Vaginal dryness – NHS

Vaginal dryness is a common problem that many women have at some point in their lives. But there are things that can help.

Symptoms of vaginal dryness

You may have vaginal dryness if you:

• feel sore or itchy in and around your vagina
• feel pain or discomfort during sex
• need to pee more often than usual
• keep getting urinary tract infections (UTIs)

These things may make you feel less like you want to have sex.

Causes of vaginal dryness

You can get vaginal dryness if you:

• go through the menopause
• are breastfeeding
• take contraceptive pills or antidepressants
• have your womb removed (a hysterectomy)
• have cancer treatments, such as chemotherapy

These things can cause a change in your hormone levels. This change can affect how much vaginal discharge or fluid you have.

You can also have vaginal dryness if you:

• are not aroused during sex
• use perfumed soaps, washes or douches in and around your vagina
• have an underlying condition, such as diabetes or Sjögren’s syndrome

How to treat vaginal dryness yourself

You can try these things before you see a GP. You can get most of them from a pharmacy without a prescription.

Do

• use water-based lubricants before sex – put these in and around your vagina, on your partner’s penis, on your partner’s fingers, or on a sex toy if you’re using one

• use vaginal moisturisers for vaginal dryness – you can put these inside your vagina to keep it moist

• use unperfumed soaps and washes around your vagina

• try to enjoy more foreplay so you feel more aroused during sex

Don’t

• do not use perfumed soaps, washes and any douches in and around your vagina

• do not put creams or lotions like petroleum jelly inside your vagina as it can cause an infection

• do not use moisturisers that are not for your vagina

Non-urgent advice: See a GP if:

• you’ve had vaginal dryness for a few weeks and things you’ve tried yourself are not working
• vaginal dryness is affecting your daily life
• you have unusual discharge or bleeding from your vagina
• you have bleeding after sex or in between your periods

If you’re getting vaginal dryness because of changes in your hormone levels, you may be prescribed creams, gels, patches or medicines to increase a hormone called oestrogen. This is called HRT.

Page last reviewed: 30 December 2021
Next review due: 30 December 2024

What Is Vaginal Dryness? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Medically Reviewed

Vaginal dryness is a common condition in older women, but it can happen at any age.

Signs and Symptoms of Vaginal Dryness

Vaginal dryness occurs when the tissues of the vagina are not well lubricated and healthy. It can occur at any age but is more common in older women. You may notice:

• Pain or discomfort during penetrative sexual intercourse
• Light bleeding after intercourse
• Soreness, itching, or burning of the vagina
• Mild vaginal discharge

Common Questions & Answers

What can cause vaginal dryness?

Vaginal dryness is usually caused by decreasing levels of estrogen, a hormone that helps lubricate vaginal tissues. Many factors can cause a decrease in estrogen, including menopause or perimenopause, childbirth, breastfeeding, smoking, and severe depression and stress.

Why am I dry down there all of a sudden?

Some soaps, perfumes, and douches can disrupt the natural balance of chemicals in your vagina and lead to dryness. Medications that contain antihistamines and certain antidepressants may have a drying effect on the body, which can reduce vaginal lubrication.

How do you get rid of dryness down there?

Lubricants can be used just before intercourse. Vaginal moisturizers, such as Replens, used on a regular basis, may also help. And if your doctor thinks it’s safe, topical estrogen and a medication called Osphena could reduce dryness.

What helps with women’s vaginal dryness?

Avoid douching or using deodorants in the area, and wash only with perfume- and dye-free soaps. Regular sexual stimulation, with a partner or alone, can help keep vaginal tissue moist and healthy.

How do you treat vaginal dryness naturally?

If you’re looking for a lubricant with natural ingredients, vitamin E vaginal suppositories may help. And regular sexual activity, especially if you allow more time for foreplay, which can increase vaginal secretions, is one very natural remedy.

Causes and Risk Factors of Vaginal Dryness

A number of factors may contribute to vaginal or genital dryness.

Low Estrogen Vaginal dryness is most often caused by a decrease in estrogen levels. Estrogen is a hormone that helps keep the tissues of your vagina lubricated and healthy. Many factors can cause estrogen depletion: (1)

• Menopause or perimenopause
• Childbirth
• Breastfeeding
• Smoking
• Surgical removal of the ovaries
• Chemotherapy and radiation in the pelvic area
• Anti-estrogen medications
• Cancer therapy
• Severe depression and stress

Douching and Other Irritants Certain soaps, lotions, perfumes, and douches can disrupt the natural balance of chemicals in your vagina, leading to dryness. Also, some tampons and condoms can cause irritations. (2)

Other Medications Allergy, cold, and asthma medicines that contain antihistamines can have a drying effect on the body and contribute to reduced vaginal lubrication. (2) Certain antidepressants may also lead to a reduction in vaginal secretions. (3)

Sjogren’s Syndrome The autoimmune disease known as Sjogren’s syndrome can cause dryness in the eyes, mouth, and vagina. (4)

How Is Vaginal Dryness Diagnosed?

Visit your doctor if you have symptoms of vaginal dryness that are severe or don’t go away. Your healthcare provider will ask about symptoms and medications you take, and may perform the following tests: (5)

• Pelvic exam to determine whether the walls of your vagina are thin, pale, or red
• Blood test to check hormone levels and for other issues that might be a cause
• Test of vaginal discharge to check for other causes of dryness

Prognosis of Vaginal Dryness

Vaginal dryness is often undertreated because so many women are too embarrassed to address the issue with their healthcare provider. Only one-quarter of women with the issue actually seek treatment. If not addressed, vaginal dryness can severely impact quality of life. However, the issue is easily corrected with proper treatment. (6)

Duration of Vaginal Dryness

Vaginal dryness will continue until it is treated, or until the temporary cause — such as breastfeeding, or medication — is resolved.

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Treatment and Medication Options for Vaginal Dryness

There are various ways to treat vaginal dryness, depending on its cause:

 Medication Options

• Topical Estrogen Available as a tablet, cream, vaginal suppository, or ring that’s placed directly into the vagina, it can alleviate symptoms of vaginal dryness. (7)
• Osphena (ospemifene) This estrogen agonist-antagonist is the only oral product approved by the U.S. Food and Drug Administration for the treatment of vaginal dryness and moderate to severe dyspareunia (painful sex). (8 PDF) It is not recommended for people with breast cancer or those at a high risk for it. (7)
• Intrarosa (dehydroepiandrosterone) This vaginal suppository can help alleviate painful sexual intercourse. (7)

Lubricants and Moisturizers

• Vaginal moisturizers (such as Replens, Lubrin, Sylk, and vitamin E vaginal suppositories) are to be used regularly, regardless of whether you have sexual intercourse or not. Read the product labels carefully: Paraben, glycerin-free, and propylene glycol ingredients can be irritating to your skin. (9)
• Vaginal lubricants are used just prior to penetrative sexual intercourse. (7) Water-based products with glycerin include Astroglide, Luvena, K-Y Jelly, and Vagisil. Those without glycerin, which may irritate some women, include Isabel Fay. Carrageenan-based products are also glycerin-free. Silicone-based products (K-Y True Feel Premium, Swiss Navy, and Wet Platinum) are safe to use with condoms.

Alternative and Complementary Therapies

• Regular sexual stimulation and activity, with a partner or alone (masturbation), can help keep tissue in the vagina moist and promote healthy vaginal tissue. (7)
• Talk with your healthcare provider about the safety of topically applied natural oils, such as coconut, olive, or sweet almond oils. (These may not be the best option if you’re concerned about STIs, however, as these oils can destroy condoms.) (9)

Prevention of Vaginal Dryness

You can prevent or minimize vaginal dryness by:

• Having regular sexual activity (7)
• Not using douches, perfumes, or deodorants in or near your vaginal area and washing only with perfume- and dye-free soaps (6)
• Allowing more time for foreplay before sex to arouse and stimulate yourself, which will increase vaginal secretions (6)

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Vaginal dryness.

What is Vaginal Dryness?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Vaginal dryness is a pathological condition that occurs under the influence of hormonal and non-hormonal causes, leading to thinning of the vaginal mucosa. It is manifested by a decrease in vaginal discharge, discomfort, itching and burning in the vagina and vulva, painful sensations during intercourse and sanious discharge after it. To make a diagnosis, a gynecological examination, extended colposcopy, colpocytological and bacteriological examination are performed, and the level of hormones is determined. In complex treatment, hormone replacement therapy, antibacterial and anti-inflammatory drugs are used.

• Causes of vaginal dryness
• Pathogenesis
• Symptoms of vaginal dryness
• Complications
• Diagnostics
• Vaginal dryness treatment
• Prognosis and prevention
• Prices for treatment

General

In the vast majority of cases, vaginal dryness occurs in menopausal women. According to the data of numerous studies, 5-6 years after the onset of menopause, this pathological condition is detected in every second woman, and 15 years after the last menstruation – in 70-80% of the examined. According to experts in the field of gynecology, during postmenopause without replacement correction of estrogen deficiency, atrophic processes in the vaginal mucosa occur in almost all women. In recent years, there has been a tendency to rejuvenate the disease, which is associated with an increase in the frequency of early menopause and the number of radical gynecological operations.

Vaginal dryness

Causes of vaginal dryness

The main cause of atrophic changes in the vaginal epithelium is permanent or temporary hypoestrogenemia. Dryness of the vaginal mucosa is most often caused by:

• Age-related decrease in estrogen secretion. Atrophic vaginitis is one of the most common postmenopausal women’s diseases.
• Radical gynecological operations. Deficiency of female sex hormones occurs after surgical removal of the ovaries or uterus with appendages.
• Radiation therapy. A decrease or loss of the endocrine function of the ovaries and a violation of the regeneration of the epithelium are observed after irradiation of the pelvic organs in the treatment of oncopathology.
• Hormonal imbalance. The secretion of estrogens is disturbed when the ovaries and brain structures that regulate the production of hormones are damaged, or the function of these organs is suppressed by drugs.
• Temporary hypoestrogenemia. Signs of dryness of the vaginal mucosa can also occur during pregnancy, lactation, before menstruation, or while taking oral contraceptives.

Not only hormonal disorders lead to the development of permanent or transient atrophic vaginitis. The regeneration of the epithelium is also disrupted by factors that act directly on the vaginal mucosa. The cause of local irritation, inflammatory or allergic reactions can be douching solutions, intimate hygiene products, barrier contraceptives, vaginal medications, opportunistic and pathogenic microflora.

Predisposing factors contributing to the pathological thinning of the vaginal mucosa are decreased immunity, low physical activity, obesity, smoking, eating spicy foods, wearing underwear made of low-quality synthetics, and promiscuous sex life. Atrophic colpitis is more often diagnosed in patients suffering from diabetes mellitus, HIV, and thyroid diseases. As a separate symptom, dryness in the vagina is observed in Sjögren’s disease.

Pathogenesis

With estrogen deficiency, the regeneration of the stratified squamous vaginal epithelium slows down. The mucous layer gradually becomes thinner, the production of secretions by the epithelial glands decreases, and the number of glycogen-containing cells decreases. Glycogen deficiency leads to a decrease in the number of lactobacilli, which create a protective acidic environment in the vagina. Against the background of gradual alkalization, conditionally pathogenic microorganisms are activated, causing local inflammation. An additional link in the pathogenesis is a decrease in the amount of hyaluronic acid, which retains water in the tissues. As a result of these changes, the mucous membrane of the vaginal walls becomes dry, more sensitive to various influences, which forms a typical clinical picture of the disease.

The mechanism of development of inflammatory-atrophic processes under the influence of non-hormonal factors is generally similar to changes in hypoestrogenemia, but in such cases, the leading role is played by a decrease in the number of epithelial cells due to their destruction and delayed regeneration. Atrophy of the vaginal epithelium is often combined with similar processes in the vulva.

Symptoms of vaginal dryness

In the early stages, the disease is asymptomatic. Over time, patients note a decrease and complete cessation of vaginal discharge. Subsequently, dryness and itching appear in the vagina, burning in the labia minora during urination, when using soap or hygienic gels. Due to insufficient lubrication, the patient experiences discomfort and pain during intercourse, after which there may be slight bleeding. The accession of a secondary infection is manifested by increased pain in the vagina and the appearance of scanty whites with a specific unpleasant odor.

Complications

The processes leading to vaginal dryness can be complicated by recurrent nonspecific colpitis. The combination of microtraumas of the thinned mucosa with a violation of the normal vaginal biocenosis creates ideal conditions for the rapid development of opportunistic and pathogenic microorganisms. In the absence of adequate treatment, the disease quickly passes into the chronic phase and is difficult to treat, which significantly worsens the patient’s quality of life. The spread of inflammation to adjacent organs leads to the occurrence of urethritis, cystitis, endometritis, oophoritis, adnexitis. With the involvement of periuterine tissue and peritoneum in the process, parametritis, perisalpingitis and even general peritonitis may develop.

Diagnostics

The development of atrophic vaginitis can be suspected on the basis of specific complaints in a climacteric patient or if non-hormonal factors that cause vaginal dryness are detected. To confirm the diagnosis allow:

• Chair inspection. The mucous membrane of the vagina looks thinned, pale, smoothed. It visualizes small red erosions and edematous hyperemic zones of inflammation with serous or serous-purulent plaque. There is contact bleeding. The pH of the vagina is increased to 5.5-7.
• Extended colposcopy. When examined under a special microscope, thinning of the mucosa and areas of hemorrhage are revealed. During the Schiller test, the mucosa, in which there is no glycogen, stains weakly and unevenly.
• Colpocytological examination. The maturity index of the vaginal epithelium is reduced, parabasal and basal cells predominate.
• Flora smear. The level of leukocytes is increased. The content of lactobacilli is sharply reduced, opportunistic microflora or pathogens of STIs can be determined.
• Determination of the level of estradiol. Usually indicated in women of reproductive age with vaginal dryness and possible impaired ovarian secretion.

To clarify the condition of the internal genital organs, the patient is additionally prescribed ultrasound and tomography of the small pelvis. To exclude the infectious nature of the pathological process, sowing on the flora, PCR diagnostics, ELISA, RIF are used. The disease is differentiated from infectious vaginitis, candidomycosis, neoplasia. In doubtful cases, an oncogynecologist, a dermatovenerologist, a rheumatologist (if Sjogren’s syndrome is suspected) is involved in the diagnosis.

Vaginal dryness treatment

The choice of therapeutic tactics is determined by the causes of the pathology, the age of the woman, the condition of the mucosa and the presence of complications. In the complex treatment of dryness of the vaginal epithelium caused by hypoestrogenemia, the following are used:

• Hormone replacement therapy. The most effective are estrogenic or combined estrogen-gestagen preparations. Female sex hormones are taken orally, used as a patch or topically (candles, rings and ointments). In addition to synthetic drugs, phytohormonal agents can be prescribed.
• Antibacterial preparations. Recommended for the development of acute nonspecific colpitis. Before prescribing an antibiotic, the pathogen and its sensitivity are determined.
• Topical anti-inflammatory treatment. Emulsions, ointments, creams, suppositories, baths and douches reduce the inflammatory component of the disease, improve tissue trophism and promote faster recovery of the mucosa.
• Restoration of normal microflora. Intravaginal use of products with a culture of lactic acid bacteria inhibits the growth of opportunistic flora.

With the development of vaginal dryness due to non-hormonal causes, therapy is aimed at stopping allergic and inflammatory reactions, stimulating tissue regeneration and general immunity. Regardless of the causes of the disease, general tonic and physiotherapeutic methods, selected taking into account contraindications, are effective in complex therapy. During treatment, a correction of the diet is necessary with the enrichment of the diet with vegetable and lactic acid products, with the exception of pickles, smoked meats, spicy and fatty dishes.

Prognosis and prevention

Timely treatment can completely get rid of vaginal dryness caused by temporary hypoestrogenemia and most non-hormonal causes, as well as significantly improve the woman’s quality of life in all other cases. Preventive measures include regular examinations by a gynecologist to identify preclinical signs of atrophic colpitis that occurs in postmenopause, after gynecological operations, against the background of hormonal and radiation therapy. The appointment of HRT is effective for the correction of menopausal and postovariectomy disorders. Taking into account the predisposing factors, for the purpose of prevention, women over the age of 40 are recommended to stop smoking, have sufficient physical activity, observe the rules of intimate hygiene, and wear cotton underwear.

Sources

1. treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

   Vaginal dryness, how to treat, symptoms, indications

   Vaginal dryness (atrophic vaginitis) is caused by both hormonal and non-hormonal disorders in a woman’s body.

   The thinning of the vaginal mucosa leads directly to the appearance of dryness. As a result, there is a decrease in secretions from the genital tract, there is a burning sensation, discomfort, pain during sex and discharge with blood impurities after it.

   Most often, this symptom occurs in women in adulthood during menopause or menopause. The ovaries cease to perform their function, begin to fade, which leads to a change in the hormonal background – estrogen deficiency develops. The intimate sphere of a woman’s life suffers most from the deficiency of this hormone.

   The main causes of atrophic changes in the vaginal epithelium:

   • Hormonal imbalance during menopause;

   • The consequences of surgical intervention on the female genital organs, mainly during the removal of the uterus and ovaries;

   • sexually transmitted infections, vaginitis;

   • Violation of the microflora of the vagina, inflammation of the vagina;

   • Thrush (vaginal candidiasis;

   • Reduced immunity, stress, depression, nervousness, increased physical and psycho-emotional stress, anemia;

   • The consequences of chemotherapy or radiation therapy in the treatment of cancer;

   • Pregnancy, postpartum period, lactation.

   Other factors that can influence the onset of vaginal dryness include:

   • obesity and diabetes;
   • promiscuity or, conversely, a rare intimate life;
   • dermatological or allergic disorders;
   • long-term use of oral contraceptives based on progesterone, diuretics, antidepressants and certain other drugs;
   • unhealthy lifestyle, smoking, excessive alcohol consumption;
   • Improper hygiene practices – excessive douching, poor genital hygiene, aggressive intimate cosmetics, vaginal medications, scented condoms or toilet paper.

   Vaginal dryness requires mandatory treatment. The vaginal secret is needed to protect the female genital organs from pathogens. If the problem is left unattended, it can lead to the development of various serious complications.

   In addition, vaginal dryness significantly reduces the quality of the sexual life of a woman and her partner.

   To confirm the diagnosis, as well as exclude more serious diseases, the doctor of our clinic:

   • Carry out a chair examination. In the presence of vaginal dryness, he will see an edematous mucosa with a characteristic gray coating and small red sores and wounds;
   • Perform a colposcopy. Examination of the walls of the vagina under a microscope will help to detect thinned mucosa
   • Will take oncocytology and smear for flora.
   • Prescribe hormonal studies, as well as ultrasound of the pelvic organs, analysis for sexually transmitted infections, etc.

   Vaginal dryness treatment

   With vaginal dryness, treatment requires an individual approach, depending on the reasons that caused the appearance of this unpleasant symptom. Based on the results of diagnostic measures, the doctor will develop an individual treatment plan for the patient.

   In our clinic, among other methods, the following procedures are used to treat vaginal dryness:

   Contour plastic is a minimally invasive procedure based on the introduction of hyaluronic fillers into the tissues of the vagina. The walls of the vagina increase in volume, swell slightly, and actively moisturize. The introduction of fillers is carried out with thin needles under local anesthesia into the submucosal layer. For intimate plastics, a gel is used, designed specifically for use in the intimate area. The effect lasts 8-12 months, the vagina becomes more sensitive, the amount of natural lubrication increases.

   Vaginal laser rejuvenation is a safe, non-invasive, painless method that improves blood circulation and activates its own neocollagenesis.