Not many people's favourite topic - but an important one nonetheless. Vaginal dryness affects many women, before and after menopause. This article outlines how it feels; why it happens and what you can do to help.
Vaginal dryness can be one of the most embarassing menopause symptoms to talk about. Most of us aren't used to talking about how we feel 'down there' but the fact is that dryness can cause a lot of discomfort. It's not just about sex, but also about how you feel day-to-day (though sex is important for most women too).
It may not be discussed but vaginal dryness is incredibly common. Some research suggests up to 60% of women suffer with dryness before or after menopause. Our own assessment data suggests over 40% of women. Many women are too embarassed to seek treatment. We're here to help you learn about what can be done to ease this pain, and to support you to ask for help.
You'll know how your own vagina normally feels. Ultimately, you're also the only person who can notice a change in your body. Exactly how vaginal dryness feels will be different from one person to the next. If you are unsure, however, some things to look out for are:
Sorness or itchiness around your vagina
Pain or discomfort after sex
Pain or discomfort during sex
Needing to go to the loo more often
Getting urinary tract infections (UTIs) more often, or repeatedly.
Any vaginal pain can naturally put you off having sex. A lack of libido can cause serious issues for you, and your partner so vaginal dryness is not one to be ignored.
Vaginal dryness at menopause happens because of oestrogen levels dropping. The hormone oestrogen is responsible for consistent lubrication. This means that it keeps the lining of your vaginal thick and moist. This part of our body is therefore very sensitive to changing levels of oestrogen. When oestrogen drops as we approach and pass through menopause, the lining of the vaginal thins and becomes drier. This can lead to irritation, feelings of discomfort and pain.
Because vaginal dryness is linked to hormone levels, it does not only happen during menopause! Any medical treatment which causes oestrogen to drop may also be linked to less moisture down there. This includes surgical removal of the ovaries, chemotherapy and some other medical treatments for cancer.
Other things can also cause vaginal dryness. Younger women suffer from it too, usually due to:
Not being aroused during sex
Using perfumed soaps, washes or douches in and around your vagina
Having underlying conditions including diabetes or Sjögren's syndrome
Taking some medications such as antidepressants and some forms of the contraceptive pill.
1. Vaginal creams and pessaries which contain estrogen
Oestrogen creams and pessaries are incredibly safe to use. Even for those who may not be eligible for HRT, local oestrogen creams are often still an option. This is because the levels of oestrogen are so low and are only absorbed into the local vaginal blood stream. This minimises any risks to your health. The only exception is for women who have active breast cancer or those that are experiencing vaginal bleeding.
Most doctors will start you on a cream or pessary to be used almost everyday for a couple of weeks. The maximum benefits following such treatments can take up to 3 months, so be patient! This treatment can be used as long as you need until you begin to notice change. They'll then suggest a reduced dose to help you maintain lubrication - usually once or twice per week.
Water based lubricants can really help to make sex more comfortable. Make sure that you are choosing a lubricant that is as body identical as possible. Good quality water based lubricants (like sylk) can help to reduce dryness during intercourse, and make it more fun! This is a great alternative if you are not eligible or comfortable using HRT. Make sure you choose a water based lubricant. These are safe to use with condoms and should not change your vaginal pH. You do not need to use lubricants regularly but should always use them prior to intercourse.
3. Non hormonal vaginal moisturisers
There are many non-estrogen moisturizers which can help to add moisture to the delicate skin and tissue. Similarly to lubricants, you want to make sure that the moisturiser you choose is as body identical as possible. These should be used regularly, as advised on the instructions of your chosen brand.
4. Washing with water
Always avoid perfumed soaps, as they can irritate delicate skin. All you need to clean yourself is warm water in the shower. Keep it as simple as that. If you are worried about an odour, and have pain, it may be worth consulting a doctor to check that there is no infection.
If you think your medication might be effecting your vaginal lubrication or sex drive, speak to your doctor to get advice on alternatives.
We know this particular symptom can be a really hard one to discuss with a partner or a doctor. It may seem embarrassing, but this stigma is often all in your head. It's really nothing to be ashamed. Opening up with your partner will help them understand and may make the topic of sex a lot less stressful for you. Vaginal dryness is neither your fault or uncommon. There are things you can do to quickly get relief and manage this symptom. If it helps, take your Alva PDF from our assessment with you to the doctor as a reminder.
Hillard, T., Abernathy, K., Hamoda, H., Shaw, I., Everett, M., Ayres, J. and Currie, H., 2017. Management Of The Menopause. 6th ed. British Menopause Society.
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Available at: https://www.nhs.uk/conditions/vaginal-dryness/ [Accessed 15 February 2020].
Women's Health Concern Factsheet. 2017. Vaginal Dryness. [online]
Available at: https://www.womens-health-concern.org/wp-content/uploads/2017/11/WHC-FACTSHEET-VaginalDryness-NOV17.pdf [Accessed 15 February 2020].
Administrator, C., 2016. Let's Talk About Vaginal Dryness | Woodlands OBGYN .... [online] Woodlands OBGYN Associates.
Available at: https://www.woodlandsobgynassociates.com/blog/lets-talk-about-vaginal-dryness/ [Accessed 11 June 2020].