How To Manage Vaginal Dryness

Vaginal dryness is a common problem that often occurs as a result of decreased oestrogen levels that changes the thickness and elasticity of the vaginal wall and vaginal pH. 

In addition to a dry feeling, you might also experience itching and a burning sensation, unpleasant smelling discharge, painful and frequent urination, and discomfort during sexual intercourse.  These symptoms can significantly impact a woman’s quality of life.

Fortunately, there are several successful treatments available that can ease the symptoms of vaginal dryness. Mild cases can often be treated with lubricants, while more severe cases may require the use of topical or oral hormone therapy.

What Causes Vaginal Dryness?

Vaginal dryness is usually associated with low oestrogen levels. 

Oestrogen maintains the thick walls of the vagina and when oestrogen levels drop vaginal tissues become thinner, drier, and less elastic. Oestrogen also maintains the levels of glycogen, which is the energy source used by good bacteria (Lactobacilli) for the healthy functioning of the vagina.

A healthy vagina is slightly acidic, maintaining a pH of between 4.0 to 4.5. When oestrogen levels drop, however, the vagina becomes more alkaline (meaning that the pH increases). The beneficial bacteria that grow in the vagina thrive in the acidic environment, and when the pH changes, that may benefit harmful bacteria more, possibly leading to a condition known as bacterial vaginosis. 

Low oestrogen levels may be triggered by many factors, including:

• Perimenopause and menopause
• Pelvic radiotherapy
• Breastfeeding or childbirth
• Chemotherapy or breast cancer treatment
• Hormonal cancer treatments
• Removal of both ovaries (surgical menopause)
• Rarely, an underlying condition such as diabetes or Sjogren’s syndrome
• Smoking
• Using perfumed products or soaps in your intimate area
• Some types of medication, such as antidepressants or oral contraceptives

How Is Vaginal Dryness Diagnosed?

Vaginal dryness is usually diagnosed by your doctor or nurse based on your symptoms and a pelvic exam. During a pelvic exam, which involves looking at your vagina and cervix, your doctor may see the classic signs of vaginal dryness and vaginal atrophy which can include a shortened or narrowed vagina, redness, swelling and thinning and dryness of the vaginal walls.

What Are The Symptoms Of Vaginal Dryness?

Regrettably, most women fail to visit their doctor when experiencing symptoms of vaginal dryness. As there are many effective treatment options available, you should not delay seeing your doctor if you experience any of the following symptoms:

• Vaginal dryness
• Redness and itching of the genitalia
• Burning sensation in the vagina
• Discharge with an unpleasant odour
• Burning sensation when urinating
• Urgency with urination
• Urinary incontinence
• Recurrent urinary tract infections
• Light bleeding
• Painful intercourse (due to decreased lubrication during sexual activity)
• Bleeding or discomfort after intercourse
• Tightening and shortening of the vagina

How Is Vaginal Dryness Treated?

Vaginal dryness is generally manageable, and treatment can be life-changing for those with more severe symptoms. 

Non-Hormonal Treatments

Although oestrogen therapy may be the most effective, there are several treatment options available that do not involve hormones, namely:

• Lubricants can treat vaginal dryness and improve comfort during sex. 
• Vaginal moisturisers, applied every 1 – 3 days, stick to the vaginal walls to help the cells maintain moisture.

Hormonal Treatments

Oestrogen therapy is an effective hormone therapy for treating vaginal dryness. Topical oestrogen treats the symptoms of vaginal dryness and vaginal atrophy without increasing oestrogen levels in your bloodstream. It is available in a cream, a vaginal pill, or a ring.

• Vaginal oestrogen cream is usually inserted into your vagina, 2-3 times per week, using an applicator.
• The vaginal ring is a thin, flexible ring that is placed into your vagina every 3 months. It releases a continuous low dose of oestrogen. 
• Vaginal oestrogen tablets are inserted into your vagina using an applicator about 2-3  times per week.

Hormone Replacement Therapy

Hormone replacement therapy may be helpful for women who have other symptoms of menopause such as severe hot flashes, but it is not recommended if you have been menopausal for longer than 10 years or if vaginal dryness is your only symptom. 

How Can You Reduce Vaginal Dryness?

Although the best course of action is to visit your doctor, the following home remedies might provide some relief:

• Using a vaginal moisturiser two to three times per week.
• Using a little pure vegetable oil or olive oil during sex (though it should be noted that oil-based substances can weaken latex and therefore cause condoms to break during sex).
• Avoid bath soaps, lotions or gels that contain perfumes. 
• Avoiding bubble baths, bath salts and scented oils.
• Not using scalding hot water while bathing or showering.
• Avoiding feminine hygiene sprays and perfumes.
• Not using adult or baby wipes in the area.
• Avoiding tight-fitting clothing and wearing 100% cotton underwear.