7 Tips for Managing Vaginal Dryness

Vaginal Dryness
Painful sex due to vaginal dryness can be treated. Mache Seibel

"My vagina feels like the Sahara down there!" I've heard this and similar unhappy complaints many times over the years from women coping with vaginal dryness. Vaginal dryness is one of the most common problems experienced in and beyond the menopausal years; it can affect as many as 1 in 3 women.

The culprit is declining estrogen, which is responsible for vaginal tissue health, lubrication, elasticity, thickness and acidity.

For many women, the beginning of vaginal dryness isn't at the time of menopause - it starts several years afterward when low estrogen levels over time decrease lubrication, and cause the tissues to narrow and shorten.

Vaginal dryness can be more than just a nuisance; it can cause itching and burning and painful sex and that can significantly impact your joy and your relationship with your partner.  In addition to the natural loss of estrogen in menopause and beyond, certain cancer treatments like radiation/chemotherapy, removal of the ovaries, anti-estrogen treatments like GnRH agonists and antagonists or aromatase inhibitors, allergy and cold medications (because of they are antihistamines that dry tissues), Sjögren's syndrome, douching and lack of foreplay can all contribute. 

It is a real problem but fortunately, there are solutions. There are things you can do to try to relieve these symptoms, many of which do not require a prescription and include:

  • Change your hygiene regimen and products: Avoid the use of douches, harsh soaps, bubble baths, scented soaps and lotions, which can make dryness and irritation worse.
  • Keep your toilet paper plain and simple: Use only unscented, whit toilet paper.
  • Go dye and perfume free: Avoid scented laundry detergents, dyes, fabric softeners and anti-cling products when washing underwear to avoid irritation.
  • Take your time: Increase foreplay prior to intercourse to allow for adequate vaginal lubrication and arousal.
  • Vaginal Lubricants: Vaginal lubricants are a great way to decrease vaginal friction providing immediate relief of dryness and painful sex. Typically they last about 20 minutes. Water and silicone based products are recommended over oil because they can break down latex condoms that increases the risk of contracting a sexually transmitted infection.
    • Water-based lubricants include Astroglide, FemGlide, K-Y Jelly, etc
    • Silicone-based lubricants include ID Millennium, Pink, Pure Pleasure, etc
    • Oil-based lubricants to AVOID include products such as Mineral Oil, etc.
  • Vaginal Moisturizers: Vaginal moisturizers differ from lubricants in that they are provide a longer lasting vaginal moisture similar to natural vaginal lubrication. When used regularly for relief of daily symptoms of dryness and/or pain with sex, the effects of vaginal moisturizers can last 3-4 days in duration.
    • Vaginal moisturizers include Fresh Start, K-Y Silk-E, Moist Again, Replens, K-Y Liquibeads, etc. Of these, Replens is has done clinical trials that compare it favorably to vaginal estrogen for mild vaginal dryness.
  • Estrogen Replacement Therapy: The use of vaginal estrogen is not appropriate for all women and the risks and benefits of use need to be discussed with your healthcare provider. Although the vaginal estrogen products are required to carry a "black box" warning about increasing the risks of breast cancer and stroke, there are not data to support that black box. It is there simply because it is an estrogen. Vaginal estrogen is highly effective in improving vaginal blood flow, improving vaginal tissue thickness and elasticity, and providing long term reversal of symptoms.
    • Estrogen replacement treatments include the vaginal tablet Vagifem, creams such as Estrace, Neo-Estrone or Premarin and the low-dose vaginal ring Estring

Be sure to speak with your healthcare provider for evaluation of other possible causes of vaginal dryness and/or irritation. Not all women respond to treatment in the same way and some women may have limited treatment options due to their medical or family history.

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