Causes of Vaginal Dryness
Vaginal dryness can make sex painful and lead to other problems like tears and infections. Anyone with a vagina can experience dryness, but it’s more common in those going through perimenopause and menopause. This can be attributed to changes in hormone levels, particularly estrogen.[1]Other things can also cause it, such as dehydration, as well as emotional issues that cause a lack of interest in sex. Unfortunately, many women with vaginal dryness do not talk about it with their healthcare provider, either chalking it up to a natural part of the aging process or avoiding it as an uncomfortable topic.
Whatever its cause, the first step in treating vaginal dryness is figuring out what’s causing it and what options there are for treating it.
Low EstrogenEstrogen helps maintain normal blood flow, vaginal tissue health, and moisture in the vagina, according to the American College of Obstetricians and Gynecologists (ACOG).[2] “You can have low estrogen when you are breastfeeding or postpartum, and you can have diminished estrogen with some types of birth control and then certainly with menopause,” says Susan Reed, MD, MPH, a professor emeritus of obstetrics and gynecology at the University of Washington in Seattle. Cancer treatments, such as chemotherapy and radiation, to the pelvis can also lead to low estrogen and decreased vaginal lubrication. Less estrogen can impact the vulva and the lining of the vagina, causing them to become thinner, drier, and less flexible, which is referred to as vulvovaginal atrophy.
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DehydrationThe cells in the vagina need to have enough water in them to function correctly. “If you’ve been exercising like crazy and haven’t been drinking enough water, you’ll be dryer,” Dr. Reed says. Some soaps, dyes, perfumes, lubricants, and scented products contain ingredients in them that draw moisture out of your cells. Plus, some medications like antihistamines can also be dehydrating.
InflammationThe chemicals in soaps, hygiene products, dyes, and perfumes can also irritate your vaginal cells and cause inflammation. “Hygiene products can have ingredients that are irritating or are harmful to genital tissues,” says Reed. “They are not recommended.”
Infections can have a similar effect. “Yeast or candida often presents as a burning or feels like sandpaper,” says Reed. “This sensation can feel like vaginal dryness due to menopause.”
Inflammation blocks two critical types of glands that are just at the outside of the vagina, she notes. “The glands produce fluid when you’re aroused. If these tissues are inflamed, they don’t function well, and you won’t get good lubrication.”
AgingThe process of getting older is complicated and can affect the whole body as well as specific tissues and organs. One area of concern is what happens to the vagina during menopause, which can significantly impact a woman’s sexual health. “Aging vaginal tissues are by their very nature dryer than the premenopausal state,” says Reed. She says younger people have better blood flow, which is needed to create the moisture that comes through vaginal tissues.
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Research from 2021 showed that, as women age, the vagina goes through various changes, including a lack of estrogen, shifts in the microorganisms living in the vagina, and alterations in the genes. During perimenopause and menopause, a drop in estrogen can cause increased vaginal pH, which leads to lower numbers of lactobacilli (beneficial bacteria) and, therefore, can increase the numbers of harmful bacteria. The drop in estrogen leads to less permeability, blood flow, and elastin, causing dryness. While scientists understand some of these changes, the details at the molecular level are not entirely clear. They are still working to fully understand how our DNA, hormonal shifts, and the vaginal microbiome are interconnected.[4]Aging is even separate from the estrogen, explains Reed. “Those [two things] are happening in parallel. Aging will cause changes in the sexual response that is not necessarily hormone-dependent,” she says. “The vascular supply and the enervation to the genitals ages, and this is independent of reproductive hormones — these changes are due to aging. So you can still have problems even when you [take] some estrogen, although estrogen can help increase blood flow.”
The Vaginal MicrobiomeExperts suspect some kind of link between the vaginal microbiome and vaginal dryness and other postmenopausal vaginal symptoms, but they have yet to confirm this association clearly.[5] According to a 2024 review by Reed and colleagues, early studies found an association between microbiomes with lower levels of Lactobacillus, a bacteria researchers think is helpful to vaginal health after menopause, and more dryness symptoms.[6]More recently, Reed and her collaborators are leading a set of five randomized clinical trials and three ancillary studies investigating postmenopausal symptoms called Menopause Strategies: Finding Lasting Answers for Symptoms and Health Trials, or MsFLASH. Throughout MsFLASH, the team has tested nine interventions in more than 1,300 women and collected nearly 16,000 samples. MsFLASH researchers theorize that since Lactobacillus produces lactic acid, it might help guard against pathogens in the vagina and help prevent dryness-related issues by fighting off infections.[7]But so far, Reed says, MsFLASH has yet to establish a clear relationship between what’s in someone’s vaginal microbiome and their vulvovaginal symptoms, including dryness. Hormone therapy likely helps increase the beneficial bacteria, Lactobacillus, which is most common in a healthy premenopausal vagina, she notes. “What is still unclear is whether these changes track with vaginal symptoms. Our research did not show that it did. More research is needed.”
Mental and Emotional Issues Could Play a RoleAccording to ACOG, stress and anxiety can have an impact on your sex life. So can problems between you and your partner.[8] “Sexual interest can be driven by sexual pleasure,” says Reed. “If the experience is not as pleasurable due to less engorgement and slow response and fewer orgasms, the interest falls [over time].”The National Institute on Aging also says that, for older adults, compounding medical conditions, such as chronic pain, incontinence, arthritis, and heart problems, can alter their attitude about intimacy and sex.[9]How to Prevent and Treat Vaginal DrynessTreatment for vaginal dryness depends on the cause. In general, Reed says, “drink more water and avoid infections or anything that irritates the tissues.” But other helpful ways to address it include:
Bolster your relationship with sex and with your partner. For dryness due to problems in the bedroom, ACOG suggests couples work on communicating. Choose a time to have sex when you aren’t too tired or stressed, and make plenty of time for foreplay. You might also try therapy. “If you have low desire, low arousal, and you’ve tried everything else, there are great therapists for this, so consider that when [your dryness] has to do with sex,” says Reed. “Vaginal dilators and pelvic PT are important to include as well as sexual behavioral therapy.”Use vaginal moisturizers and lubricants. There are tons of over-the-counter moisturizers that can be applied every few days either inside your vagina or externally to the vulva, ACOG says.[10] They protect vaginal tissue even when you aren’t having sex by sticking to the vaginal walls, helping to keep them hydrated, and encouraging the body to generate natural lubrication. Lubricants help with dryness and pain during sex, offering an immediate relief. You can buy different kinds of water-based or silicone-based lubricants over the counter.[11] Products like coconut oil and petroleum jelly work too, but such oil-based lubricants can damage condoms. “Our [research] group found no difference between lubricants and moisturizers, and usually lubricants are cheaper,” notes Reed. “Lubricants should be used at least two times per week and also with sexual activity.”Try Osphena.
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This is a prescribed oral medication designed to address the discomfort associated with painful intercourse and vaginal dryness.[12] “Osphena can be associated with a small risk of leg clots and adverse cardiovascular events, so it is slightly more risky than any of the local vaginal treatments,” says Reed. “It is marketed for use when local therapies fail.”If you experience problems with vaginal lubrication because of low estrogen, you may benefit from treatment with hormones. According to Reed, research on the vaginal microbiome showed that estrogen promotes vaginal health. “Hormone therapy will improve the health of vaginal tissues — the cells become plumper, moister, and thicker,” she says. Some hormonal therapies include:
Local Treatments In some cases, doctors recommend localized treatments like vaginal estrogen inserts. “Vaginal estradiol can be helpful in those who do not get benefit from lubricants,” says Reed, “but the effect size or the amount of benefit is relatively small. Prasterone vaginal is recommended when other local treatments fail and is likely low risk.”Systemic Treatments If you’re also experiencing symptoms like hot flashes, an oral medication or a skin patch that releases estrogen throughout the body is an option. Both local and systemic approaches can be used together to effectively treat vaginal dryness.[13]Vaginal dryness is a common and frustrating condition. But Reed says the important thing to remember is “it’s treatable. No size fits all, and the first thing you try may not work. If something doesn’t work, try again and see a provider.”