• Vaginal Changes

Why am I Dry Down There? An Easy Guide to Understanding Vaginal Dryness

Medically reviewed and edited by Rhonda Honeycutt, FNP

Vaginal dryness is more than just an inconvenience — it can disrupt daily life, strain relationships, and cause discomfort. 

Whether you're approaching menopause or dealing with hormonal changes, understanding the causes and finding the right solutions is essential. 

In this article, we explore the causes of vaginal dryness and provide practical steps and treatments to help you restore your comfort and confidence.

What is Vaginal Dryness?

Vaginal dryness (or VD) can affect women of all ages but is particularly common in those approaching or going through menopause due to hormonal changes. 

Menopausal women often experience moderate to severe vaginal dryness. Women between the ages of 17 to 50 are more likely to report vaginal pain during sex, which is often accompanied by other intimacy issues related to dryness. 

This discomfort can lead to negative feelings about sexual intercourse, causing a decrease in sex drive and potentially affecting intimate relationships. 

Additionally, vaginal dryness can lead to a decrease in natural lubrication, which can impact normal vaginal discharge and make your symptoms more uncomfortable.

Although vaginal dryness can be managed or even treated in many cases, cultural stigmas around discussing such conditions often cause women to suffer in silence, despite the availability of effective treatments.

Symptoms of vaginal dryness

A qualified gynecologist must make a formal diagnosis of vaginal dryness. The following are signs and symptoms you may experience:

• General discomfort in the genital area  

• Itching, soreness, and burning in or around your vagina  

• Skin irritation  

• Pain during intercourse  

• Frequent urinary tract infections (UTI)  

What are the Causes of Vaginal Dryness?

Menopause 

Before and during menopause, there is a gradual decline in estrogen and progesterone levels. This significant hormonal shift leads to a decrease in vaginal fluid production, resulting in vaginal dryness. 

Menopausal hormone therapy (MHT) can be used to increase estrogen levels and alleviate dryness, but it may increase the risk of developing hormone-sensitive breast cancer.

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Hormone therapy for breast cancer

Certain types of breast cancer are sensitive to reproductive hormones. If a cancer is estrogen-sensitive, it can grow or worsen with an increase in estrogen levels. 

Similarly, progesterone-sensitive breast cancers can be affected by elevated progesterone levels. 

Treatment for these cancers often focuses on stopping the body from producing either estrogen or progesterone, depending on the type of cancer. 

This reduction in hormone levels can lead to decreased vaginal fluid production, resulting in vaginal dryness.

Medication

Antipsychotics and antidepressants, commonly used to treat schizophrenia, depression, and other mental health conditions, can cause sexual dysfunction, including a lower libido and vaginal dryness. 

Sexual dysfunction related to these medications occurs in 45-80% of men and 30-80% of women, making it a significant concern for those on long-term treatment.

Mental health

Depression can also lead to anhedonia, which is the inability to feel pleasure in normally enjoyable activities, further diminishing sexual desire.

Additionally, hormonal imbalances linked to depression may reduce natural lubrication, contributing to vaginal dryness and discomfort during sexual activity.

Medical conditions

Vaginal atrophy

Vaginal atrophy is a condition where the lining of the vagina becomes thinner, often accompanied by a decrease in cervical fluid production, typically due to lower estrogen levels. 

While it is most common in perimenopausal or menopausal women, it can affect women of any age if their estrogen levels fluctuate. Many postmenopausal women may overlook this condition, assuming it is a normal part of aging.

Diabetes

Individuals with diabetes are at a higher risk of sexual dysfunction. 

Prolonged high blood sugar levels can damage the nerves and blood vessels that supply the genital organs, leading to reduced blood flow and sensation in the area. 

This lack of sensation can hinder sexual arousal, which in turn can cause vaginal dryness due to a decrease in the production of vaginal fluid.

Childbirth and breastfeeding

Postpartum mothers often experience a reduced interest in sexual activity, largely due to fatigue from caring for their newborn and concerns about body image. 

This can lead to vaginal dryness and painful intercourse (dyspareunia). Additionally, after childbirth, estrogen and progesterone levels drop significantly, further decreasing vaginal fluid production and contributing to discomfort during sex.

Lifestyle habits

Lifestyle habits can play a significant role in contributing to vaginal dryness. Here are some factors you should be mindful of:

• Smoking: A 2017 study found that women who smoked were more likely to experience vaginal dryness and go into early menopause, as smoking damages the cells that make up the vaginal wall, leading to tissue wasting.  

• Harsh soaps: Avoid soaps, body washes, or creams with harsh chemicals or strong fragrances, as they can disrupt your vagina’s natural pH balance, leading to dryness, burning, and itching.  

• Stress: Mental or physical stress can increase cortisol levels, which lowers testosterone and reduces blood flow to the genitals, impacting arousal and causing vaginal dryness.  

How to Treat Vaginal Dryness

Vaginal dryness is a common issue among women and can cause significant discomfort and distress. Many treatment options are available, including hormone therapies. 

However, hormone therapies should be avoided by women at high risk of heart disease, uterine cancer, or those using medications to induce menopause. 

Vaginal moisturizers

Vaginal moisturizers are products designed to help with vaginal dryness by being absorbed into the vaginal tissue, rather than sitting on the surface like lubricants. 

Common brands include Replens, K-Y, and Revaree. Additionally, 100% pure coconut oil has been used to moisturize the vaginal canal. 

These moisturizers are available in various forms, such as creams, vaginal suppositories (pills inserted into the vagina), or gels, and they do not require a prescription as they contain no hormones. 

Hyaluronic acid-containing moisturizers are often recommended by healthcare providers for their ability to draw moisture into the skin, helping to relieve irritation and discomfort. 

They are not necessarily intended for use during sexual activity but are ideal for regular moisture maintenance.

Vaginal lubricants

Vaginal lubricants are water, oil, or silicone-based treatments used to relieve vaginal dryness during sex. They do not contain hormones and are applied directly to the skin to reduce friction during intercourse. 

Popular examples include K-Y Jelly and Astroglide. These lubricants sit on the skin’s surface, providing temporary relief for discomfort caused by dryness during sexual activity.

Estrogel

Estrogel is an FDA-approved hormonal gel applied topically in and around the vaginal area to treat vaginal dryness caused by decreased estrogen levels after menopause or the removal of the ovaries. 

It helps relieve symptoms such as vaginal dryness, irritation, hot flashes, night sweats, and painful sex associated with menopause.

Like all estrogen-containing hormone replacement therapies, Estrogel can increase the risk of heart disease, stroke, and uterine cancers. It is only available with a doctor’s prescription.

Vaginal estrogen cream

Vaginal estrogen creams are prescription-only treatments used to treat vaginal dryness, itching, and painful intercourse (dyspareunia) caused by menopause. 

These creams, such as Estrogel, Estrace cream, and Premarin cream, are categorized as local hormone replacement therapy (HRT). While effective in alleviating menopausal symptoms, they can increase the risk of endometrial cancer.

Vaginal estrogen tablets or rings

These are prescription tablets or rings inserted into the vagina to relieve menopausal symptoms. 

As local hormone replacement therapy medications — meaning they deliver hormones directly to the vaginal tissues rather than the entire body — they also carry an increased risk of uterine cancer. 

Some options, like the Estring vaginal ring, are long-lasting and can provide relief for up to three months. A soft, flexible ring is inserted into the vagina, where it steadily releases estrogen over that period.

Oral medications 

When it comes to treating menopausal symptoms like vaginal dryness and other related issues, several medications are available. Below are two commonly prescribed options: 

• Hormone replacement therapy (HRT): These tablets are used to alleviate menopausal symptoms and help with osteoporosis by improving bone density. 

• Ospemifene: This selective estrogen receptor modulator (SERM) improves vaginal cell production and increases vaginal canal thickness to relieve dryness and improve lubrication. 

Although it doesn't contain estrogen, it still carries the risk of causing endometrial cancer and is FDA-approved for this use. 

How to Prevent Vaginal Dryness

Preventing vaginal dryness involves making certain lifestyle changes and addressing any underlying health issues. 

By following these steps, you can help maintain natural lubrication and overall vaginal health:

• Exercise more regularly to improve circulation and overall well-being.  

• Focus on improving general health to support hormone balance.  

• Avoid using strong or fragranced soaps, as they can cause irritation and dryness.  

• Engage in sufficient foreplay before sexual activity to promote natural lubrication. 

• Limit smoking and alcohol consumption to reduce their impact on hormone levels. 

• Treat any underlying medical conditions with guidance from your doctor to prevent further complications.

When Should I See a Doctor for Vaginal Dryness?

You should seek treatment for vaginal dryness if it begins to significantly affect your quality of life or you experience additional concerning symptoms, like painful intercourse. 

Here are some more symptoms that can occur alongside vaginal dryness and require medical attention:

• Abnormal vaginal bleeding  

• Itching, burning, or irritation around the vaginal area  

• Pain during sexual intercourse (dyspareunia)  

• Frequent urinary tract infections (UTIs)  

• Vaginal discharge with an unusual color or odor  

• Pelvic pain or discomfort  

• Swelling or redness in the vaginal area  

• Difficulty urinating or painful urination  

Where Can I Learn More About Vaginal Dryness and Sexual Health?

If you're experiencing vaginal dryness or other related symptoms, LifeMD can help. 

A team of healthcare professionals is available to offer personalized guidance and prescribe medications to help alleviate discomfort and enhance your quality of life. 

These board-certified doctors can also address any questions you have about sexual health and assist in ruling out any serious underlying conditions.

Make your appointment today and take control of your health – all from the comfort of your own home.

Rhonda Honeycutt, FNP

Rhonda has been a Family Nurse Practitioner since 2013. She loves working with patients and seeing improvements in their health through collaboration in care plan decisions. Rhonda is licensed in 50 states and is bilingual. Her hobbies and interests include reading, exploring new languages, and spending time outdoors with her son, spouse, and 10 dogs.

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