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Vaginal dryness is a common symptom during and after menopause, but it can happen at any age and for various reasons.

Vaginal dryness usually results from low estrogen levels. Estrogen is the hormone that keeps the lining of the vagina lubricated, thick, and elastic.

Vaginal dryness is a common problem, but many people do not seek help, as they may not realize it is a health issue for which they can get help.

It can lead to pain during intercourse, contributing to a loss of sexual desire. It can also cause discomfort during sports and other physical activity, and increase the risk of vaginal infections.

Several treatments are available to relieve the symptoms of vaginal dryness.

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Vaginal dryness usually results from a drop in estrogen levels. Estrogen levels begin to decrease as menopause approaches.

The ovaries produce estrogen, and estrogen controls the development of female body characteristics, such as breasts and body shape. It also plays a key role in the menstrual cycle and pregnancy.

Estrogen helps keep the tissues lining the vagina thick, moisturized, and healthy. As levels decline, the lining becomes thinner, drier, and less elastic. These changes are known as vaginal atrophy.

Estrogen levels can drop for various reasons including:

  • menopause
  • surgical removal of the ovaries (which can trigger menopause)
  • childbirth and breastfeeding
  • treatments for cancer, including chemotherapy and radiation
  • anti-estrogen drugs for treating breast cancer or endometriosis

Other causes of vaginal dryness can include:

  • Sjögren’s syndrome, an autoimmune disorder that involves inflammation of the salivary and tear glands.
  • Using antihistamines, which help manage cold and allergy symptoms by drying secretions. Side effects can include vaginal dryness and trouble urinating.
  • Antidepressants, which sometimes have sexual side effects such as vaginal dryness, decreased libido, and difficulty having an orgasm.
  • Stress and anxiety, which can affect libido and vaginal lubrication.
  • Reduced blood supply to the vagina.
  • Flammer syndrome, in which blood vessels react in an unusual way to stimuli such as cold and stress.

Females who smoke may experience menopause earlier than those who do not, and so vaginal dryness may occur at an earlier age in this group.

People with vaginal atrophy and vaginal dryness may experience:

  • vaginal itching
  • burning
  • irritation
  • pain during sex
  • discomfort during physical activity
  • a higher risk of vaginal infections and urinary tract infections

If the dryness is due to a fall in estrogen levels, they may also have:

  • lower levels of natural vaginal secretions
  • a tightening of the vaginal opening
  • a narrowing of the vagina

Together, these changes are known as dyspareunia. They can lead to pain during penetrative sex.

Vaginal dryness is a health issue that affects many people. A doctor can suggest treatment to help resolve the discomfort it can cause.

People should seek medical advice if they experience the following symptoms or other signs of change in their vaginal health:

  • burning
  • itching
  • dryness
  • intercourse pain
  • irritation

The doctor will likely:

  • ask about vaginal and other symptoms
  • ask about menstrual changes
  • do a pelvic examination
  • in some cases, take a swab for a lab test

No single test can diagnose vaginal atrophy and vaginal dryness. A doctor will usually base the diagnosis on the symptoms.

It might feel embarrassing and uncomfortable to discuss such personal details, but doctors are used to having these types of conversations. Seeking help is the first step toward managing symptoms.

Various treatment options are available for vaginal dryness. Some are available over-the-counter, while others need a prescription.

Topical estrogen cream

One option is topical estrogen therapy, a medication in the form of a cream or ointment that a person can apply directly to the vaginal area to relieve symptoms.

A person using a topical cream will absorb less estrogen compared with taking estrogen as a pill. As a result, the risk of adverse effects is relatively low.

Examples of topical estrogen therapies include:

  • Vaginal ring (Estring). The person inserts a flexible ring into the vagina where it continually releases low amounts of estrogen into the tissues. The person should replace the ring every 90 days.
  • Vaginal cream (Estrace, Premarin). People can use an applicator to apply the cream into the vagina. Research shows that estrogen cream is an effective and well-tolerated treatment for vaginal atrophy and dryness, compared with a placebo.
  • Vaginal tablet (Vagifem). The person will use an applicator to place a tablet into the vagina.

There is limited research into the long-term effects of topical estrogen, but these are more likely to be safe compared with oral hormone replacement therapy.

Females who have a history of breast cancer, who are or may be pregnant, or who are breastfeeding should talk to their doctor about the safety of topical estrogen therapy. The doctor may recommend non-hormonal treatments instead.

Over-the-counter treatments

Over-the-counter treatments may help with vaginal dryness.

For example, a person can use lubricants at the time of intercourse to increase moisture. Water-based lubricants may be preferable to oil-based lubricants, as oil-based ones can lead to irritation and condom breakage.

A person can also use vaginal moisturizers every 1 to 2 days to help maintain the vagina’s natural moisture. They are available for purchase online.

A number of lifestyle changes can help combat vaginal dryness and discomfort.

Regular sex

Regular sexual activity, whether alone or with a partner, can help manage vaginal dryness.

Blood flow to the vaginal tissues increases during arousal, and this helps stimulate moisture production.

Adequate foreplay and arousal before sex can help overcome vaginal dryness and make sex more enjoyable.

Avoid some hygiene products

Many body products and personal hygiene products contain fragrances and dyes that can irritate or dry out the vaginal tissue.

The vagina contains a delicate balance of good bacteria and is self-cleaning. There is no need for douching or using fragrant soaps around the sensitive vaginal area.

Phytoestrogen supplements

Phytoestrogens are compounds that act similarly to estrogen in the body. They occur in plant-based foods, including soy, nuts, seeds, and tofu.

One review suggests that consuming phytoestrogens may improve vaginal dryness and hot flashes slightly during menopause. However, the evidence is limited and more research is needed.

Vaginal dryness is a common symptom often linked to a drop in estrogen levels, including at the start of menopause. It is not likely to have significant health consequences, but it can be a source of discomfort.

Topical estrogen cream is one low-risk treatment. Mild symptoms can be treated with over-the-counter options, including vaginal moisturizers and using lubricants during sexual activity.