Vaginal dryness is a common condition for a number of reasons, but it's rarely a hot topic at the dinner table. The condition is usually associated with the menopause, but around 17 % of women aged 18 to 50 will also experience vaginal dryness at some point.
Here, Dr Juliet McGrattan gives us the lowdown on the causes, symptoms and treatments for vaginal dryness with tips from Dr Karen Morton a gynaecologist and obstetrician, and Krystal Woodbridge, a psychosexual therapist at the College of Sexual Relationship Therapists (COSRT):
What is vaginal dryness?
Vaginas are naturally moist. They produce their own lubrication to keep them healthy and comfortable. Day-to-day lubrication is produced by glands on the surface of the cervix and the vaginal wall. This slightly acidic moisture helps to keep the vaginal area clean, preventing infections such as thrush, while removing dead cells.
A second type of lubrication occurs when you become sexually aroused. According to Morton, the Bartholin glands at the entrance of the vagina release a slippery mucus and the vaginal walls become even wetter, providing the extra moisture needed to make sexual intercourse pleasurable.
When natural lubrication reduces, the tissues of the vaginal wall dry out, become less elastic and prone to irritation and discomfort.
Vaginal dryness symptoms
Having a dry vagina may only give you symptoms from time to time but it can progress and cause upsetting symptoms every day. Here’s what you may experience:
Pain or discomfort during sex – touching and penetration
Difficulty inserting or removing a tampon
Pain during repetitive exercise such as running
Recurrent urine infections
Recurrent vaginal infections such as bacterial vaginosis
Vaginal dryness causes
A dry vagina becomes more common as you age but young people can experience it too. Hormonal changes in the body are the commonest trigger but there are other causes too:
Vaginas change a lot during the peri and post menopause due to falling levels of the hormone oestrogen. The vaginal walls become thinner, less elastic and less sensitive. There are fewer mucous producing cells and therefore less moisture. '
After the menopause, the pinkness, juiciness and waviness of the vaginal tissue diminishes, and it can start to look more like the skin on the back of your hand,' says Morton. 'If there's no lubrication, your vagina will feel dry and stiff, and sex can feel a bit like rubbing with sandpaper.'
2. Pregnancy and breastfeeding
The hormonal changes during childbirth and breastfeeding can trigger vaginal dryness in some women. 'If there's a lack of moisture, the ecosystem may become disturbed and women may become more prone to an overgrowth of unhealthy germs,' says Morton. 'For example, bacterial vaginosis (BV), thrush and urinary tract infections (UTIs) can be more common.'
3. Stress and depression
Psychological stress can lower oestrogen levels resulting in a dry vagina. It’s not unusual for stress and depression to lower libido or make it harder to become aroused too. Having a low sex drive and a dry vagina is difficult and can potentially lead to relationship problems.
Women who smoke have lower oestrogen levels than those who do not smoke. This can result in vaginal dryness and there’s evidence that smoking can upset the ecosystem of the vagina too potentially making infections more likely.
5. Medical conditions
A dry vagina could be a symptom of a medical condition. Sjögren’s syndrome is an autoimmune condition where dryness of the eyes, skin, mouth and vagina are common. Diabetes is another condition which can affect vaginal moisture and can present with recurrent vaginal infections and the need to pee frequently.
Side effects of certain medications can include vaginal dryness. Common examples are the hormonal contraceptive pill, antidepressants, antihistamines and chemotherapy used to treat cancer.
7. Perfumed products
You can strip away your vagina’s natural moisture by over washing and using perfumed products such as washes, douches and feminine deodorants. This upsets the pH balance of the vagina and also puts you at higher risk of developing vaginal infections such as thrush and bacterial vaginosis.
Vaginal dryness treatments
For immediate relief of vaginal dryness, you can use an artificial lubricant or vaginal moisturiser. Always use one that is specifically designed for use in the vagina. Look for perfume-free, water-based lubricants for everyday use. Remember that lubes containing petroleum jelly or mineral oil can damage condoms.
If the dryness is linked to falling oestrogen levels during the peri and post menopause then hormone replacement therapy (HRT) is a great solution for women that can use it. Either as full HRT or as an oestrogen cream or pessary that you just apply to the vaginal area. 'If you're taking HRT, you shouldn't really need anything else,' says Morton.
'But if for one reason or the other you still experience dryness, you can give your vagina some nourishment using some oestrogen cream or a pessary, twice a week. This should be plenty to keep the tissue well-nourished, healthy and resistant to germs.'
Vaginal dryness prevention tips
A dry vagina due to hormonal changes and falling oestrogen levels is hard to prevent but there are some causes of dryness that you can avoid:
Don’t over clean or douche your vagina. A quick wash twice a day is plenty.
Avoid perfumed products. Stick to plain water or a very mild, unperfumed soap in your nether regions and use plain toilet paper rather than fragranced wipes.
Use a mild washing powder and softener when washing your underwear.
Use stress management techniques and ask for help if your mood is low.
Discuss with your doctor if changing a medication might help.
Seek advice early in the perimenopause. A short course of oestrogen cream and a low maintenance dose can keep your vagina plump and moist.
Have lots of foreplay before intercourse.
Look for patterns of vaginal dryness linked to your menstrual cycle. With hormonal fluctuations there may be certain times of the month where using a few days of lube will prevent dryness.
Vaginal dryness and sex
When it comes to being intimate, vaginal dryness can seriously impact your sex life. Penetration or even touching can feel uncomfortable and painful due to the dryness and thinning of the vaginal tissue. 'When sex starts to hurt, why would you want to do it? This of course has a massive impact on your sex life, your relationship and happiness in general' says Morton.
According to Woodbridge, if there are sexual intimacy problems, there may be linked to other problems. 'Quite often if the sex isn't there, people become disconnected. You shouldn't have to grin and bear it if sex is painful just to keep your partner happy, so it's really important to talk about it,' she says.
'You might want to try a vaginal moisturiser or lubricant to make sure you're fully lubricated before sex,' says Woodbridge. 'There's a massive choice out there now. I'd recommend using a silicone based lubricant as the water based one dries very quickly. If you suffer with thrush, I wouldn't use ones with glycerine in it, as this can upset the vaginal environment and cause irritation.'
To get the best out of your sex life, it's important to find the most comfortable sexual position. Make sure you're really relaxed, aroused and using lots of lubricant beforehand.
'Put a couple of pillows under the small of your back or under your bottom in missionary position, as this raises your pelvis up and makes entry easier,' says Woodbridge. 'Or doggy style can help because it changes the location of the pressure inside. If you're on top, it can help as you can control the pressure and the rhythm and look after you own comfort. So, it's about experimenting with what works and what doesn't.'
When to see your doctor about vaginal dryness
Don’t be embarrassed about seeing your doctor. A dry vagina can be very uncomfortable and upsetting. If you experience any of the following, make an appointment as soon as you can:
Unexpected vaginal bleeding, especially if you are post-menopausal
An unusual smell or discharge from your vagina
Recurrent vaginal itching
Frequent urination, especially if it is accompanied by tiredness and weight loss
Recurrent urine infections
Low mood or unmanageable levels of stress
Any vaginal lumps, bumps or skin changes
You are using HRT but still have vaginal dryness
Your vaginal dryness is affecting your daily life
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