Women with newborn babies. Women in perimenopause. Women in menopause. What do these women all have in common? They’re going through hormonal changes, and all are prone to vaginal dryness. According to the The Gallup Target Market Report on Vaginal Dryness (2004), there are about 13.9 million women who’ve experienced vaginal dryness.

Vaginal dryness can be a stressful condition that can cause painful intercourse (especially upon penetration), itching, malodor (bad smell), or discomfort with simple tasks like walking. The challenge with treating women with vaginal dryness, though, is that there are a variety of causes that must be properly identified to effectively treat it.

Some of the physiological causes of vaginal dryness include:

• Hormonal changes that can occur after childbirth or menopause
• Reactions to irritants like soaps or detergents
• Medications like cancer treatments, blood pressure pills, and antihistamines
• Birth control pills
• Radiation to the pelvis
• Some autoimmune conditions

Some of the emotional causes of vaginal dryness include:

• Anxiety
• Sexual pain disorders that prevent a proper sexual response
• Insufficient arousal because of low libido or issues with the partner
• Trauma
• Depression
• History of sexual abuse

Vaginal dryness is often caused by low estrogen. Low estrogen leads to a decrease in blood flow to the vaginal tissue which causes the vaginal lining to thin, lose elasticity, and become more fragile. With these changes, there is an increase in inflammation, vaginal bleeding, and chance of vaginal infection.

The most common ways to treat vaginal dryness are:

• Adequate foreplay. Foreplay increases vaginal secretions. If painful intercourse is the main symptoms of vaginal dryness, it is important to take your time during foreplay to increase arousal and arousal fluids.
• Personal lubricants. Lubricants work to reduce friction thereby decreasing pain for skin that is already thin and fragile. They may be water-based, oil-based (not recommended), or silicone-based. Lubricants are applied just before intercourse and work immediately, are not long-lasting, and are not absorbed into the body.
• Vaginal moisturizers. Moisturizers also work to reduce friction but work differently from the lubricants. They are longer acting, lasting 3 to 4 days, and they are absorbed into the skin increasing hydration in the vaginal tissue. This is a good option for women who have symptoms of vaginal dryness that are not limited to intercourse. For women using moisturizers who still have discomfort during penetration, using a lubricant while also using a moisturizer may be a helpful option to consider.
• Vaginal estrogen inserts. Estrogen therapies reverse vaginal thinning and dryness. Localized estrogen therapy inserted into the vaginal comes in the form of rings, pellets, and creams. This is a great option for women who have severe vaginal atrophy and moderate to severe vaginal dryness. Because of the minimal absorption of some vaginal estrogen therapies, this can be an option for breast cancer patients.
• Systemic estrogen therapy. This is a more potent form of estrogen therapy that also reverses vaginal thinning and dryness. Oral estrogen pills or an estrogen patch applied to the skin that releases estrogen into the entire body both improves blood flow to the vaginal lining and improves the thickness and elasticity of the tissue. This treatment option is best for women who are in need of the highest dose of estrogen therapy, and can be used in conjunction with a vaginal estrogen insert. This higher dose of estrogen is also what is used to treat menopausal women who are suffering from hot flashes and night sweats. Estrogen therapy may slightly increase the risk of breast and uterine cancer, so it must be used under a skilled physician’s care and balanced with progesterone if you still have a uterus. The risk and benefits of long-term systemic hormone replacement therapy should be discussed with your OBGYN before stopping or starting hormone therapy.
• ThermiVa. ThermiVa is a non-surgical in-office procedure that encourages your body to produce more collagen, a youthful protein, increasing the elasticity and moisture of the vagina. ThermiVa emits radiofrequency through a wand that is gently applied into the vagina and externally around the vulva to address vaginal dryness and loss of elasticity as well as urinary incontinence and loss of response to sexual stimuli. Please read more about ThermiVa on our blog.

At my clinic, the Southern Institute for Women’s Sexual Health, in Covington and New Orleans, LA, I have structured my schedule to allow for adequate time with each patient. In order to identify the correct causes of vaginal dryness in my patients, it’s imperative that I get an extensive medical history and perform a thorough exam including a vulvoscopy and other pertinent tests. If vaginal dryness is affecting intimacy with your partner or the comfort of daily living, or if you are seeing an increase in vaginal or vulvar infections, please call my office at 985-871-0707, email me at info@siwsh.com, or visit our Facebook page. Thank you for taking the time to read this article – I hope you’ve found it helpful!