What Are the Causes of Vaginal Dryness in Women?

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Vaginal dryness is a common symptom that women experience during menopause and possibly for years after it ends. However, vaginal dryness can occur at any age for many other reasons.

Menopausal Women
Menopausal Women

Vaginal dryness is the result of lower estrogen levels. Estrogen is a female hormone that keeps the vaginal lining lubricated, thick and flexible. A lack of vaginal lining lubrication may not be a serious problem for some people, but it can have a serious effect on a woman’s sex life and cause pain and discomfort during sex. Fortunately, there are several treatments that can alleviate symptoms of vaginal dryness.

Reasons for vaginal dryness

Vaginal dryness is a common symptom of menopause. Vaginal dryness is usually caused by a decrease in estrogen levels. Estrogen levels begin to fall as menopause approaches.

Ovaries produce estrogen, which controls the development of features of the female body, such as breasts and body shape. Estrogen also plays an important role in the menstrual cycle and during pregnancy.

Estrogen usually makes the tissue that makes the vagina thick, moist and healthy. As the level drops, women notice that the lining of their vagina becomes thinner, drier, less supple and light pink blue in color. These changes are called vaginal atrophy.

Estrogen levels can also drop for reasons unrelated to menopause, such as:

  • Childbirth
  • Breastfeeding
  • Chemotherapy and radiotherapy
  • “Surgical menopause,” when the ovaries are surgically removed.
  • Anti-estrogen drugs used to treat breast cancer or endometriosis

There may be other causes of vaginal dryness:

Sjögren syndrome:  Sjögren syndrome is a complex autoimmune disease that includes inflammation of the salivary and lacrimal glands. Vaginal mucous membrane tissue can also become inflamed, leading to vaginal dryness.

Antihistamines: These drugs, such as diphenhydramine, are used to treat colds and allergic symptoms, as well as to dry secretions. Side effects may include vaginal dryness and urinary problems.

Antidepressants: Some antidepressants can cause sexual issues such as decreased libido, vaginal dryness and difficulty achieving an orgasm.

Smoking: Women who smoke are more prone to early menopause than non-smokers, so vaginal dryness may occur at a younger age in this group.

Menopause connection

Vaginal dryness is associated with menopause, as estrogen levels drop during menopause. Studies show that about 20% of perimenopausal and postmenopausal women seek treatment for vaginal dryness. However, the real number of people with symptoms would be closer to between 40 and 50 %.

Vaginal atrophy and vaginal dryness can cause pain and discomfort during sex and increase the risk of vaginal infections.

Reduced estrogen levels also weaken the mucous membrane of the urinary tract, which can lead to more frequent urinary tract infections. These symptoms are called genitourinary syndrome of menopause or GSM.

With genitourinary syndrome of menopause women may also experience bleeding after sex or vaginal burns and itching. These symptoms can certainly affect a woman’s quality of sex for the worst.

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Of course, every woman who goes through menopause will have different symptoms, and these symptoms will vary in severity. No woman will have the same experience.

Symptoms

Night sweats and insomnia are felt during the perimenopause.

Other symptoms, often associated with vaginal dryness and atrophy, are vaginal itching, burning and irritation. These changes in the vagina make it easier for infections to occur.

As mentioned above, a decrease in estrogen levels in perimenopause reduces the amount of natural vaginal secretions.

Reduced estrogen levels can also lead to the tightening of the vaginal opening making sex more painful. Pain during sex is known as dyspareunia.

Women in perimenopause may also experience some of the following symptoms:

  • Mood is changing.
  • night sweats
  • Insomnia
  • fatigue
  • acne
  • urinary problems
  • memory problems
  • hot flashes

Diagnosis

Any change in your vaginal status is worth calling your doctor, including any of the following symptoms:

  • A burning feeling
  • Itching
  • Dryness
  • Pain during sex

Your doctor will probably do a pelvic exam and ask for a complete history of vaginal symptoms and menstrual changes.

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A pelvic exam will help your doctor check for vaginal changes and rule out other causes of discomfort, such as infection. The doctor may also take cell and vaginal discharge samples to check for infection.

There is no single test to diagnose vaginal dryness and atrophy, and doctors often use the symptoms to make a diagnosis.

Discussing such personal information can be uncomfortable and inconvenient, but doctors are used to these types  of conversations. It is important that women ask for help in dealing with their symptoms.

Treatment

There are many ways to treat vaginal dryness. Your doctor can prescribe some of them, and some can be obtained over the counter.

Local estrogen cream

The usual treatment for vaginal dryness caused by low estrogen levels is local estrogen therapy. These are medications that are applied directly to the vagina to relieve symptoms.

This method involves much less absorption into the body of estrogen than would be the case if estrogen pills were taken. As such, these medications are considered relatively low risk.

The following are some examples of local estrogen therapy:

The vaginal ring: This elastic ring is inserted into the vagina, where it constantly releases a small amount of estrogen into the tissue. The ring is changed every 3 weeks.

A vaginal tablet (Vagif): This procedure also includes an applicator to place the tablet in the vagina.

Vaginal cream (Premarin): The applicator is often used to apply the vaginal cream. Studies have shown that estrogen cream is an effective and well-tolerated treatment for vaginal atrophy and dryness compared to placebo.

Currently there is a lack of research on the long-term effects of local estrogen. The methods listed here are considered safe especially when compared to traditional hormone replacement therapy.

Women with a history of breast cancer who may be pregnant or nursing should talk to their doctor about the safety of local estrogen therapy. Non-hormonal therapy options are also possible.

over-the-counter treatments

There are also over-the-counter procedures that help combat vaginal dryness.

A lubricant can be used during sex to increase moisture and make sex less painful. It is recommended that water-based gels be used instead of oil-based ones, as the former can cause irritation and condom breakage. Local vaginal moisturizers can be used daily to maintain the natural moisture in the vagina.

Home remedies

There are many ways to combat vaginal dryness, including simple lifestyle changes:

  • Eating nuts and seeds can improve hot flashes and vaginal dryness.
  • Having sex regularly can help combat vaginal dryness, either alone or with a partner.

Blood flow to vaginal tissues increases when a woman is stimulated, which helps stimulate moisture production. Proper foreplay and stimulation before sex will help reduce vaginal dryness and make sex more enjoyable.

Hygiene products

Many intimate care products contain aromas and dyes that can irritate or dry out vaginal tissues. The vagina contains a delicate balance of good bacteria and is self-cleaning. There is no need to use scented soaps.

Products that contain phytoestrogens

Phytoestrogens are compounds that act as estrogen in the body. They are found in plant products such as soybeans, nuts, seeds, and tofu. Studies show that phytoestrogens are associated with a slight improvement in vaginal dryness and hot flashes.

Underwear

Synthetic underwear can increase vaginal irritation and restrict air circulation. People should choose cotton underwear that promotes good air circulation and allows the vagina to breathe.

Conclusion

Vaginal dryness is a common symptom in women going through menopause. Although not associated with significant health issues, vaginal dryness can be a source of discomfort.

Treatment with local estrogen cream is a low-risk treatment. Mild symptoms can be treated without prescription, including vaginal moisturizers and lubricants used during sex.

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References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800285/

https://www.ncbi.nlm.nih.gov/pubmed/29916947

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