Vaginal dryness

Women’s estrogen levels go up and down pretty much throughout their reproductive years—they are highest just before ovulation and lowest during menstrual periods. This can cause the vagina to feel dry and itchy at the start of periods.

During perimenopause—which can last up to 10 years before menopause in some women—and menopause, estrogen levels drop dramatically. The vagina becomes thinner and atrophies in most women. The result: dryness. But this is just one—albeit, a big—cause for vaginal dryness.

Smoking, being insufficiently aroused during sex, birth control pills and practices like douching or using female hygiene products that are not prescribed by a doctor can also cause vaginal dryness. Whatever the cause, the symptoms of vaginal dryness can be similar. They include:

• Vaginal itching and/or itchiness around the vagina
• Light bleeding or soreness in and around the vagina, especially after sex (read more: vaginal pain)
• Pain during sex
• Watery or thicker than usual discharge that may be a sign of an infection
• Increased incidence of urinary tract infections (usually linked to the drop in estrogen during menopause)
• Urge to urinate becomes more frequent (frequent urination)
• Low libido

Vaginal dryness may increase the risk of sex injuries like vaginal cuts and tears. If you experience bleeding after sex, you should consult a doctor as soon as possible.

You should also see a doctor if your vaginal dryness is accompanied by severe itching.

(Vaginal discharge can give medical professionals many clues about your health. Whether you have low, no or changed discharge, make sure to tell your doctor about it when you go for regular checkups.)

In 2009, researchers published the findings of the Global Survey of Sexual Attitudes and Practices—which was administered to 6,725 women across 11 countries: UK, Germany, Japan, Australia, Canada, Spain, Italy, Mexico, Argentina, Brazil and Thailand—in The Journal of Sexual Medicine. According to the survey, based on self-reported symptoms, younger women typically attributed vaginal dryness to inadequate arousal during sex while older women said the cause was mostly ageing and menopause. Both are right, of course. From dehydration to diabetes, there are many conditions that can cause vaginal dryness. The most common causes of vaginal dryness include:

Longer-term causes

• Menopause: The drop in estrogen levels during perimenopause and menopause are among the most common causes of vaginal dryness the world over. Women have reported this reason for vaginal dryness (usually a sign of vaginal atrophy which is common in menopause) across many surveys, including the Revealing Vaginal Effects at Mid-Life (REVEAL), Women’s Voices in Menopause (WVM), Vaginal Health: Insight, Views, & Attitudes (VIVA), Clarifying Vaginal Atrophy’s Impact on Sex and Relationship (CLOSER), and Real Women’s Views of Treatment Options for Menopausal Vaginal Changes (REVIVE) surveys. 
• Childbirth and breastfeeding: During pregnancy, the body’s hormone levels are very high. They start plummeting the moment you give birth. Following childbirth, estrogen levels drop suddenly and then continue falling for some time. New moms who breastfeed may also have vaginal dryness as breastfeeding suppresses estrogen production—this usually resolves on its when they stop breastfeeding.
• Being on birth control pills: These pills work by regulating the female hormones in the body. A potential side effect could be vaginal dryness. If the discomfort persists, talk to your doctor about a prescription for a different contraceptive pill.
• Certain medications: Drugs like antidepressants can cause vaginal dryness.
• Pelvic surgeries: Surgeries such as hysterectomy or oophorectomy (also called ovariectomy) can cause a drop in estrogen levels. The removal of ovaries from the body is also known as surgical menopause. An oophorectomy may be done to reduce the risk of ovarian cancer or breast cancer in those at risk, in case of ovarian torsion, endometriosis or an abscess or pocket filled pus in the fallopian tube and an ovary (tubo-ovarian abscess).
• Cancer treatments, including chemotherapy
• Smoking: Smoking can cause a drop in estrogen levels, too, which can result in vaginal dryness.
• Immune disorders like Sjogren’s syndrome can cause vaginal dryness
• Diabetes: High blood sugar in diabetes can damage the blood vessels, including the blood vessels in the vagina. This reduces lubrication in the vagina. Additionally, it impacts blood flow to the vagina, which in turn can impact arousal during sex which is another known cause of vaginal dryness.
• High blood pressure: Hypertension or high blood pressure can also reduce blood flow to the vagina and cause dryness.

Short-term causes

• During intercourse, inadequate arousal in women can cause vaginal dryness
• Vaginal dryness at the start of the periods usually eases on its own as the production of estrogen in the body rises again
• One of the symptoms of vaginitis, inflammation in the vagina, is vaginal dryness. This can occur for a number of reasons. For example, a new or perfumed detergent you might be using for underwear could irritate the skin. Or using soap (instead of plain, lukewarm water) to wash the vulva could have the same effect.
• Drinking alcohol can cause dehydration and dull the mind-body connection. One of the effects of these could be vaginal dryness.
• Taking antihistamines (allergy medicine) that contain diphenhydramine, which can dry up bodily secretions
• Menstrual hygiene products like tampons can also cause vaginal dryness.
• Stress can also cause vaginal dryness

Temporary vaginal dryness is usually nothing to worry about, nor is the occasional dry vagina during sex. However, you should see a doctor if the vaginal dryness persists, often causes pain during sex or bleeding afterwards, is accompanied by severe itching, abdominal pain, pelvic pain, change in bowel movements like constipation, fatigue, loss of appetite or sleep disturbances.

To diagnose vaginal dryness, the doctor will start by asking you about your symptoms. He or she may also ask about your medical history and sexual history. Do tell your doctor if you have recently changed your contraceptive pill or if you are on medication such as antidepressants.

Next, a physical examination of the vagina will be done to look for telltale signs of dryness. In case your doctor suspects an underlying cause like approaching menopause, he or she may prescribe the appropriate therapy for you.

Often, vaginal dryness is nothing to worry about. Solutions like lubricants can help reduce pain during sex and prevent sex injuries like vaginal cuts and bleeding. When it comes to lubricants, some people like to use coconut oil. While coconut oil is considered generally safe for use on the skin, it is important to note that it may deteriorate latex condoms, making them less effective.

Vaginal moisturisers can help to reduce any itchiness and feeling of pressure associated with vaginal dryness. These may be used on their own or in conjunction with vaginally delivered estrogen.

Estrogen creams, tablets or rings may also be prescribed by your doctor, especially if he or she finds menopause to be the cause of your vaginal dryness. If you are using creams that are applied directly to the vagina, make sure they don’t contain any parabens, glycerine or other agents that could irritate the skin and mucosal lining. Also, check with your doctor about the correct dosage of estrogen for you, especially if you are using estrogen cream as these may contain higher levels of the hormone.

A DHEA ( dehydroepiandrosterone) vagina suppository may be recommended by a doctor for those who can't, or don't want to, use estrogen-based therapies.

Vaginal laser therapy may be advised to some women to relieve vaginal atrophy associated with menopause.