Vaginal Dryness: What to Do About It?

Vaginal dryness can be an unpleasant and stress-inducing symptom. Most often it is noticed during menopause, however, it can happen anytime. It is usually accompanied by other symptoms and is a sign of changes in hormone levels. Read on to find out what causes vaginal dryness and the remedies available to treat it.

The cause of vaginal dryness

The main reason for vaginal dryness is the decrease in the levels of a female hormone, called estrogen. It is a hormone that is mainly produced in the ovaries and is in charge of keeping the vagina lubricated and maintaining the thickness and elasticity of the vaginal lining. When the estrogen levels drop, all these functions are disrupted and result in the drying and thinning of the vaginal walls, causing unpleasant symptoms.

Vaginal symptoms of low estrogen

The decrease in estrogen levels can cause vaginal dryness, accompanied by other symptoms such as:

• Vaginal itchiness
• Frequent, painful urination
• Recurrent urinary tract infections
• Painful sexual intercourse
• Light spotting

How is it diagnosed?

To diagnose the cause of vaginal dryness, a medical provider will ask some questions about a patient’s medical history including symptoms, possible irritants, medications, and past illnesses. Tests can be performed to differentiate the diagnosis such as urinalysis, a pelvic exam, an ultrasound of the uterus, or a vaginal pH level test.

Conditions associated with vaginal dryness

Vaginal dryness can be permanent or temporary, depending on the condition that causes lower estrogen levels. Here are some examples:

• Genitourinary syndrome. During menopause, estrogen levels drop, resulting in symptoms such as vaginal dryness, itching, painful sexual intercourse, and urination.
• Surgical removal of the ovaries. Ovaries are the main source of estrogen production. When the ovaries are removed, estrogen levels drop significantly.
• After chemotherapy or radiation therapy to the pelvic area. This causes damage to the tissue of the ovaries, resulting in reduced levels of estrogen.
• Postpartum and breastfeeding. After the delivery of the baby and during breastfeeding estrogen levels decrease. Vaginal dryness disappears when breastfeeding ends or becomes less frequent.
• Drugs. Using medication, such as danazol, medroxyprogesterone, leuprolide, nafarelin, and cold or allergy drugs, can disrupt estrogen levels — causing vaginal dryness. Usually, the symptoms stop after stopping the medication.
• Sjögren’s syndrome. This is an autoimmune condition that targets the glands that secrete fluid. This can cause a dry mouth and eyes in addition to vaginal dryness.

Treatment

There are a lot of options to treat vaginal dryness, including over-the-counter drugs, hormonal medication, and other non-hormonal procedures.

Over-the-counter treatment

In case of vaginal dryness, women should start using over-the-counter options to alleviate the symptoms. It is easily accessible without a prescription, hormone-free, and safe to use. Here are some examples:

• Vaginal moisturizer. Often contains hyaluronic acid and is formulated to maintain moisture in the vaginal tissues. There are two types of moisturizers. One type you can insert into the vaginal canal and one that is used for the vulva. Usually, it is used around 3 times a week to maintain the results.
• Lubricant. Used by sexually active women to reduce friction and eliminate discomfort during intercourse. Lubricants can be water-based or oil-based. Water-based are safer to use with latex condoms since oil breaks down latex. Do not ever attempt to use other oils, honey or other food for lubrication in the vaginal canal without checking with a healthcare provider.

Prescribed treatment

These treatment options are prescribed by a doctor and suggested when over-the-counter options are ineffective. Prescribed treatment often contains hormones and is suggested for vaginal dryness and other genitourinary syndrome symptoms. The use of hormonal therapy is monitored by medical professionals thoroughly, and the results are not permanent — they last as long as you are using the treatment.

• Vaginal estrogen. Contains low doses of estrogen and is one of the most effective treatments for vaginal dryness. Vaginal estrogen restores the lining of the vaginal walls and increases elasticity and connective tissue when used regularly. It is sold in the form of a cream, capsules, or an estrogen ring. The main difference between these are that the estrogen creams and capsules are inserted into the vagina regularly and the estrogen ring is inserted into the vagina and can be replaced every 3 months.
• Dehydroepiandrosterone (DHEA). A hormone that turns into estrogen and testosterone. It comes in the form of a suppository that you insert into your vagina once a day. It is not a popular option, because more research has been done on vaginal estrogen than on DHEA. Nevertheless, it is a more suitable option for people who cannot take estrogen.
• Ospemifene. A selective estrogen receptor modulator (SERM) is used for the treatment of genitourinary syndrome. It acts similarly to estrogen in the vaginal tissues and must be taken daily. It is in the form of a pill and is usually preferred by those who dislike using vaginal medication. It is not recommended for patients who have had breast cancer or are at a high risk of developing it.

Other treatment options

The best results can be achieved with a combination of hormonal and non-hormonal treatments. Here are examples of some non-hormonal procedures:

• Laser therapy. Although the research is limited and short-term, the results show that using a vaginal carbon dioxide laser helps to improve cell renewal, circulation, and vascularization of the vaginal tissue. It is thought to be an effective and safe treatment option for women who suffer from genitourinary syndrome after menopause.
• PRP. Platelet-rich plasma injections are considered to be a beneficial treatment option for vaginal dryness by promoting tissue regeneration. Nevertheless, further research is needed to prove the claims.

Natural remedies for vaginal dryness

Herbal treatments have been used to improve vaginal lubrication. However, the following list is not medically approved as an effective treatment for vaginal epithelium regeneration and vaginal dryness.

Vitamin E and D are believed to be beneficial for vaginal dryness treatment due to increasing differentiation in the vaginal epithelium and keratinocyte proliferation. It's important to maintain a healthy, varied diet rich in vitamins, minerals, and healthy fats for your body to be able to produce hormones optimally.

Vaginal dryness is caused by the decrease in levels of estrogen, which is common after menopause. Nevertheless, it can be a problem earlier in life. The symptoms can be alleviated by using over-the-counter lubricants and vaginal moisturizers, although the most effective option is hormonal treatment, which can be prescribed by your doctor. If you are affected by vaginal dryness, contact your healthcare provider to find optimal treatment combinations that work for you.