Many women experience vaginal dryness. It can really be a problem during times when estrogen levels are low such as: after childbirth; with the use of certain medications; and before and during menopause. Estrogen is a hormone produced by the ovaries that stimulates the cells inside the vagina to remain fluffy, elastic, and well lubricated. As estrogen levels drop, the vagina can become atrophic (thin, dry, and less elastic) and the chemical balance (pH) can change, as the normal acid producing bacteria in the vagina become scarce.

Examination of the vagina is very important in determining the cause of vaginal dryness or discomfort. There are benign skin conditions, such as contact dermatitis, lichen sclerosis, psoriasis, infections, scaring, and occasionally cancers of the vulva and vagina that can also cause vaginal pain and dryness. Therefore, it is important to have a full vaginal exam before starting treatment.

Common treatments:

• Vaginal lubrication: Vaginal lubricants and moisturizers are available at most pharmacies without a prescription. The best lubricants are usually the messiest. Liquid lubricants (in a bottle that you can shake) have less sugar and are less likely to dry into a firm sticky gel. The top selling brands are Astroglide, K-Y liquid, Lubrin and Moist Again. Apply the lubricant liberally before intercourse to both the vulva and your partner. There are also longer acting lubricants: Replens, K-Y Long Lasting and RepHresh, that help balance the vaginal pH and keep the vaginal tissue moist for days. Douching is never recommended because it can cause serious burns to thin skin, change the vaginal bacterial environment (which makes infection more common), and trigger allergic reactions.
• Regular stimulation: The old saying “use it or lose it” is true for women as well as men. Regular sexual stimulation improves blood flow to the vagina, assists in healing, and promotes vaginal cell turnover and lubrication. Regular participation in creative, non-painful, sexual activity is crucial for vaginal health.
• Prescription medications: Only after regular stimulation and vaginal lubrication have failed is prescription treatment indicated. Prescription medications replace vaginal estrogen which helps to restore thickness and elasticity to the vagina. These medications come in a variety of creams, vaginal pills, and vaginal rings. Since they are non-systemic (local) estrogen, they do not carry the same side effects or risks as estrogen replacement therapy used for hot flashes and other menopausal symptoms. Typically, cream type medication is used daily for the first 2 weeks, and then reduced to 2-3 times per week. If the vaginal ring is chosen, it is inserted and provides a continuous dose for 90 days. Whichever medication is used, symptom improvement is usually noticed by the sixth week of treatment. However, if symptoms have not resolved in six weeks, a re-examination is necessary for consideration of further treatment.

Vaginal dryness may seem like a minor or simple problem, but the consequences of painful and infrequent intimacy in a relationship have been well studied. Couples who engage in regular, frequent, and pain-free intimacy stay married longer, live longer and are happier. In some situations, treatment may require several examinations and medications, but the results are definitely worth the effort.