The vagina is a wonderfully complex place. It’s at once a self-cleaning oven, a literal vessel of life, and a pleasure center. But when hormonal changes throw off the vagina’s delicate ecosystem, your vagina can really become a source of discomfort and frustration.
Vaginal dryness, a.k.a atrophic vaginitis, affects an estimated 40 percent of women aged 40 to 55, though it can strike at any age. And while it may be tempting to brush it off as no big deal or a perimenopausal symptom every woman deals with, it’s something to take seriously—and not just because it can make sex painful.
“If left untreated vaginal dryness can cause vaginal tissue to crack and sores can develop,” explains Monte Swarup, MD, FACOG, and founder of HPD Rx. It is also linked with an increase in risk of urinary tract infections.
Many women skip talking about vaginal dryness with their doctors out of embarrassment. But that’s a shame, because effective treatments are out there. Here’s a guide to vaginal dryness and what you can do about it.
Why does vaginal dryness happen?
Vaginal dryness occurs when estrogen production drops. In addition to helping regulate your menstrual cycle, estrogen keeps vaginal tissue moist, thick, and elastic.
Vaginal dryness is most often related to perimenopause and menopause, when your body experiences a natural decrease in estrogen production. But a drop in estrogen (and ensuing vaginal dryness) can also happen during pregnancy and breastfeeding. Certain medications, like certain forms of birth control, endometriosis drugs, or estrogen-blocking drugs used after breast cancer, can also mess with your estrogen levels and bring on vaginal dryness. For some women, mild vaginal dryness can occur alongside the normal ups and downs of their menstrual cycle, most usually on the days just before and after the start of a period when estrogen levels are lowest.
“Cold and allergy medications and some antidepressants can dry out vaginal tissue as well,” adds Dr. Swarup, even though these drugs don’t affect your estrogen levels.
How is vaginal dryness treated?
For some women, vaginal dryness doesn’t cause any bothersome symptoms at all, says Dr. Swarup. If it’s only happening intermittently with your period or if it’s happening because of breastfeeding, you may choose to wait it out. But if it is causing problems, there’s no reason to put up with it when effective treatments are out there.
“The most common treatment is low-dose vaginal estrogen cream, tablet or ring, to reinvigorate vaginal tissues,” Dr. Swarup says. These work by providing the cells of the vagina with the estrogen necessary to rejuvenate the cells of the vagina, restoring elasticity. Some estrogen is absorbed into the bloodstream from these products, though the low dose makes risk of side effects minimal.
Over-the-counter lubricants can be helpful if dryness only bothers you during sex or if it’s mild. Water-based lubricants designed specifically for intercourse are your best bet, especially if you use condoms. (Oil-based lubes can damage latex condoms.)
Moisturizers, which can also be bought in the pharmacy without a prescription, are designed to help your vagina retain moisture. These are not the same as lubricants, which are usually labeled “external use only.” Vaginal moisturizers contain hyaluronic acid and aim to increase the water content of the vaginal tissues. They are suppositories that are meant to be inserted into the vagina a few times a week. Some research suggests these products can be as effective as some hormonal treatments, which is great news for women who can’t use estrogen.
More recently, “vaginal rejuvenation” treatments, which use lasers, electromagnetic pulses, or radio waves to stimulate vaginal tissue, have been used to help with vaginal dryness. Generally speaking, the science backing up the use of these technologies is still so early that many experts don’t recommend it just yet. (In fact, the U.S. FDA issued a 2018 warning about the lack of science to back them up for this issue, especially for breast cancer survivors whose vaginal dryness can be severe.) However, there are some signs of the science catching up: One 2020 trial found that laser therapy could be as effective as hormonal treatments. The other downside of these treatments: they’re considered cosmetic and so insurance doesn’t cover them.
Amelia Harnish is a journalist with a focus on women, health, and culture. She’s written for Women’s Health, Cosmopolitan, New York Times, the Wall Street Journal, and more.