Many patients come to me first when vaginal dryness
causes difficulty with their sex lives. But oftentimes this isn’t their only
problem; the soreness, burning, and itching that accompany vaginal dryness can make
it uncomfortable to sit, stand, exercise, urinate or even work. Vaginal dryness
can affect our everyday lives, whether or not we are sexually active.
Perimenopausal and menopausal women with vaginal dryness often say they feel like
their bodies — and their lives — are drying up. Even my younger patients
worry about early menopause and permanent changes in the vagina. First, I’ll
say that neither your body nor your life is drying up! The vagina is very resilient
— and so are you.
Vaginal dryness is a common symptom and there are many possible causes for it, from
diet and stress to — one of the most frequent issues — hormonal imbalance.
Like almost everything in our lives, feeling better depends on finding the underlying
cause and your unique solution. With some willingness to explore and the right support,
vaginal dryness can be easily remedied — the natural way.
A healthy vagina
Moisture is normal for a healthy female vagina, and so is a reasonable amount of
vaginal discharge. Though vaginal discharge does change naturally with your hormonal
cycles and aging, normal vaginal fluid is typically a clear to whitish substance
with a pasty or slippery consistency and no strong odor. It will include a stringy,
egg-white-like discharge from the cervix, or what is called fertile mucus,
at around the time of ovulation. With sexual arousal, you will typically experience
slippery, clear secretions from small glands on either side of the vulva called
the skenes glands. (To learn more about changes in vaginal secretions,
read our article on predicting ovulation.)
Your body relies on the hormones estrogen and progesterone to produce adequate lubricating
secretions for your vagina. During perimenopause and menopause, when hormones are
shifting, it’s very common for some women to experience vaginal dryness as
fewer secretions are produced. However, women of all ages can experience vaginal
dryness. And there are a variety of reasons for it, some of them less complicated
Common causes of simple vaginal dryness
If you are experiencing vaginal dryness, look into the following common causes first.
You may find that changing one or two of these factors can give you relief from
your symptoms right away.
Personal hygiene products. Feminine sprays and harsh soaps
(especially antibacterial and deodorant soaps) can rob the delicate vaginal and
vulvar tissues of moisture. Even Dove and Ivory, though cleverly marketed to appear
gentle, can dry your genital tissue because they are not pH-balanced. Many feminine
douching products can also cause more harm than good, a well-known fact in medicine
that still has not reached all women. Swimming pool and hot tub chemicals can also
be terribly drying to all of our skin cells, including those in the vulva and vagina.
You may also want to switch to a laundry detergent containing no perfumes or other
irritants that could remain as residue on your underwear.
Diet. Estrogen is essential for lubricating the vagina.
Since estrogen is ultimately produced from cholesterol, our bodies’ ability
to efficiently produce and metabolize estrogen relies heavily on the fat we consume
in our diets. But while there is a correlation between fat in our diets and estrogen
levels, we need to remember to consume fats that help us create health and hormonal
balance rather than those that promote disease. Hydration is also key for all the
mucous membranes of the body to remain moist. While we like to think of drinks containing
caffeine and alcohol as part of our diet, caffeine and alcohol have drug-like actions,
including a diuretic (dehydrating) effect, that can be much more pronounced
in some women. Women in perimenopause and menopause may have more difficulty
clearing the body of these substances, and overconsumption of either — particularly
alcohol — can exacerbate vaginal dryness.
Medications. Certain drugs, including allergy and cold
medications and some antidepressants, tend to dry out mucous membranes, including
vaginal tissues. The birth control pill is also a common cause of vaginal dryness
because the hormones it contains are not natural to the human body.
If you have ruled out the above factors, you may be experiencing some degree of
hormonal imbalance, a very common root cause of vaginal dryness in women over 40.
Disorders associated with vaginal dryness
While lifestyle measures, hormonal imbalance, and stress can contribute to vaginal
dryness, there are also a number of medical disorders that may cause or present
with vaginal dryness. For example, the autoimmune disease known as Sjögren’s
syndrome can cause vaginal dryness in addition to dry eyes and dry mouth,
due to the body’s own attack on the glands responsible for secretions.
Women with a range of other underlying vaginal disorders often experience vaginal
dryness. We review atrophic vaginal changes, more severe atrophic vaginitis, lichen
sclerosis, and vulvodynia in relation to vaginal dryness in our subpage on conditions
associated with vaginal dryness. Some of these issues are rare and can be difficult
to recognize, so we strongly recommend seeing a gynecological provider or nurse
practitioner specializing in menopause as opposed to a general practitioner if you
are concerned about these issues, or if the natural support measures we recommend
do not provide enough relief.
Vaginal dryness and hormonal imbalance
Your hormones can lose their delicate balance for a number of reasons, the most
common of which is the hormonal shifting that occurs during perimenopause and menopause.
(This imbalance can be even more severe in women who have had a hysterectomy.) Depending
on your genetics, diet and lifestyle, your body will naturally begin to shift its
hormone production as it prepares to end ovulation cycles.
Because progesterone levels tend to diminish first as women enter perimenopause,
some women experience a relative increase in estrogen levels, and they
may need to balance that shift with progesterone supplementation. Others, particularly
women who are near or past menopause, may experience a drop in both estrogen and
progesterone levels. Given that one of estrogen’s many responsibilities is
to keep the vagina lubricated, it’s very common for a drop in estrogen to
lead to vaginal dryness.
While commonly thought of as a problem for women in perimenopause and menopause,
hormonal imbalance can also occur in women who have premature ovarian failure, polycystic
ovarian syndrome (PCOS), anorexia, or pituitary and hypothalamus issues; and in
women who have recently experienced childbirth, are breastfeeding, have imbalanced
diets, have gone through cancer therapy, or smoke cigarettes.
Stress, emotions, and vaginal dryness
One very important cause of vaginal dryness that often goes unrecognized is stress.
This is particularly common in younger women prior to perimenopause. After I hit
30, I was working 10-hour days, getting very little sleep, stressed out, drinking
too much coffee with not enough water intake, and not eating as well as I could.
When I started experiencing vaginal dryness, I worried that I was in early menopause.
But in looking back, I realized that I was pushing my body to the limit without
enough support, and making little to no time for restorative behavior or sexual
thinking. Then getting pregnant made it clear: this was not early menopause lurking
for me; I just needed to take better care of myself physically and emotionally.
Many of us tend to ignore the physical manifestations of stress, yet it can have
a powerful impact on our systems. By taxing the adrenals, chronic stress drives
down androgens (such as testosterone), which can interfere with the normal female
sexual response cycle. This can ultimately affect the stages of arousal and reduce
natural lubrication. Many causes of stress arise in our overextended lives, which
is why simply taking some time for yourself or making a permanent change in your
schedule can help tremendously.
Stress can also stem from deeper emotional work we have yet to do. Scientists are
discovering more and more about the relationship between emotions (especially negative
ones) and sex hormones in the body and brain. Interestingly, we now know that the
brain contains hormone receptors. Though we are still learning about this, research
is linking our emotional history with our sexual hormones, and could help explain
why the latter may be tapped out.
There are many programs available for emotional healing. The Hoffman Institute,
where the Quadrinity Process is taught, has been a great resource for many of our
patients — but their courses require a significant financial and time commitment.
The Emotional Freedom Technique (EFT), while not as extensive, can be practiced
at home or with a trained EFT practitioner. Both offer you the tools you need to
gently unearth emotions about your past and deal with them in a healthy way so that
they no longer negatively impact your wellbeing.
Vaginal dryness and sex
I can’t tell you how many women think it’s over. They’re dried
up, they fear, and they’ll never have sex again. I always tell them this story:
I have a 75-year-old patient who in the past year became a widow. Her husband was
quite ill for many years and sexual relations was not a part of their marriage for
close to three decades! Because it had been such a long process of nursing her husband
and caring for him during the process of dying she felt like she had properly grieved
his loss and wanted to get back out there in the dating arena quickly. It was actually
one of her dying husband’s wishes for her. Well this patient knows how to embrace
the moment and not only did she have a new boyfriend three months later but he was
also 30 years younger than her! Because she been on some bioidentical hormone replacement
already with me her sex drive was quite high so she was ready to “romp in the hay”
however, she was surprised to find that she had vaginal dryness that was taking
away from her pleasure and ability to enjoy this newfound outlet of passion and
stress reduction. I explained to her that even though she had been on hormones previously
that we hadn’t used local estriol applied to the actual vaginal tissues because
she was not having any issues until she became sexual active again. I explained
that because she’d gone so long without sex, she had some atrophic changes in her
vagina and urethra, which is why she was so dry and feeling discomfort.
In her case, topical estriol vaginal cream helped boost the local estrogen and plump
up the vaginal tissue and urethra, while also providing more moisture. After a few
short weeks they were engaging in sexual activity and she was having no pain and
enjoying this new found intimacy.
What can I say? She is my idol. I love to see how she appropriately grieved her
husband but moved forward with her life in a knock your socks off kind of way. She
laughs when strangers call her boyfriend her son or give her strange stares when
they are engaging in public displays of affection. Myself and my staff got to witness
this entire transformation of this lovely lady. She used to walk in the office feeling
fatigued, depressed and defeated. Now she walks in and we want to have what she’s
having! Take home lesson – life is what you make of it and you are never to old.
Most of the women I talk to feel the opposite is true — their bodies are fine but
their passion is gone — or they’re somewhere in the middle. How we deal with sex
and arousal is a big factor when it comes to vaginal dryness, menopausal or not.
It’s also important to understand that sometimes vaginal dryness during sex can
stem from simply not being sufficiently “turned on.” A woman needs about 20 minutes
of thinking about sex before her body fully responds physically. When women are
stressed, the last thing they think about is time for feeling sexy, yet we all need
this time to get the brain primed and ready. Vaginal dryness and low libido in general
can be remedied and need not get in the way of a fulfilling sex life. To learn more
about the physical aspects of libido, read our article on low sex drive in women
— causes and solutions.
If sex continues to be a painful experience for you despite these efforts, it may
be helpful for you to explore your sexual history. Research tells us that up to
one in three women may have been sexually abused, and though it’s difficult to bring
these memories to the surface, past sexual abuse can manifest itself physically
in your body, especially when, as is usually the case, there are unresolved feelings
and emotions. We’ll be dealing with this sensitive topic in a later article, but
you can refer to the programs mentioned above for support in emotional healing.
Using your self-knowledge and instincts as a guide, you can find the underlying
causes of your vaginal dryness. And once you understand the root causes, you can
start investigating solutions.
Natural solutions for vaginal dryness — the Women's Health
Unfortunately, many women are living with vaginal dryness because conventional medicine
isn’t offering options that work for them. I talk to women all the time who
tell me their doctors say their only options are to use synthetic hormones, or to
try Premarin vaginal cream or old-fashioned K-Y Jelly. These options go from one
extreme to another, but what many women don’t know is that there are plenty
of options in-between, and most of them you can get from your conventional practitioner.
Keep in mind that it may take some experimentation before you find what works. We
always advocate for beginning at the root cause of a problem. And this begins with
taking the time to listen to our bodies. With an understanding of what is out of
balance, you can guide your recovery through your own reading and, if necessary,
find a practitioner willing to provide options that work for you.
The following suggestions for natural support can be highly effective for vaginal
dryness. We always recommend a natural approach first. If your vaginal dryness doesn’t
resolve right away, don’t give up; even if these options don’t cure
your vaginal dryness, they can augment the effects of any prescriptions you may
decide to use and possibly allow you to use a lower dose for a shorter duration.
Stay hydrated. This may seem obvious, but if you’re
chronically dehydrated, your body is going to have a hard time staying lubricated.
Remember that all caffeinated and alcoholic beverages can dehydrate you, too. So,
drink plenty of water whenever possible. A good place to start is half your weight
in ounces daily.
Choose gentle hygeine products. Don’t use douches
or perfumed feminine hygeine sprays, and avoid the use of drying soaps and bubble
baths. Try pH-balanced soaps that do not include antibiotics or chemical deodorants.
Eat a balanced diet. Eating a well-balanced diet, including
an appropriate amount of healthy fats, will support your overall health and make
sure your body is making as much estrogen as it can. Also be sure to eliminate simple
sugars and food sensitivities.
Increase key isoflavones in your diet. Many women respond
very well to daily intake of whole foods like soy and flaxseed, which are high in
isoflavones and lignans known to be helpful for vaginal dryness. While soy and flaxseed
contain some of the highest levels of phytonutrients helpful for vaginal dryness,
there are many other foods that contain phytoestrogens which, by mimicking the body’s
natural estrogens, serve as a buffer when levels fluctuate. Adding these foods to
your diet could give you the extra little hormone boost you need. Foods high in
phytoestrogens include other legumes, nuts, apples, celery, cherries, and many more.
As always, eating a diet rich and varied in plant foods helps balance your hormones,
and it’s one of the easiest ways to treat vaginal dryness! And an important
note about soy – you should only consume soy products that are non-GMO. Given that
this limits the number of soy options available to you, I recommend my patients
start by adding flaxseed to their diets first, and only add soy if they can find
the non-GMO kind.
Take a medical-grade nutritional supplement. Giving your
body the highest level of nutritional support available is always a good idea, no
matter what symptoms you’re experiencing. Your body simply cannot function
normally or heal itself without the necessary ingredients. We know, for example,
that omega-3 essential fatty acids support healthy cell membranes and hormonal balance.
Our SHOP offers an excellent option with our
Perform regular self-exams. It may seem like an odd thing
to add to your to-do list, but we encourage you to make time to look at your vagina
regularly with a mirror. If you keep track of changes, you may be able to link them
to dietary habits, changes in your cycles, emotional situations, and so forth.
Try a quality lubricant. Instead of sticking with the
old K-Y Jelly, which contains methylparaben, consider a more natural lubricant like
Sylk or the new paraben- and glycerin-free Astroglide. Some women have success with
a dab of natural oil, like sweet almond or grapeseed, after bathing. A personal
lubricant can greatly help some women during sex, and can be a fun part of foreplay.
Look into vitamin E suppositories. Many women with vaginal
dryness have had success using vitamin E suppositories. Vitamin E applied locally
can help restore thin vaginal tissue. You may Vitamin E suppositories find them
in certain health food stores or a compounding pharmacy without a prescription.
Consider phytotherapy and other hormone therapies. Ancient
cultures used plants like black cohosh, red clover and kudzu to treat vaginal dryness.
These phytoestrogens have proven helpful for reducing vaginal dryness in many studies.
Since low estrogen is at the core of most vaginal dryness in perimenopause and menopause,
localized estrogen therapy is the most effective treatment for stubborn cases. We
like to suggest bioidentical estrogen creams or suppositories that are applied directly
to the vagina, rather than ingested like conventional forms of higher-dose synthetic
HRT. Since the bioidentical estrogen vaginal creams work directly upon the genital
tissue at a low dose, only trace amounts of the estrogen enter the circulation and
the associated risk is generally considered very low.
Choosing the right bioidentical vaginal estrogen product is key. Estriol is the
weakest of the three estrogens, but I find it works very well for plumping up thinning
tissues. Pharmaceutical companies have yet to develop a brand name estriol product,
but you can obtain a prescription for a custom-compounded vaginal estriol cream
or suppository from a healthcare provider who prescribes bioidentical hormones.
Read our subpage on natural estrogen options for treatment of vaginal dryness for
more information. Even some women on low-dose systemic HRT, like the patches, need
this extra vaginal support.
Confront negative emotions and stress. If other measures
haven’t worked for you, it may be helpful to explore your past. Writing in
a journal or talking to a trusted friend can help you uncover answers you may have
overlooked. Your emotional well-being is vital to a healthy body. If you have any
negativity regarding sex, relationships, or your partner, talk to someone about
your feelings. Bottling them up may allow them to easily resurface.
Don’t wait to take steps to help your vaginal dryness!
Whether it’s menopause that is causing a shift in estrogen production, an
unbalanced diet, stress or an emotional past, our bodies are all unique. And in
the end, taking the time to get to the bottom of your vaginal dryness allows much
more room for personal growth, comfort and happiness.
Know that vaginal dryness is a natural symptom of hormonal imbalance, and we have
had great success in helping women restore lubrication naturally. Treatment may
come from a variety of sources, but it is your own body that decides which remedy
or combination of remedies is the right one. If one option doesn’t have the
desired effect, work with your practitioner to find another. There are many roads
to the solution.
1 Gallup target market report on vaginal dryness; 2002. Gallup study
of female sexual dysfunction.
2 Goldin, B., & Gorbach, S. 1988. Effect of diet on the plasma levels,
metabolism, and excretion of estrogens. Am. J. Clin. Nutr., 48 (3 Suppl.),
787–790. URL: http://www.ajcn.org/cgi/reprint/48/3/787 (accessed 06.26.2007).
3 Rieg., T., et al. 2005. Requirement of intact adenosine A1 receptors
for the diuretic and natriuretic action of the methylxanthines theophylline
and caffeine. J. Pharmacol. Exp. Ther., 313 (1), 403–409. URL:
http://jpet.aspetjournals.org/cgi/content/full/313/1/403 (accessed 07.09.2007).
4 Mayo Clinic Staff. 2006. Vaginal dryness: Causes. MayoClinic.com URL:
http://www.mayoclinic.com/health/vaginal-dryness/DS00550/DSECTION=3 (accessed 06.26.2007).
5 Science Daily: 2006. Women on hormone therapy regain response. URL:
http://www.sciencedaily.com/releases/2006/10/061017084350.htm (accessed 06.26.2007).
6 Chiechi, L., et al. 2003. The effect of a soy rich diet on
the vaginal epithelium in post menopause: A randomized double blind trial. Maturitas,
45 (4), 241–246. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/12927310
Brzezinski, A. 1997. Short-term effects of phytoestrogen-rich diet on
postmenopausal women. Menopause: Journal of the North American Menopause Society,
4 (2), 89–94.
Uesugi, T., et al. 2003. Evidence of estrogenic effect by the three-month
intervention of isoflavone on vaginal maturation and bone metabolism in early postmenopausal
women. Endocr. J., 50 (5), 613–619. URL (PDF): http://www.jstage.jst.go.jp/article/endocrj/50/5/613/_pdf
7 Cancer Council NSW. 2006. Soy foods, phytoestrogens and cancer fact
sheet. URL: http://www.cancercouncil.com.au/editorial.asp?pageid=256 (accessed 07.02.2007).
Martin, J., et al. 2007. Does an apple a day keep the doctor away because
a phytoestrogen a day keeps the virus at bay? A review of the anti-viral properties
of phytoestrogens. Phytochemistry. 68 (3), 266–274. URL: http://www.ncbi.nlm.nih.gov/pubmed/17182070
8 Giardinelli, M. 1952. Effect of alpha–tocopherol in some disorders
of the menopause and in atrophy of the vaginal mucosa. Minerva Ginecol., 4,
Stewart, E. 2000. The V Book: A Doctor’s Guide to Complete Vulvovaginal Health.
NY: Bantam. This book is written by Dr. Elizabeth Stewart, a gynecologist specializing
in vulvar dermatology at the Brigham & Women’s Hospital in Boston, Massachusetts.
Boston Women’s Health Book Collective. 2005. Our Bodies, Ourselves: A New
Edition for a New Era. NY: Touchstone.