“Vaginal dryness may be a problem for women at any age, although it occurs more frequently in older women, particularly after menopause”.1

Umbrella
What may the Vaginal Dryness Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Atrophic Vaginitis
  • Genital Atrophy
  • Genitourinary Syndrome of Menopause
  • Urogenital Problems
  • Vaginal Atrophy
  • Vaginal Dryness
  • Vaginal Symptoms
  • Vulvovaginal Atrophy

Vaginal Dryness

What is vaginal dryness?

DotS the definition of vaginal dryness may vary. In Vaginal Dryness: Overview – What Is Vaginal Dryness? the (United States) Cleveland Clinic’s definition is:

“Vaginal dryness is a painful symptom that affects a person’s quality of life. It can cause pain during sitting, exercising, peeing and sexual intercourse. Normally, your vaginal lining is lubricated with fluid that helps keep it thick and elastic. Vaginal dryness happens when the tissues in your vagina are dry, thin and not well-moisturized. This leads to discomfort, especially during sex”.2

Vaginal Dryness and Menopause

What is the association between vaginal dryness and menopause?

In Vaginal Dryness After Menopause: How To Treat It? published 07 December 2022, the author explains:

“Vaginal dryness is a hallmark sign of the genitourinary syndrome of menopause, also known as atrophic vaginitis or vaginal atrophy. With this condition, vaginal tissues become thinner and more easily irritated — resulting from the natural decline in your body’s estrogen levels during menopause”.3

Genitourinary Syndrome of Menopause

What is the genitourinary syndrome of menopause (GSM)?

DotS the definition of GSM may vary. On page one in Vaginal Dryness, published December 2022, the North American Menopause Society’s (NAMS) definition is:

“The genitourinary syndrome of menopause (GSM) includes bothersome vaginal, vulvar (lips of the vagina), and urinary symptoms that can affect quality of life, sexual satisfaction, and even your relationship with your partner”.4

On page one in Vaginal Dryness the NAMS explain:

Menopause and aging can affect the genitourinary system in these ways:

  • “Loss of estrogen at menopause may cause the vaginal tissues to become thin and dry, with decreased elasticity and lubrication, often resulting in pain with sexual activity, routine pelvic examinations, and even discomfort wiping after urination or wearing certain clothing
  • Symptoms such as burning, itching, or irritation of the vulva; lack of lubrication and vaginal dryness; and discomfort or pain with sexual activity are common
  • Burning on urination, increased frequency or urgency of urination, and increased risk for urinary tract infections also can occur
  • Burning on urination, increased frequency or urgency of urination, and increased risk for urinary tract infections also can occur
  • Symptoms may be more severe in women who undergo menopause as a result of the surgical removal of both ovaries (surgical menopause) or because of chemotherapy for cancer treatment and in those who receive aromatase inhibitors for prevention or treatment of breast cancers”.5

Cause

What may cause vaginal dryness?

In Looking After Yourself: Sex and Relationships – What Can Affect Your Sex Life? Dry Vagina and Pain During Sex the (Australian) Jean Hailes for Women’s Health (JH) note:

“The loss of oestrogen at menopause causes changes in the tissues of your vagina and vulva. This means your vagina becomes drier and less elastic, which can lead to vaginal irritation, vaginal atrophy and pain during sex”.6

Other Causes

Apart from decreased estrogen, what may be other causes of vaginal dryness?

The NAMS explain:

“It is important to stop using soap and powder on the vulva, stop using fabric softeners and anti-cling products on your underwear, and avoid wearing panty liners and pads”.7

Menopause

Is there an association between menopause and vaginal dryness?

According to the (United States) Mayo Clinic:

“Vaginal dryness may be a problem for women at any age, although it occurs more frequently in older women, particularly after menopause”.8

Common or Not

How common is vulvovaginal atrophy (VVA)?

On page one in Could Altering Vaginal Microbiome Treat Vaginal Dryness and Painful Sex During Menopause? dated 25 January 2023, according to the NAMS:

“It is estimated that VVA occurs in approximately 50% of menopausal women”.9

Go Away or Not

Does vaginal dryness improve with time?

The NAMS note:

“Unlike hot flashes, which typically improve with time, GSM usually worsens over time without treatment”.10

Treatment

What are some treatments for vaginal dryness?

In Vaginal Dryness: Treatment the MedlinePlus elaborate on:

“There are many treatments for vaginal dryness. Before treating your symptoms on your own, a health care provider must find out the cause of the problem”.11

In Questions To Ask Your GP About Menopause: How Can I Manage Vaginal Dryness? Dr Elizabeth Farrell, gynaecologist and Medical Director of the JH explains:

“Many women are too embarrassed to ask this question, but if you’re suffering, try to seek help because there are treatments. Lubricants, vaginal moisturiser and vaginal oestrogens can help, as can regular intercourse”.12

In Vaginal Dryness: Treatment Options the NAMS elaborate on:

  • “Nonhormone Remedies
    • Vaginal Lubricants…
    • Vaginal Moisturizers…
    • Regular Sexual Stimulation…
    • Expanding Your Views of Sexual Pleasure…
    • Vaginal Dilators…
    • Pelvic Floor Exercises…
  • Vaginal Hormone Therapy…
    • Low-dose local estrogen…
    • FDA-approved low-dose vaginal estrogen products…
    • Dehydroepiandrosterone (DHEA; Prasterone)
    • Low-dose vaginal estrogen or DHEA and a history breast or uterine cancer…
  • Systemic Estrogen Therapy
  • Other Therapies…
    • Ospemifene
    • Vaginal Laser Therapy…”.13

Vaginal Lubricants and Vaginal Moisturizers

What are some examples of vaginal lubricants and vaginal moisturizers?

 In Vaginal Dryness: Care and Treatment – How Is Vaginal Dryness Treated? Lubricants and Moisturizers for Vaginal dryness the Cleveland Clinic explain:

“Lubricants and moisturizers are available without a prescription and can be purchased at drug or grocery stores. They work by replenishing your vaginal tissue and making it wet, which can help with pain during sex. You shouldn’t use moisturizers (such as for your face or body) that aren’t meant for your vagina.

  • Vaginal moisturizers: Apply vaginal moisturizers to the inside of your vagina every few days to keep your vaginal lining healthy. Some examples include Replens™, Luvena® and KY® Liquibeads.
  • Vaginal lubricants: Apply lubricants just before sexual intercourse to ease discomfort caused by sex. Astroglide® and KY® Jelly are examples of water-based vaginal lubricants. There are also silicone-based and oil-based lubricants”.14

Vaginal Estrogen

Can estrogen be placed directly into the vagina?

On page one in Deciding About Hormone Therapy Use, published July 2022, the NAMS elaborate on:

Vaginal Dryness“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina. (The MenoNoteVaginal Dryness” covers this topic in detail)”.15

In The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Effectiveness: Local Treatment of Urogenital Atrophy published online 30 October 2023, the authors note:

“Urogenital symptoms due to estrogen insufficiency are under-recognized and under-treated. These symptoms can be effectively treated with an array of local therapies including intravaginal estrogen preparations or DHEA (prasterone) and intravaginal moisturizers. Concurrent progestogen therapy is not required. Many women require local therapy, in addition to systemic MHT, to relieve urogenital symptoms. It is important patients understand that treatment needs to be ongoing and is not simply a short course of therapy”.16

Compounded Vaginal Estrogen and Testosterone

Are compounded vaginal estrogen and testosterone recommended for treatment of GSM?

On page two in Vaginal Dryness the NAMS’s notes include:

Notes:
Compounded vaginal estrogen and testosterone are not FDA regulated or recommended for treatment of GSM in most cases”.17

Ospemifene for Urogenital Atrophy

Can Ospemifene be used for vulvo-vaginal atrophy symptoms in postmenopausal women?

In The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Effectiveness: MHT Formulations and Options published online 30 October 2023, the authors explain:

“Ospemifene is an oral selective estrogen receptor modulator indicated for vulvo-vaginal atrophy symptoms in postmenopausal women (60 mg/day). Ospemifene has an estrogen-like effect in the vagina (increases superficial cells and decreases parabasal cells, and lowers vaginal pH) and alleviates dyspareunia. The most common adverse effect is VMS, which occur in 10% of treated women”.18

Regular Sexual Activity

Can regular sexual activity help?

In Menopause Signs and Symptoms: Vaginal Dryness and Painful Sexual Intercourse the (United States) Endocrine Society note:

“A drop in estrogen levels from menopause can cause the vagina to become dryer and more fragile. The vaginal dryness usually becomes worse with a lack of sexual activity. Sex stimulates blood flow in the vagina and aids in the production of vaginal fluids. So, sex actually keeps the vagina lubricated and healthy”.19

In Consumer Health: Treating Vaginal Dryness After Menopause the Mayo Clinic also note:

“Regular sexual activity or vaginal stimulation — with or without a partner — also helps maintain healthy vaginal tissues in women after menopause”.20

Health Care Provider

What if I think I have vaginal dryness?

If you think you have vaginal dryness, it may be in your best interest to choose to talk to your health care provider about this. The Mayo Clinic explain:

“Vaginal dryness affects many women, although they frequently don’t bring up the topic with their doctors.

If vaginal dryness affects your lifestyle, in particular your sex life and relationship with your partner, consider making an appointment with your doctor. Living with uncomfortable vaginal dryness doesn’t have to be part of getting older”.21

The NAMS note:

“Persistent vaginal dryness and painful intercourse should be evaluated by your healthcare provider. If it is determined to be a symptom of menopause, vaginal dryness can be treated with low-dose vaginal estrogen, or the oral selective estrogen-receptor modulator (SERM) ospemifene can be used”.22

The MedlinePlus explain:

“Contact your provider if you have vaginal dryness or soreness, burning, itching, or painful sexual intercourse that does not go away when you use a water-soluble lubricant”.23

On page two in Vaginal Dryness the NAMS note:

“Notes: Vaginal and vulvar symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your healthcare professional if symptoms do not improve with treatment”.24

Health Topics A-Z

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Sources

  1. Vaginal Dryness: Basics – Definition. 01 February 2023. Mayo Clinic https://www.mayoclinic.org/symptoms/vaginal-dryness/basics/definition/sym-20151520 Accessed: 26 March 2024
  2. Vaginal Dryness: Overview – What Is Vaginal Dryness? Last Reviewed: 26 July 2022. Cleveland Clinic https://my.clevelandclinic.org/health/symptoms/21027-vaginal-dryness Accessed: 26 March 2024
  3. Laughlin-Tommaso, S. K. Vaginal Dryness After Menopause: How To Treat It? 07 December 2022. https://www.mayoclinic.org/vaginal-dryness-after-menopause/expert-answers/faq-20115086 Accessed: 26 March 2024
  4. Vaginal Dryness: Treatment Options. 2022: 1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 26 March 2024
  5. Vaginal Dryness: Treatment Options. 2022: 1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 26 March 2024
  6. Looking After Yourself: Sex and Relationships – What Can Affect Your Sex Life? Dry Vagina and Pain During Sex. Last Updated: 19 January 2024 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-a-z/menopause/looking-after-yourself#sex-and-relationships Accessed: 26 March 2024
  7. Menopause FAQs: Menopause Symptoms – Q. How can I counteract vaginal dryness during menopause? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-menopause-symptoms Accessed: 26 March 2024
  8. Vaginal Dryness: Basics – Definition. 01 February 2023. Mayo Clinic https://www.mayoclinic.org/symptoms/vaginal-dryness/basics/definition/sym-20151520 Accessed: 26 March 2024
  9. Could Altering Vaginal Microbiome Treat Vaginal Dryness and Painful Sex During Menopause? 25 January 2023:1. North American Menopause Society https://www.menopause.org/docs/default-source/press-release/ospemifene-impact-on-vaginal-mirobiome.pdf Accessed: 26 March 2024
  10. Vaginal Dryness. 2022: 1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 26 March 2024
  11. Vaginal Dryness: Treatment. Review Date: 12 July 2023. MedlinePlus https://www.nlm.nih.gov/medlineplus/ency/article/000892.htm Accessed: 26 March 2024
  12. Questions To Ask Your GP About Menopause:  How Can I Manage Vaginal Dryness? Last Updated: 17 January 2024 | Last Reviewed: 22 August 2022. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/news/questions-to-ask-your-gp-about-menopause Accessed: 26 March 2024
  13. Vaginal Dryness: Treatment Options. 2022: 1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 26 March 2024
  14. Vaginal Dryness: Care and Treatment – How Is Vaginal Dryness Treated? Lubricants and Moisturizers for Vaginal Dryness. Last Reviewed: 26 July 2022. Cleveland Clinic https://my.clevelandclinic.org/health/symptoms/21027-vaginal-dryness Accessed: 26 March 2024
  15. Deciding About Hormone Therapy Use. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 26 March 2024
  16. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Effectiveness: Local Treatment of Urogenital Atrophy. First Published Online 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 26 March 2024
  17. Vaginal Dryness: Notes. 2022: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 26 March 2024
  18. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: Management – MHT Formulations and Options. First Published Online 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 26 March 2024
  19. Menopause Signs and Symptoms: Vaginal Dryness and Painful Sexual Intercourse. Endocrine Society. https://www.endocrine.org/menopausemap/signs-and-symptoms/index.html Accessed: 26 March 2024
  20. Consumer Health: Treating Vaginal Dryness After Menopause. 04 May 2021. Mayo Clinic https://newsnetwork.mayoclinic.org/discussion/consumer-health-treating-vaginal-dryness-after-menopause/ Accessed: 26 March 2024
  21. Vaginal Dryness: Basics – When To See A Doctor. 01 February 2023. Mayo Clinic https://www.mayoclinic.org/symptoms/vaginal-dryness/basics/when-to-see-doctor/sym-20151520 Accessed: 26 March 2024
  22. Menopause FAQs: Menopause Symptoms – Q. How Can I Counteract Vaginal Dryness During Menopause? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-menopause-symptoms Accessed: 26 March 2024
  23. Vaginal Dryness: When To Contact A Medical Professional. Review Date: 12 July 2023. MedlinePlus https://www.nlm.nih.gov/medlineplus/ency/article/000892.htm Accessed: 26 March 2024
  24. Vaginal Dryness: Notes. 2022: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 26 March 2024
Topic Last Updated: 26 March 2024 – Topic Last Reviewed: 26 March 2024

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