5 Causes of Vaginal Dryness
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Low Estrogen
Dehydration
The cells in the vagina need to have enough water in them to function properly. “If you’ve been exercising like crazy and haven’t been drinking enough water, you’ll be dryer,” Dr. Reed says. Some soaps, dyes, perfumes, lubricants, and scented products have ingredients in them that draw moisture out of your cells. And some medications like antihistamines can also be dehydrating.
Inflammation
The chemicals in soaps, hygiene products, dyes, and perfumes can also irritate your vaginal cells and cause inflammation. “Hygiene products can have ingredients that are irritating or are harmful to genital tissues,” says Reed. “They are not recommended.”
Infections can have a similar effect. “Yeast or candida often presents as a burning or feels like sandpaper,” says Reed. “This sensation can feel like vaginal dryness due to menopause.”
Inflammation blocks two critical types of glands that are just at the outside of the vagina, she notes. “The glands produce fluid when you’re aroused. If these tissues are inflamed, they don’t function well, and you won’t get good lubrication.”
Aging
The process of getting older is complicated, and can affect the whole body as well as specific tissues and organs. One area of concern is what happens to the vagina during menopause, which can significantly impact a woman’s sexual health. “Aging vaginal tissues are by their very nature dryer than the premenopausal state,” says Reed. She says younger people have better blood flow, which is needed to create the moisture that comes through vaginal tissues.
Aging is even separate from the estrogen, explains Reed. “Those [two things] are happening in parallel. Aging will cause changes in the sexual response that is not necessarily hormone-dependent,” she says. “The vascular supply and the enervation to the genitals ages and this is independent of reproductive hormones — these changes are due to aging. So, you can still have problems even when you [take] some estrogen, although estrogen can help increase blood flow.”
The Vaginal Microbiome
But so far, Reed says, MsFLASH has yet to establish a clear relationship between what’s in someone’s vaginal microbiome and their vulvovaginal symptoms, including dryness. Hormone therapy likely helps increase the beneficial bacteria, Lactobacillus, which is most common in a healthy premenopausal vagina, she notes. “What is still unclear is, do these changes track with vaginal symptoms? Our research did not show that it did. More research is needed.”
Mental and Emotional Issues Could Play a Role
How to Prevent and Treat Vaginal Dryness
Treatment for vaginal dryness depends on the cause. In general, Reed says, “Drink more water and avoid infections or anything that irritates the tissues.” But other helpful ways to address it include:
- Bolster your relationship with sex, and with your partner. For dryness due to problems in the bedroom, ACOG suggests couples work on communicating. Choose a time to have sex when you aren’t too tired or stressed, and make plenty of time for foreplay. You might also try therapy. “If you have low desire, low arousal, and you’ve tried everything else, there are great therapists for this, so consider that when [your dryness] has to do with sex,” says Reed. “Vaginal dilators and pelvic PT are important to include as well as sexual behavioral therapy.”
- Use vaginal moisturizers and lubricants. There are tons of over-the-counter moisturizers that can be applied every few days either inside your vagina or externally to the vulva, ACOG says. They protect vaginal tissue, even when you aren’t having sex, by sticking to the vaginal walls, helping to keep them hydrated, and encouraging the body to generate natural lubrication. Lubricants help with dryness and pain during sex, offering an immediate relief. You can buy different kinds of water-based or silicone-based lubricants over the counter. Products like coconut oil and petroleum jelly work too, but such oil-based lubricants can damage condoms. “Our [research] group found no difference between lubricants and moisturizers, and usually lubricants are cheaper,” notes Reed. “Lubricants should be used at least two times per week, and also with sexual activity.”
- Try Osphena. A prescribed oral medication designed to address the discomfort associated with painful intercourse and vaginal dryness. “Osphena can be associated with a small risk of leg clots and adverse cardiovascular events, so it is slightly more risky than any of the local vaginal treatments,” says Reed. “It is marketed for use when local therapies fail.”
If you experience problems with vaginal lubrication because of low estrogen, you may benefit from treatment with hormones. According to Reed, research on the vaginal microbiome showed that estrogen promotes vaginal health. “Hormone therapy will improve the health of vaginal tissues — the cells become plumper, moister and thicker,” she says. Some hormonal therapies include:
- Local treatments: In some cases, doctors recommend localized treatments like vaginal estrogen inserts. “Vaginal estradiol can be helpful in those who do not get benefit from lubricants,” says Reed, “but the effect size or the amount of benefit is relatively small. Prasterone vaginal is recommended when other local treatments fail and is likely low risk.”
- Systemic treatments: If you’re also experiencing symptoms such as hot flashes, an oral medication or a skin patch that releases estrogen throughout the body is an option, per ACOG. Both local and oral approaches can be used together to effectively treat vaginal dryness.
Vaginal dryness is a common and frustrating condition. But Reed says the important thing to remember is “it’s treatable. No size fits all, and the first thing you try may not work. If something doesn’t work, try again and see a provider.”
Additional reporting by Carolyn Bernhardt.
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