• Vaginal Changes

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

Medically reviewed and edited by Lauren Cramer, PA- C

Published: October 01, 2024
Updated: November 18, 2025
5 mins

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 commonly experience moderate to severe vaginal dryness due to declining estrogen, which can make sex uncomfortable or painful. However, vaginal pain during sex can occur at any age. Women 17-50 may report pain for a variety of reasons – such as pelvic floor tension, infections, hormonal birth control, or lack of arousal – and dryness is often one contributing factor.

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

When estrogen levels drop, the vaginal tissue becomes thinner and produces less natural lubrication. This can change your normal vaginal discharge and make dryness, burning, or pain feel more intense.

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. 

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

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, anxiety 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’s 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, physical recovery, and body image concerns. At the same time, after childbirth, estrogen and progesterone levels drop significantly – especially in breastfeeding women – which reduces natural vaginal lubrication. These hormonal and physical changes can lead to vaginal dryness and painful intercourse (dyspareunia), making sex feel uncomfortable even when the desire is there

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. Consult with your healthcare provider to review your HRT options

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

When choosing a vaginal lubricant, it’s important to consider osmolality – the concentration of dissolved particles in the product. Lubricants that are highly concentrated (hyperosmolar) can pull water out of the vaginal cells, which may lead to irritation, burning, or tiny microtears in the tissue over time.

Ideally, look for lubricants that are iso-osmolar or low-osmolar, meaning they’re closer to the natural environment of the vagina and less likely to disrupt or damage the tissue. Some water-based products are quite hyperosmolar, while many silicone-based and certain specially formulated water-based lubes are gentler on the vaginal lining.

Checking labels, choosing products marketed as “iso-osmolar,” “vaginal-friendly,” or “gynecologist-recommended,” and avoiding very sugary or glycerin-heavy formulas can help reduce irritation and support long-term vaginal health.

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, and painful sex associated with menopause.

Like all estrogen-containing hormone replacement therapies, it’s only available with a healthcare provider’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. 

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 local 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. While it carries the risk of causing endometrial cancer, it’s 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, you don’t have to tough it out alone. With personalized hormone therapy, expert guidance, and support that fits your life, getting back to balance is more accessible than ever – thanks to the LifeMD Women’s Health Program.

Visit our site to learn more about how to take the first step toward feeling like you again.

Lauren Cramer, PA- C

Lauren is a passionate and dedicated board-certified physician assistant. She received her Bachelor’s degree in Kinesiology and Exercise Science from SUNY Cortland — graduating magna cum laude while competing as a three-sport collegiate athlete in indoor and outdoor track and cross country. She went on to complete her Master’s degree in Biological Sciences and earn her Physician Assistant degree from Daemen College in Buffalo, New York. Lauren has years of focused experience in perimenopause, menopause, and postmenopause care, specializing in hormone replacement therapy (HRT), bone health optimization, and a functional medicine approach to women’s wellness. She integrates evidence-based hormone therapy with lifestyle, nutrition, and metabolic strategies to support long-term vitality, cognitive health, and bone density. In addition to her women’s health expertise, Lauren has a well-rounded background in allergy, asthma, otology, laryngology, and rhinology. Functional medicine has always been a passion of hers, and she continues to pursue advanced certification to deepen her ability to deliver personalized, root-cause care to her patients.

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