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What causes vaginal dryness?

If you experience discomfort during sex, recurrent urinary tract infections (UTIs) or irritation in your vagina, it may be due to vaginal dryness. Vaginal dryness—medically known as vaginal atrophy—is a very common condition, says Yan Yu Chen, D.O., a Piedmont obstetrician and gynecologist.

“Vaginal dryness can really affect your quality of life,” says Dr. Chen. “Some people believe it’s a natural part of the aging process and nothing can be done, but that’s not exactly true. There are many treatments we can use to help improve vaginal dryness.”

Here are the signs to watch for and what you can do to alleviate symptoms.

Symptoms of vaginal dryness

Symptoms of vaginal dryness include:

  • Recurrent vaginal infections

  • Irritated vaginal area

  • Burning sensation in the vagina

  • Painful intercourse

  • Bleeding after sex

  • Recurrent urinary tract infections

Your gynecologist may be able to tell if you have vaginal dryness during your yearly pelvic exam.

“The vaginal tissue will look different and the mucosa [inner lining of the vagina] will be pale, thin and dry,” says Dr. Chen.

What causes vaginal dryness?

“Vaginal atrophy is most often caused by a decrease in estrogen,” says Dr. Chen. “As women get older, their ovaries produce less estrogen. Most women who experience vaginal dryness—about 60%—are postmenopausal, though dryness can occur before menopause.”

Other causes of vaginal dryness include:

  • Taking certain anti-estrogen medications, such as medicines for fibroids, painful periods or endometriosis

  • Breastfeeding

  • Hormonal treatments that cause a decrease in estrogen

  • Prior history of cancer, particularly radiation therapy or the surgical removal of the ovaries

  • Douching

  • Exposure to fragranced soaps and irritating, nonbreathable fabrics 

Oral birth control pills aren’t typically a culprit: “Most combination birth control pills contain estrogen and progesterone, so that doesn’t usually cause vaginal dryness,” she says. “However, the progestin-only methods can contribute to it.”

Vaginal dryness treatment options

“I spend a lot of time learning about each patient’s medical history, then I perform a physical,” says Dr. Chen. “This helps guide the treatment plan.”

She recommends starting with non-hormonal therapy to increase vaginal lubrication and promote a more acidic environment to protect normal flora in the vagina. She suggests using a vaginal moisturizer three to four times a week and a personal lubricant when you’re sexually active.

“Vaginal moisturizers are basically rehydrating lotions for the vagina and lasts longer than a lubricant,” she says. “They come in creams, gels and suppositories.”

If this doesn’t help or symptoms persist, your gynecologist may recommend prescription hormonal treatments that replace estrogen. Estrogen is also available in many forms:

  • Oral pill

  • Suppository

  • Ring

  • Gel

  • Patch

Most vaginal preparations of estrogen therapy contain a much smaller dose of the hormone than systemic estrogen taken by mouth.

“We start with the lowest dose possible for the shortest duration possible,” she says. “Most women see a big difference in two to four weeks. We see patients for follow-ups every 12 weeks or longer, depending on the clinical course.”

However, some women aren’t good candidates for estrogen therapy, such as those who have had prior or current breast or endometrial cancer.

“If this is the case, we may still be able to use estrogen therapy, but we’ll follow the patient more closely and use the smallest amount possible to alleviate symptoms if other methods fail,” says Dr. Chen. “We don’t want to use high doses of estrogen therapy if a woman had an estrogen-sensitive cancer.”

Another potential risk of estrogen therapy is venous thrombosis (blood clots). Aging, obesity and smoking can increase the risk of blood clots, so ask your doctor if this therapy is right for you.

Can vaginal dryness be prevented?

“Safe, regular sexual activity can help maintain vaginal health because it helps preserve the natural mucosal integrity of the vagina,” says Dr. Chen. “If you’re not sexually active, the tissue can atrophy.”

Some women have such severe vaginal atrophy that the vagina loses elasticity and they may need to use a dilator before they can attempt intercourse, she says. If it becomes that severe, a referral to a pelvic floor therapist can also be helpful. Check with your gynecologist to see if these options are available to you. 

How to talk to your gynecologist about vaginal dryness

While it may feel embarrassing to talk to your doctor about vaginal dryness, Dr. Chen assures that gynecologists have heard it all before and want to help.

“This issue is very, very common—we have these conversations all the time,” she says. “It’s our job to help you. We can’t treat vaginal dryness and any other conditions if we don’t know it is bothering you. Start the conversation about your symptoms and your gynecologist will review treatment options by the end of the visit.”

She adds that every woman should see a gynecologist once a year for a well-woman exam.

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