Vaginal Dryness

Chronic vaginal dryness, which results from less-than-normal lubrication in your vagina, is usually caused by changes in your estrogen level. Your production of estrogen may drop while you’re breastfeeding, for example; some women experience vaginal dryness all the time they’re lactating, but the problem disappears once breastfeeding stops. And just before menopause, your estrogen level begins to decline, which can lead to vaginal dryness as well.

Chronic vaginal dryness is different from the occasional dryness you may feel if you aren’t relaxed during sex or have intercourse before you’ve had enough time to become aroused. In such a case, you may not produce the lubrication that normally accompanies sexual arousal, and intercourse may feel uncomfortable.

Other conditions can cause episodes of vaginal dryness as well. Spermicides rarely create a problem, but using them several times in the same day may make your vagina feel a bit dry; using diaphragms may also lead to dryness because they can block the downward flow of the vaginal secretions from the cervix and upper vagina. Douching can result in vaginal dryness, and yeast and other common infections may irritate your vagina and cause a feeling of dryness, even though the vagina is actually well lubricated. Women who have had their ovaries surgically removed or have undergone pelvic irradiation for cancer may also experience vaginal dryness, which usually goes away on its own.

What are my treatment options?

If you’re breastfeeding, an over-the-counter lubricant can work wonders in alleviating vaginal dryness, particularly during sex. When you stop breastfeeding, your hormonal levels will return to their normal state and your vagina will no longer feel dry.

For vaginal dryness that causes you difficulties during sex, an over-the-counter lubricant such as K-Y Jelly or Replens may be a short-term solution. If the problem is that you routinely feel rushed into sex before you’re ready for it, it would also be good to let your partner know that you need to spend more time on foreplay before having intercourse. Women and men are typically different in their approach to sex: Men tend to get aroused more quickly than women do. So suggest that he slow down — say, that you spend about half an hour caressing and relaxing with each other before intercourse — and see what happens.

Stay clear of Vaseline and other products containing petroleum if you use a diaphragm or condom and want to avoid pregnancy. These lubricants can cause the latex in your contraceptive device to deteriorate (and let sperm into the uterus). There’s a wide choice of products, including K-Y Jelly and Astroglide, that contain no petroleum.

If you’re approaching menopause and experiencing vaginal dryness as a result of fluctuating estrogen levels, your doctor may recommend a topically applied estrogen cream. And during sex, over-the-counter lubricants can’t hurt, either. Interestingly, having sex during and after menopause can help keep the lining of the vagina more elastic and less likely to feel painfully dry.

A woman who’s had pelvic radiation for cancer may be troubled by vaginal dryness. It’s likely to go away by itself, but if not, a doctor may recommend treatment that might include hormone replacement therapy.

Some women have used alternative methods of treatment with reported success. Although this hasn’t been tested scientifically, herbalists say that teas made of black cohosh, among other herbs, can help thicken vaginal mucus. German studies have reported few side effects from black cohosh other than occasional stomach upset, but the herb’s effects have not been studied for longer than six months. It may have blood-pressure lowering effects, so don’t take it if you’re already on blood pressure medication. And because of its possible effects on hormone levels, don’t take black cohosh if you’re pregnant or on birth control pills.

According to some herbalists, dandelion and oat-straw tea also tends to help restore normal vaginal lubrication. Let your doctor know about any herbs or supplements you’re using, since some can interact with medications.

What is atrophic vaginitis, and why does it cause dryness?

If you’re going through menopause, the reduction in your estrogen level can sometimes lead to atrophic vaginitis, which causes a thinning of the vaginal tissues, a loss of elasticity, and dryness. In some cases, this can cause intercourse to be extremely painful, and K-Y Jelly may not solve the problem. To treat it, your doctor may prescribe an estrogen cream that will help stimulate lubrication in the vagina.

Your physician might recommend short-term hormone replacement therapy, or HRT, to ease vaginal dryness and other symptoms of menopause. If so, talk to your doctor and make sure you’re monitored regularly — studies published in the Journal of the American Medical Association suggest that HRT can increase your risk of heart disease, stroke, blood clots, and invasive breast cancer, although the risk appears greater for older women.

So-called phytoestrogens, found in certain plants (like soy) have also been shown to relieve vaginal dryness and other menopausal symptoms. Because researchers aren’t sure what amount of phytoestrogens work best, discuss the question of dietary changes with your physician.

When should I call a doctor?

You should consult your doctor if you’re experiencing chronic vaginal dryness that causes you distress. And since the sensation of dryness may be due to an infection, check with your doctor if you notice other symptoms in addition to dryness, such as burning, itching, spotting after intercourse, or an unusual discharge or irritation.

If I have chronic vaginal dryness and it isn’t treated, could it lead to more serious problems?

Yes. If you’re experiencing vaginal dryness all the time, it might be due to an infection, so the best thing is to call your doctor. If dryness in a menopausal woman goes untreated, she may develop chronically thinner vaginal tissue. This makes her vagina vulnerable to harmful bacteria and infections.

Are there ways to prevent vaginal dryness?

If you douche frequently, stop doing so. Your vagina has a self-cleaning mechanism that makes douching unnecessary.

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Willhite LA, O’Connell MB. Urogenital atrophy: prevention and treatment. Pharmacotherapy;21(4):464-80

Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women – Principal Results From the Women’s Health Initiative Randomized Controlled Trial. JAMA;288:321-333.