Vaginal Dryness: Common Causes and What You Can Do About It

Do you have vaginal dryness, burning, decreased lubrication, or pain during sex? You're not alone.

These symptoms commonly occur when estrogen levels decline, typically when a woman is breastfeeding or as a result of menopausal changes, known as as genitourinary syndrome of menopause (GSM). GSM occurs because of the normal decrease in estrogen in the vagina, vulva, and bladder that occurs with menopause. With lower estrogen, the vaginal and vulvar tissue can become thinner, less lubricated and more easily irritated. GSM also can cause urinary symptoms like pain with urination and recurrent urinary tract infections.

About 30 to 50 percent of postmenopausal women experience these symptoms. Unfortunately, many women do not generally discuss these problems with their healthcare providers.

Medications to Help With Vaginal Dryness

The first step is to tell your healthcare provider. There are a number of treatment options that can help relieve your symptoms. Your provider can prescribe vaginal or oral medications.

• Vaginal estrogen is a treatment that helps with the thickness and elasticity of the vulva and vagina. Estrogen can be formulated in multiple ways as a topical treatment for the vagina and vulva at low doses that have very low risk. There are creams (sold under the brand names Estrace and Premarin), vaginal tablets (sold under the brand names Vagifem and Yuvafem), vaginal suppositories (sold under the brand name Imvexxy) and the vaginal ring (sold under the brand name Estring). All of these treatments are effective, and you should choose based on your personal preference, cost and lifestyle.
• Ospemifene is an oral tablet that treats painful intercourse caused by GSM. It is a selective estrogen receptor modulator (SERM), meaning that it is not estrogen, but acts on estrogen receptors, causing an estrogen-like effect on vaginal tissues.
• Prasterone (DHEA or Intrarosa), is a vaginal suppository taken nightly for pain with sex caused by GSM in menopause.

Stopping any of these medications will cause the symptoms to return, so the medications need to be continued for ongoing relief. Women with a history of breast cancer should discuss which options are right for them with their physician and oncologist. Many of these options have been studied in women with specific breast cancers.

Non-Medication Options for Vaginal Dryness

Non-medication options include vaginal stimulation, which can help keep vaginal tissues healthy by increasing blood flow. Over-the-counter options include vaginal moisturizers that help with vaginal and vulvar dryness, and lubricants that can be used during sexual intercourse. Safe products to use include the brands Uberlube, Yes, and Good Clean Love.

Lastly, vaginal laser treatment has shown promise in many studies of improving the symptoms of GSM. A narrow cylinder is placed into the vagina, and the laser makes shallow microscopic changes in the vaginal skin that promotes healing and tissue regeneration. The treatment is quick, painless and well-tolerated. It is not typically covered by healthcare insurance.

Vaginal dryness is very common and there are treatments that are available to increase your quality of life. There are many options that you can try, so take the time to find the right one for you.

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The Female Sexual Health Program at University Hospitals is dedicated to addressing all of the sexual health concerns women may have throughout their lifetime. Our primary goal is to provide a unique and open environment of care where women feel empowered, confident and comfortable discussing this important aspect of their health.