Vulvovaginal Dryness

Vulvovaginal dryness is a common condition that can affect women at any age, though it becomes especially prevalent during and after menopause, impacting more than half of postmenopausal women and causing discomfort that extends far beyond the bedroom.

Table of contents

• What Is Vulvovaginal Dryness?
• How Common Is This Condition?
• What Causes Vulvovaginal Dryness?
• Recognizing the Symptoms
• How Is It Diagnosed?
• Treatment Options
• When to See a Doctor

What Is Vulvovaginal Dryness?

Vulvovaginal dryness occurs when the tissues in the vagina lack normal moisture and lubrication. Normally, the vaginal walls are kept moist with a thin layer of clear fluid that helps keep the tissue healthy, thick, and elastic^[1]. This natural lubrication makes activities like sexual intercourse more comfortable and helps protect against infections^[6].

When dryness develops, the vaginal tissues become thin, dry, and less well-moisturized, leading to discomfort during everyday activities and particularly during sex^[1]. The condition is sometimes part of a broader medical issue called vaginal atrophy or, more recently, genitourinary syndrome of menopause (GSM), which includes both vaginal and urinary symptoms related to hormonal changes^[7].

How Common Is This Condition?

Vulvovaginal dryness is more common than many people realize. Around 17% of women between the ages of 18 and 50 report experiencing vaginal dryness during sex, even before menopause begins^[1]. After menopause, the numbers increase significantly—more than half of postmenopausal women experience vaginal dryness^[1].

Studies suggest that approximately 15% of premenopausal women and up to 57% of postmenopausal women experience this condition^[7]. More than one in three women aged between 57 and 69 years report vaginal dryness, yet most don’t discuss it with their doctor^[3]. It affects more than one in two females after menopause^[3].

What Causes Vulvovaginal Dryness?

In most cases, vulvovaginal dryness happens when estrogen levels decrease. Estrogen is the female hormone responsible for keeping vaginal tissues lubricated and healthy^[1]. When estrogen levels drop, the lining of the vagina becomes thinner and produces less moisture^[6].

The most common reason for declining estrogen levels is menopause, the time when a woman’s menstrual periods end permanently. However, estrogen levels can also drop due to several other reasons^[1]:

• Breastfeeding and the period right after childbirth
• Removal of the ovaries through surgery (called oophorectomy)
• Cancer treatments such as chemotherapy, radiation, or hormone therapy
• Medications used to treat conditions like uterine fibroids or endometriosis
• Birth control pills or other forms of hormonal contraception
• Certain antidepressants and antihistamines (medications for allergies and cold symptoms)

Other factors that can contribute to vaginal dryness include^[1][3]:

• Medical conditions like diabetes or Sjögren’s syndrome (an autoimmune disorder that causes dryness throughout the body)
• Not being sexually aroused or insufficient foreplay before sex
• Using scented or perfumed soaps, sprays, douches, or washes in or around the vagina
• Smoking cigarettes
• High levels of stress
• Dehydration

Recognizing the Symptoms

Vulvovaginal dryness causes a range of symptoms that can affect both comfort and quality of life. The condition can cause pain during sitting, exercising, urinating, and sexual intercourse^[1].

Common symptoms include^[1][5]:

• Burning and itching sensations in and around the vagina
• Soreness in the vaginal and vulvar area (the external genitals)
• Pain or discomfort during sexual intercourse
• Bleeding or spotting after sex, which occurs when the thin vaginal wall tissues break open
• Unusual vaginal discharge
• Less desire to have sex

The condition can also affect the urinary system, causing^[1][3]:

• Needing to urinate more frequently than usual
• Painful urination
• Recurrent urinary tract infections (UTIs) or yeast infections

Because less moisture in the vagina leads to less moisture in the vulvar area, you may feel dryness or irritation during normal daily activities like walking, sitting, or putting on underwear^[1].

How Is It Diagnosed?

Healthcare providers diagnose vulvovaginal dryness based on your medical history and a physical examination^[1]. Your doctor will ask about your symptoms, when they started, any medications you’re taking, and factors that make the symptoms better or worse^[3].

The diagnostic process may include^[1][3]:

• A pelvic exam to view the inside of your vagina and check whether the vaginal walls are thin, pale, or red
• Testing of vaginal discharge to rule out infections
• Hormone level tests to determine if you are in menopause
• A urine test if you have urinary symptoms
• An acid balance test, which involves taking a sample of vaginal fluids to check the vagina’s pH level

Tests are not usually needed unless you have other symptoms that need to be investigated^[3].

Treatment Options

Several safe and effective treatments are available for vulvovaginal dryness^[1]. The right treatment depends on the cause of dryness, your overall health, and your personal preferences.

Over-the-Counter Options

Many women find relief with products available without a prescription^[3]:

Vaginal moisturizers can be used regularly, typically 2 to 3 times a week, to help maintain hydration in vaginal tissues. The effects of a moisturizer generally last longer than those of a lubricant^[10].

Water-based lubricants are applied just before sexual activity and can reduce discomfort during intercourse for several hours^[3][10]. It’s important to choose products that don’t contain glycerin or warming properties, as women who are sensitive to these substances may experience irritation^[10]. Avoid petroleum jelly or other petroleum-based products if you’re also using condoms, because petroleum can break down latex condoms^[10].

Women should choose a product that is optimally balanced in terms of both osmolality and pH, and is physiologically most similar to natural vaginal secretions^[7].

Prescription Hormone Treatments

If over-the-counter options don’t provide enough relief, your doctor may recommend hormone therapy^[1]:

Topical estrogen therapy delivers estrogen directly to the vaginal area through creams, tablets, rings, or suppositories placed inside the vagina. These work well to treat vaginal dryness and deliver estrogen at lower doses than pills or patches, with only a little absorbed into the bloodstream^[1][6].

Systemic hormone therapy comes in the form of pills or skin patches. This may be recommended if you have other menopausal symptoms like hot flashes, but it may not provide adequate estrogen to treat vaginal dryness on its own. In such cases, you may need to add a vaginal hormone medicine as well^[1].

You should discuss the risks and benefits of estrogen replacement therapy with your healthcare provider^[6]. These treatments are not recommended for everybody^[5].

Lifestyle Approaches

Several self-care measures can help manage vulvovaginal dryness^[3][5]:

• Use unperfumed soaps and washes around your vagina
• Avoid perfumed soaps, washes, and douches in and around your vagina
• Don’t use creams, lotions, or moisturizers that are not specifically for vaginal use, as they can cause more irritation or infection
• Take time before sex to ensure you’re fully aroused—engage in foreplay with your partner and try to relax
• Stay hydrated
• Avoid smoking

When to See a Doctor

You should see a healthcare provider if^[3][5]:

• 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 from your vagina
• You have bleeding after sex or between your periods
• You need to urinate more often than usual
• You keep getting urinary tract infections

Many women feel reluctant or embarrassed to discuss vaginal dryness with their doctor, but remember that it’s a common medical condition with effective treatments available. Healthcare providers are experienced in addressing these concerns and can help you find the right solution^[3].

Vaginal dryness can make you more likely to develop yeast or bacterial infections, cause painful sexual intercourse that may affect your relationship with your partner, and increase your risk of urinary tract infections^[6]. Proper treatment will ease symptoms most of the time^[6].