How to treat vaginal dryness

Vaginal dryness is common. It affects nearly 20% of women ages 42-53, and that number rises to over a third of women ages 57-69. Yet, despite its prevalence, many women are embarrassed by this condition. More than 50% of women don’t report vaginal dryness to their healthcare providers, and fewer than 4% of women affected are using any proven therapies to counteract their symptoms. 

If you experience this all-too-common condition, you should know there are many effective vaginal dryness treatments.

Why am I dry down there all of a sudden? 

The most common cause of vaginal dryness is declining estrogen levels, which can occur for several reasons. If you’re noticing new vaginal dryness, it could be due to the following:

• Perimenopause and menopause: “In peri- and postmenopausal women, vaginal dryness is one of the common side effects of declining estrogen levels,” says Laurence Orbuch, MD, an OB-GYN and director of GYN Laparoscopic/Robotic Associates LA. Perimenopause can begin in a woman’s 40s, as menstrual flow and cycles change in the approach to menopause. The transition to menopause can last between two to eight years, before a woman’s menstrual periods completely stop, according to the U.S. Department of Health and Human Services, Office of Women’s Health.
• Breastfeeding: “Younger women who are nursing babies also have very low estrogens,” says Mary Jane Minkin, MD, an OB-GYN at Yale University’s School of Medicine in New Haven, Connecticut.
• Medications: “Some women who are on a very low dose birth control pill may also have vaginal dryness,” Dr. Minkin says. In younger women, vaginal dryness is often a side effect of hormonal birth control pills and other medications, including antidepressants and antihistamines, that affect normal vaginal lubrication. Anti-estrogen medications used to treat endometriosis and uterine fibroids can cause vaginal dryness—as can chemotherapy and radiation for cancer treatment.
• Health conditions: Vaginal dryness can be caused by certain conditions such as diabetes and Sjogren’s syndrome. People with diabetes are more likely to have dry skin in general. On top of that, high blood sugar can interfere with lubrication. With Sjogren’s, certain glands become inflamed, which reduces the production of tears and saliva and can also affect the glands that keep the vagina lubricated. Yeast infections or vulvar rash can also lead to vaginal dryness.
• Lack of arousal: Women who are not adequately stimulated during sexual activity can experience vaginal dryness—due to stress, change in libido, or lack of desire. It’s common and distressing for both sexual partners.

While vaginal dryness can affect women of all ages, it becomes more prevalent as women approach and reach menopause.

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Vaginal dryness or something else? 

Women who are experiencing vaginal dryness that interferes with their daily activities or sex life, should consult with their healthcare provider to determine the cause of their discomfort. “It’s important to rule out a dermatologic condition, such as a yeast infection or vulvar rash, that may be causing vaginal dryness,” Dr. Orbuch says. “In addition, any vulvar or vaginal infections should also be ruled out. Vulvovaginal yeast infections can be treated with over-the-counter antifungal medications.”

To diagnose vaginal dryness, your healthcare provider will take a medical history and conduct a physical exam. They will ask about symptoms and medications being taken and a pelvic exam can show if a woman has thin and dry vaginal tissue, due to lack of estrogen. Common symptoms of vaginal dryness include: 

• Pain or bleeding during sex, especially difficulty with penetration
• Vaginal itching, soreness, or pelvic pain
• Vaginal friction pain
• Increased urination 
• Urinary tract infection
• Loss of interest in sex

The good news is vaginal dryness is a treatable condition and your healthcare provider can work with you to determine the best treatment options.

7 vaginal dryness treatments

There are several different ways to treat vaginal dryness depending on your age and the severity—including natural remedies for vaginal dryness as well as over-the-counter and prescription options. “For women in the menopausal age group, hormone replacement therapy or vaginal estrogen cream along with non-hormonal vaginal moisturizers can also be very helpful to alleviate the symptoms of vaginal dryness,” Dr. Orbuch says. Your healthcare provider will work with you to form an appropriate treatment plan.

1. Contraceptives

“In women of reproductive age who are taking oral contraceptives, vaginal dryness may occur due to the hormonal suppressive effects of the oral contraceptive pills, and the cessation of ovulation,” Dr. Orbuch says. “If this is the case, choosing a different oral contraceptive or other contraceptive method can rapidly fix this.” The hormones in birth control pills affect everyone differently. For some, any hormonal method can cause vaginal dryness. Switching to a birth control method that does not contain hormones can help, such as a copper IUD, condoms, or the birth control sponge.

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2. Vaginal moisturizers

Dr. Minkin says women can start by treating themselves with non-hormonal over-the-counter (OTC) remedies, such as Replens, which comes both in a vaginal gel form with a prefilled applicator to insert into the vagina and also as a topical version which can be applied externally to the vulva. Unlike lubricants which are used prior to sex, vaginal moisturizers can be used regularly to alleviate dryness and help replenish vaginal moisture. 

3. Vaginal lubricants

Vaginal lubricants can ease dryness and are available over the counter. Using an OTC vaginal lubricant such as Astroglide Wet, or K-Y Jelly, right before sex, can make sex more enjoyable if you have vaginal dryness. Lubricants reduce friction during sexual intercourse and should not be confused with vaginal moisturizers. It is important to avoid using flavored or scented lubricant or those that produce other sensations (such as “tingles” or “heats up with touch”) as they may irritate the vagina. 

4. Topical estrogen therapies

“If women don’t achieve relief from over-the-counter remedies, they should consult a healthcare provider to see about using a prescription vaginal estrogen product,” Dr. Minkin says. “These come in many varieties: creams, vaginal inserts, and rings. It’s all about finding the best treatment for each patient and whether they want to use a localized hormonal product or a non-hormonal one.”

• Vaginal ring: Prescription estradiol vaginal rings—such as Estring or Femring—contain estrogen and are used to treat symptoms of menopause including vaginal dryness and irritation. It’s a soft, flexible, ring that releases estrogen over the course of 90 days. 
• Vaginal tablet: Vagifem and Yuvafem are prescription estradiol tablets inserted vaginally to release estrogen locally and ease vaginal dryness.
• Vaginal cream: Prescription vaginal estrogen creams work similarly to OTC vaginal moisturizers. They are inserted into the vagina with an applicator. Some common brand names include Estrace and Premarin, which are also available in oral form.
• Patches: Prescription estradiol patches can also help with vaginal dryness by evening out low estrogen levels.

It’s important that you discuss important medical issues such as a history of migraine with aura, blood clots, or stroke and/or family members that have experienced these conditions, with your provider before using this treatments. 

RELATED: List of estrogens

5. Oral/systemic medications

Dr. Minkin notes that many women often get relief from vaginal dryness by using over-the-counter products. If those don’t work, there are also many prescription medications available, such as Estrace (estradiol), Osphena (ospemifene), Prefest, and Premarin. These treatments help to replace declining estrogen levels and improve vaginal dryness.

6. Sexual counseling

If sexual dysfunction is causing vaginal dryness, there are several ways work toward a solution. Your healthcare provider may recommend different arousal techniques to discuss with your partner, such as massage or erotic videos. Or, talking with a mental health professional—either alone or with a partner—can help work through the emotional causes of vaginal dryness. These treatments can be used in combination with medication, lubricant, or hormonal treatments.

7. Lifestyle changes

Avoid body washes, soaps, bubble baths, and lotions that contain the following ingredients that can cause vaginal dryness and irritation:

• Sodium lauryl sulfate
• Parabens 
• Perfumes and synthetic fragrances

Don’t use douches, vaginal washes, or talcum powder in the vaginal area. Additionally, stay hydrated. Drink six to eight glasses of water each day. Dehydration can lead to vaginal dryness. If you smoke, now is a good time to quit. Smoking affects blood flow to your body’s tissues, including your vagina, leading to dryness.

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Compare vaginal dryness medications

Although vaginal dryness is a common problem that many women experience at some point in their lives, some suffer in silence. If you’re experiencing vaginal dryness, it’s important to know you’re not alone and to talk to your doctor or pharmacist about what treatment option might work best for you.

“Vaginal dryness is a chronic issue, so women need to keep using the product,” Dr. Minkin says. “While menopause symptoms such as hot flashes do tend to get better over time, vaginal dryness tends to get worse without intervention.” But don’t lose hope—when you find the right treatment, it can reduce symptoms and allow you to return to a normal life.