Vaginal dryness: Causes, symptoms and treatment

Experiencing vaginal dryness and all the symptoms that come with it — including soreness, itching, and painful sex — is a discomfort many of us are familiar with. And frustratingly, it can have a detrimental effect on everything from sleep to relationships. 

It can happen for many different reasons (more on this below), and while it’s commonly linked to menopause, it affects people of all ages. It’s estimated that around 17% of women under the age of 50 and over half of women over the age of 51 who have reached menopause have experienced vaginal dryness at some point in their lives.

Thankfully, vaginal dryness can often be easily explained, and there’s plenty you can do to help relieve your symptoms and get back to enjoying life again. Here, obstetrician and gynecologist (OB-GYN) Dr. Sara Twogood explains what causes vaginal dryness, what you can do to ease your discomfort, and when you should speak to your health care professional. 

What is vaginal dryness?

First things first, vaginal dryness is essentially what it sounds like — dryness caused by a lack of moisture in the vagina. 

Typically, there’s a natural layer of moisture that coats your vaginal wall. It can be thin in texture and may be sticky to the touch. The production of this fluid all depends on the blood flow to your vagina. The cells in your vagina also respond to estrogen, which means your estrogen levels can really impact how dry you feel down there (but more on that below.) 

Vaginal dryness is most commonly linked to menopause, which is all about changes in hormone levels. You might hear your medical professional describe it as vaginal atrophy (when the walls of your vagina become thinner, dryer, or irritated). This can happen during the transition into menopause (sometimes described as perimenopause), and it’s estimated that 45% of postmenopausal women will develop vaginal atrophy. 

But vaginal dryness isn’t just uncomfortable. A recent study looked into the impact that it has on the quality of life of premenopausal and postmenopausal women. It found that people who experienced vaginal dryness were more likely to say that it impacted their life at work and at home. This isn’t something you should have to deal with alone, so reach out to your health care provider to see which treatments could work for you (more on that below.) 

Vaginal dryness symptoms

So, how do you know what you’re experiencing is vaginal dryness and not something else to be concerned about? Dr. Twogood says the main symptoms to look out for include:

• A sensation of dryness in the vulva and vaginal area (you might describe the feeling as irritated, inflamed, itchy, sensitive, or tender)
• Discomfort when wiping the vulva area after going to the bathroom 
• Bleeding after penetrative sex
• Feeling uncomfortable while wearing a tampon or menstrual cup
• Irritation from sitting in certain positions or walking and running

If you’ve been experiencing low libido alongside vaginal dryness and pain, then you certainly aren’t alone. Vaginal dryness can be a contributor to pain with sex too, as natural lubrication can make sex easier and more enjoyable. This, in turn, can affect your relationships and your daily mood, potentially leading to anxiety and stress. 

It’s important to remember that you should never feel pressured to have sex when you don’t feel comfortable. And if you’re nervous about speaking to your partner or aren’t sure what to say, then don’t be afraid to use your health care provider as support.

What causes vaginal dryness?

While vaginal dryness can be disruptive to everyday life in more ways than people who haven’t experienced it might imagine, the good news is that we understand many of its causes. “Vaginal dryness is typically caused by low estrogen levels,” says Dr. Twogood, noting that it’s common to have a drop in estrogen “right after a period [temporarily], in the postpartum phase, [and] while breastfeeding.” This drop is permanent after menopause.

Estrogen is one of the hormones responsible for regulating your monthly menstrual cycle. It also plays a critical role in maintaining the blood flow to your vagina, triggering the production of vaginal lubrication.

If you experience a drop in your estrogen levels, then your body will slow down or put a pause on this process. The tissue in your vulva and vagina may also become thinner and more delicate. The result? The walls of your vagina become less flexible and are more vulnerable to becoming inflamed and irritated. 

Vaginal dryness may be most closely linked with menopause, as that’s when your natural estrogen levels drop permanently. But there are also some other factors that may trigger soreness or irritation: 

Hormonal changes: 

• Breastfeeding and childbirth alter your hormone levels. At this time, your estrogen levels will be low.
• Hormonal birth control, like the pill or intrauterine device (IUD or coil), causes a drop in your natural estrogen levels. 
• In some cases, chemotherapy and hormone therapy to treat cancer can impact the way your ovaries work and change your body’s ability to produce estrogen. 

Nonhormonal causes: 

• Cold and allergy medications can have an overall drying effect on the body.
• Some antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can reduce the amount of lubrication your body produces. 
• Sjögren syndrome is a condition that impacts your body’s ability to produce fluid such as saliva, tears, and discharge.  
• Chronic anxiety and stress can affect the blood flow to your vagina, which will, in turn, impact how much natural lubrication you can create.
• Using perfumed, scented, or harsh products on your vulva can irritate the walls of your vagina and your vagina’s natural pH balance. This can cause conditions like vaginitis and leave you feeling dry and irritated. 
• You might experience vaginal dryness during sex or intimacy if you aren’t feeling aroused (or turned on) or you aren’t ready for penetrative sex.  

Depending on your age and whether you’re approaching menopause, you may experience vaginal dryness for different reasons. Here’s what to expect. 

Vaginal dryness before and after your period

You might have noticed that your discharge changes throughout your cycle, and you may feel drier at some points in the month. This is totally normal.

Day one of your cycle is marked as the first day of your period (which is easy to work out if you track your period.) During your monthly bleed, your estrogen and progesterone levels are low. After your period ends, your estrogen levels rise. This is known as the follicular phase. 

Your estrogen levels peak in the run-up to ovulation (when your ovaries release an egg for fertilization around day 14 of your cycle.) This may mean your discharge has a similar consistency to that of an egg white, and you’re less likely to experience vaginal dryness. As your estrogen levels drop again shortly afterward, you may notice that you feel dryer or more irritated. 

Vaginal dryness during menopause

The number one reason for a drop in estrogen, and therefore vaginal dryness, is menopause. 

In addition to vaginal dryness, other common menopause symptoms include a lower libido and hot flashes. They are both caused by a drop in your estrogen levels. 

While the average age of menopause in the United States is 51, you might experience symptoms earlier. If you’re in your 30s, then menopause may not even be on your radar, but some people report experiencing the symptoms associated with menopause between their 30s and their 50s. This is called perimenopause.

This isn’t something you have to manage alone. Your health care provider should fully explain what’s going on as you transition to menopause, how you can manage dryness and other symptoms, and treatment options that fit your lifestyle. 

Vaginal dryness after birth and during breastfeeding

During pregnancy, your estrogen and progesterone levels rise dramatically. As your placenta develops, it will also begin to release estrogen and progesterone. However, your hormone levels don’t remain high after you give birth. Within 24 hours of delivery, your estrogen and progesterone levels will drop to what they were before you got pregnant. As estrogen is responsible for stimulating blood flow to the vagina, you may notice that you feel drier or more irritated in the period after giving birth.

Your body will start to produce prolactin (the hormones that encourage your breasts to grow and trigger your body to start producing milk) before you give birth. If you choose to breastfeed your baby, then your estrogen levels will drop further, as estrogen can impact your ability to produce milk.   

Vaginal dryness treatment

If you’ve experienced vaginal dryness, then it’s totally normal to feel frustrated. But the good news is there are a number of treatments available to help. So how do you know which option is right for you? 

“It depends on the cause,” explains Dr. Twogood. “For menopausal treatment, topical (vaginal) estrogen creams and suppositories are often the first line.” 

Estrogen creams and tablets can be applied to your vagina and will slowly help to increase estrogen. They work locally, meaning they’ll increase your estrogen levels, specifically in your vagina. There are other prescription medications that your health care provider may recommend for you. However, before you start taking any new medication, it’s important to speak to a medical professional about the benefits and any potential side effects. 

If the causes of your vaginal dryness aren’t hormonal, then Dr. Twogood says, “using oils like jojoba, olive, or coconut oil as vulvovaginal moisturizers may be helpful too.” Topical lubricants and moisturizers may give you more immediate relief from pain and discomfort. But it could be good to check out the label first. While they might smell nice, you should avoid using any lotions on your vulva that are heavily scented. 

If you’ve been diagnosed with Sjögren syndrome, your health care provider may prescribe you a medicine that can help your body produce fluids. An example of this is pilocarpine. Be sure to speak with a doctor to explain your symptoms so they can help relieve your pain and stress. 

How to manage vaginal dryness

“Sometimes it’s impossible to prevent vaginal dryness altogether. However, paying attention to your body, identifying the symptoms when they occur, and troubleshooting and treating early may help make the treatment more effective or work quicker,” says Dr. Twogood. 

Here are some suggestions you might want to consider: 

• Lubricants: Lubricants may help in alleviating pain during sexual intercourse if you have mild to moderate vaginal dryness. If you’re using barrier protection like condoms, then oil-based products should be avoided. The oil breaks down the latex and makes the condoms easier to break. 
• Avoid scented products: The skin around your vagina is particularly sensitive, and something as simple as changing your soap or washing detergent can irritate your skin. Try to avoid any products that are heavily scented. 
• Vaginal moisturizer: Vaginal moisturizer is a type of cream applied inside the vagina to keep it moist. Talk to your health care provider about the best options — and avoid anything with flavors, colors, or perfumes, which can be irritating.  
• Avoid smoking: Smoking reduces blood flow, which could mean less blood and oxygen reach your vagina. Smoking can also reduce the activity of the estrogen your body produces.
• Regular sex: Blood flow to the vaginal tissues elevates when a woman is sexually aroused, so getting frisky is actually one of the best things you can do to reduce the severity of vaginal dryness. Bear in mind that this doesn’t have to involve penetration or a partner — so certainly don’t suffer through pain — anything that increases blood flow to the area will help. 

When to see a doctor for vaginal dryness

If you’ve noticed unusual discharge, bleeding after sex or in between periods, or vaginal dryness interfering with your everyday life, then reach out to your health care provider. You don’t have to suffer in silence. 

In order to deduce what might be causing your dryness, your medical professional will start your appointment by taking your medical history. They may ask you about your menstrual cycle, sexual history, and any previous health conditions. 

They may then conduct a pelvic exam where they look at your vaginal walls with a speculum (a piece of equipment often used during smear tests to open the vaginal walls). If they suspect that you may have low hormone levels, you might also have a blood test.

Vaginal dryness: The takeaway

While vaginal dryness is most commonly linked with menopause, it can affect you at any point. Other life events, such as having a baby, perimenopause, or switching up your birth control, can cause dryness. 

The good news is that it’s often simple to treat, and you may not even need to see your health care provider to do so. Some over-the-counter remedies (like lubricants and moisturizers designed especially to be used on your vagina) could ease your discomfort. 

Hormonal changes are a part of life, but they don’t have to get in the way. If you’ve been suffering in silence (and itchiness), hopefully now you’ve got the pointers you need to begin treating vaginal dryness.