over-the-Counter Options

Often, even when vaginal dryness is caused by a hormonal problem, an over-the-counter topical therapy can be very effective. You can use these as needed. If your dryness is only symptomatic during and after sex, you can use a topical product before sex. If you experience dryness more frequently, you can use them on a more regular basis.

Treatment options include:

  • Vaginal moisturizers: Vaginal moisturizers include over-the-counter products such as Replens, a once-daily vaginal suppository used to increase vaginal lubrication. If you want to try a moisturizer, check with your doctor to make sure that it is safe.
  • Vaginal lubricants: Vaginal lubricants include over-the-counter products such as Astroglide and K-Y Jelly. When vaginal dryness is a problem during intercourse, vaginal lubricants act as a supplement to make sex more comfortable.

Always choose a water-based vaginal lubricant. Never use a petroleum-based product such as Vaseline for vaginal lubrication, because this can create a breeding ground for infection. If you are having protected sex using a condom, make sure you are using water-based or silicone-based lubricant. Other lubricants and oils, like coconut oil, will degrade the condom and may also damage diaphragms used for birth control.

Prescription Medications

If you are suffering from chronic vaginal dryness related to perimenopause or menopause, your doctor may prescribe a topical medication to increase estrogen. Vaginal estrogens provide the most effective relief of vaginal dryness of all treatment options, but they are not appropriate for everyone.

Vaginal Estrogens

Topical prescription treatments for vaginal dryness caused by reduced estrogen levels include:

  • Estring: Estring is a vaginal ring that slowly releases estrogen directly into the vaginal tissues. Inserted into your vagina by you or your doctor, Estring effectively treats vaginal dryness for three months.
  • Vagifem: Vagifem is a vaginal tablet that you insert into your vagina using a disposable applicator. You will need to insert the vaginal tablet once daily for two weeks, and then twice weekly for as long as you need it.
  • Premarin or Estrace: While the oral pill forms of Premarin and Estrace are most frequently prescribed, they both are available in vaginal cream formula as well. Your doctor will advise you on how to use vaginal estrogen creams should this be the treatment of choice.

Women who use vaginal estrogens may experience fewer recurrent urinary tract infections. Though helpful for many, it is not safe to use estrogen products if you are pregnant, breastfeeding, have a history or risk of breast, uterine, ovarian, cervical or vaginal cancer, or if you have vaginal bleeding.

Non-Estrogen Medications

Though not recommended or used to treat vaginal dryness itself, there are non-estrogen medications that can be used to relieve some of the symptoms associated with the condition. These medications are not as commonly used as estrogen-containing medications, and, though they may be considered an option for women who can't take estrogen due to a history of cancer, their hormonal effects can produce side effects. Speak with your doctor about the pros and cons for you.

  • Osphena (ospemifene): A prescription pill that is used for the treatment of painful sexual intercourse for menopausal or postmenopausal women, ospemifene binds to estrogen receptors, decreasing the fragility of the vaginal tissue that occurs during and after menopause.
  • Prasterone (dehydroepiandrosterone): A prescription hormone therapy, dehydroepiandrosterone is a steroid hormone that can be used orally for treatment of menopausal symptoms or as a vaginal insertion for treatment of thinning vaginal tissue.

Women who are experiencing menopause may benefit from over-the-counter, prescription, or natural treatments for related symptoms. Talk to your doctor about your options.

A Word From Verywell

Often, women say that most distressing aspect of vaginal dryness is that it interferes with sexual enjoyment and causes discomfort during or after sex. Feeling stressed or rushed when having sex can exacerbate the issue. Relaxing and taking time for arousal may help.

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