Menopause Symptom Guide: Vaginal Dryness

Medically reviewed by:

Emily Hu, MD

Vaginal dryness is pretty much what it sounds like - feeling not well lubricated, itchy and irritated, and even “too tight.” It can make sex anything from uncomfortable to extremely painful.

What is vaginal dryness?

Starting as early as your 40s, your vaginal walls become drier, and as a result, thinner and less pliable. Untreated, this leads to a number of side effects, from painful sex to general discomfort. Also called atrophic vaginitis or GSM (genitourinary syndrome of menopause), vaginal dryness is experienced by over 50% of women.

What’s the cause?

Vaginal dryness is caused by the decline of estrogen in your body. While other menopausal symptoms typically go away over time, vaginal dryness tends to persist and often gets progressively worse because it’s the result of physical changes in the vagina.

What’s happening inside your body?

By stimulating specific receptors in your vagina, estrogen helps increase blood flow and the natural lubrication that keeps the vagina healthy, thick and elastic. These secretions also create a slightly acidic environment that helps prevent urinary tract infections, bacterial vaginosis and yeast infections.

Beginning in perimenopause, both the amount of estrogen and the number of estrogen receptors in your vagina begin to decline. This can lead to vaginal dryness, and cause your vaginal walls become thinner and less elastic. Itching, burning, pain (especially during sex) and an increase in infections can result.

What does the research say?

A comprehensive literature review in the American Journal of Obstetrics and Gynecology found that vaginal estrogen therapy was the fastest and most effective treatment for GSM. 80-90% of women reported subjective improvement and relief from GSM symptoms.
A 2013 survey of postmenopausal women published in the Journal of Sex Medicine found that vaginal dryness interfered with sleep, quality of life and temperament in a quarter of study participants.
A recent clinical article drew the following distinction between lubricants and moisturizers: Lubricants provide short-term relief from vaginal dryness and painful sex, while moisturizers mimic natural vaginal secretions and help your vaginal tissues retain more moisture. The authors also recommended selecting a product that doesn’t include parabens or microbicides to best mimic your natural vaginal secretions.

How is vaginal dryness diagnosed?

Vaginal dryness, especially during menopause, is extremely common. A doctor will diagnose you based on your description of symptoms.

What are effective treatments?

The good news is that vaginal dryness is quickly and easily treated and can even be reversed.

Vaginal estradiol: The preferred treatment if you are just having vaginal dryness and not other symptoms of menopause. Vaginal estradiol targets only your vaginal tissue. It works by helping to restore a normal vaginal pH (between 3.8 and 4.5), thickening your vaginal tissue and increasing vaginal secretions. It comes in cream, tablet and ring forms.
Estradiol: (transdermal patch, oral, gel and cream) Estradiol replaces the exact form of estrogen that your ovaries are no longer producing. If you experience additional menopause symptoms (hot flashes, night sweats or brain fog), estradiol is the most effective treatment.
Selective estrogen receptor modulator (SERM) Ospemifene: Ospemifene mimics some functions of estrogen by stimulating estrogen receptors in your vagina to increase lubrication and lower your vaginal pH, which will return it closer to its pre-menopausal state.
DHEA (dehydroepiandrosterone): DHEA is a steroid hormone that’s produced by your adrenal glands and can be converted into estrogen in your body. Intrarosa (a non-estrogen vaginal insert) is a prescription DHEA that’s FDA-approved for painful sex in post-menopausal women.

What are some non-medical treatments?

While less effective than the medical treatments, some women find that these help:

Lubricants: These provide short-term relief for vaginal dryness and pain when applied prior to sex. Water-based lubricants with osmolality (the degree to which they draw water out of your cells) of under 1200 mOSM/kg are recommended. Some people prefer to use coconut, olive, avocado and peanut oils, but these are not recommended to use with latex condoms or diaphragms, as they can damage the latex. Never use body lotions or moisturizers because some ingredients may irritate your vagina.
Moisturizers: Moisturizers can be a more effective treatment than lubricant if you’re experiencing day-to-day discomfort from vaginal dryness. Applied every one-to-three days, moisturizers rehydrate your vaginal tissue and lower your vaginal pH (making it more acidic). The rehydration and lowering of vaginal pH is why moisturizers last longer than lubricants. Your vagina will only absorb what it needs, so consider wearing a sanitary pad or panty liner because it will expel the rest.
Supplements: While Intrarosa is the only FDA-approved prescription DHEA treatment, there are many non-prescription oral DHEA supplements that may help with your vaginal dryness, but there isn’t conclusive scientific evidence of their effectiveness.
Lifestyle changes: Switching to cotton underwear can help reduce irritation and friction. Due to its breathable material, it can lower the risk for potential infections.
Increased sexual activity: While this can be understandably difficult if you’re already experiencing painful sex or disruptive vaginal dryness, increased sexual activity can improve blood flow to your vagina. Over time, this can help reduce GSM symptoms.

What to do next:

Connect with an OBGYN who treats menopause: Many doctors will list their specialties/areas-of-interest on their website, or you can ask when making your appointment.
Determine your options: Collaborate with your doctor to identify and understand the treatment options available to you given your medical history.
Decide what works for you: You know your body best. Select your treatment and keep communicating with your doctor to make sure it’s working optimally for you.