Menopause And Your Sexual Health: When Dryness Equals Discomfort


During menopause, estrogen production slows and then stops. When that happens, a number of changes — many of them unwelcome — happen in a woman’s body. Periods become irregular and then stop. You may have hot flashes, mood swings, a deeper voice, and an increase in facial hair.

Vaginal dryness is another common symptom of menopause — and close to one out of every three women experiences it while going through “the change.” And it becomes even more common after menopause. Vaginal dryness also can occur at any age from a number of different causes. It may seem like a minor irritation. But the lack of vaginal moisture can have a huge impact on your sex life. Fortunately, several treatments are available to relieve vaginal dryness.

Although they gladly said “good riddance” when it came to their tampons and pads, some postmenopausal women may not be so pleased to bid farewell to the natural lubrication they experienced in their younger years.

What causes vaginal dryness?

Normally, the walls of the vagina stay lubricated with a thin layer of clear fluid. The hormone estrogen helps maintain that fluid and keeps the lining of the vagina healthy, thick, and elastic. During menopause, the drop in estrogen levels reduces the amount of moisture available. It also makes the vagina thinner and less elastic. This is called vaginal atrophy.

In addition to menopause, estrogen levels can drop from:

Other causes of vaginal dryness include:

  • Sjögren’s syndrome (an autoimmune disorder that attacks cells in the body that produce moisture)
  • Allergy and cold medications and certain antidepressants
  • Douching
  • Lack of enough foreplay before sexual intercourse

No matter what the cause, vaginal dryness can be extremely uncomfortable. It can lead to itching, burning, and painful intercourse.

How is vaginal dryness diagnosed?

Any burning, itching, or discomfort in the vaginal area warrants a call to your doctor or gynecologist. The doctor will take a health history and find out how long you’ve been experiencing symptoms and whether anything — such as douching or taking medication — seems to worsen them.

Your doctor will then do a pelvic exam, checking your vagina for any thinning or redness. The exam will help rule out other possible causes for your discomfort, including a vaginal or urinary tract infection. The doctor may also do a Pap test to remove and test cells from your vaginal wall or cervix.

How is vaginal dryness treated?

The most common treatment for vaginal dryness due to low estrogen levels is topical estrogen therapy. Topical estrogen replaces some of the hormone your body is no longer making. That helps relieve vaginal symptoms, but it doesn’t put as much estrogen in your bloodstream as oral estrogen hormone therapy (HT).

Most women use one of three types of vaginal estrogen:

  • Vaginal estrogen ring (Estring). You or your doctor inserts this soft, flexible ring into the vagina. There it releases a steady stream of estrogen directly to the vaginal tissues. The ring is replaced every three months.
  • Vaginal estrogen tablet (Vagifem). You use a disposable applicator to insert a tablet into your vagina once a day for the first two weeks of treatment. Then you insert it twice a week until you no longer need it.
  • Vaginal estrogen cream (Estrace, Premarin). You use an applicator to insert the cream into your vagina. You will typically apply the cream daily for one to two weeks then reduce the frequency to one to three times a week as directed by your doctor.

Any type of estrogen product can have side effects, such as vaginal bleeding and breast pain. Topical estrogen may not be recommended for women who:

There isn’t much research on the long-term use of topical estrogen, but doctors believe it is safe to use in the long term.

What is the connection between menopause and vaginal dryness?

During menopause, when estrogen levels start to drop, the vaginal walls become thinner, less elastic and less lubricated. This can result in a number of symptoms, including vaginal dryness and dyspareunia or pain during sexual intercourse which is said to be one of the most bothersome vaginal symptoms of menopause. Decreased lubrication can also cause discomfort, bleeding and tearing of the vaginal tissues during intercourse.

Is it normal?

If you are postmenopausal and experiencing painful intercourse or vaginal dryness, take comfort in knowing you are not alone. According to a survey of women ages 40 to 84, more than half of postmenopausal women surveyed (56 percent) experienced vaginal dryness. In fact, 83 percent who experience vaginal dryness say the dryness bothers them “a little to a great deal.” What’s more, one in four of the postmenopausal women surveyed (26 percent) reported they experienced painful intercourse.

Why am I experiencing vaginal dryness and the related pain during sex?

Why the decrease in vaginal moisture and the resulting painful sex with menopause?

The most common cause is declining estrogen.

The hormone estrogen helps keep the vagina healthy by maintaining its elasticity and lubrication. As a woman ages, her ovaries produce increasingly less estrogen, leading to a thinner, less flexible and drier vagina.

What can I do about vaginal dryness and painful intercourse?

One of the biggest obstacles when it comes to treating vaginal dryness and painful intercourse is that women don’t address it, with their partners or their health care professionals. More than six in 10 of the postmenopausal women surveyed who reported experiencing painful intercourse (62 percent) and more than half who reported experiencing vaginal dryness (53 percent) admitted they are at least somewhat embarrassed to talk about their condition.

And of the postmenopausal women surveyed, 45 percent who reported experiencing vaginal dryness and 41 percent who reported experiencing painful intercourse had not spoken to their health care professional about their condition.

Why so hush-hush about vaginal dryness? Among the postmenopausal women surveyed who had not spoken with their health care professional, embarrassment (30 percent vaginal dryness, 33 percent painful intercourse) and the belief that there is nothing that can be done medically to help the condition (20 percent vaginal dryness, 27 percent painful intercourse) were the top reasons why.

Embarrassment aside, many women may not believe their vaginal problems are treatable. More than a third of the postmenopausal women surveyed who reported experiencing vaginal dryness (37 percent) and 41 percent who reported experiencing painful intercourse agreed with the statement, I do not believe there’s anything that can be done medically to help improve my condition.” Fortunately, that is not the case.

Vaginal dryness and painful intercourse that interfere with your lifestyle in particular, your sexual health warrant a trip to your health care professional. After all, vaginal dryness and painful intercourse due to menopause are a natural part of aging you can do something about.

In order to keep the vagina more lubricated, try using a vaginal moisturizer (Replens), which you can buy at your local drugstore or supermarket. You can make intercourse more enjoyable by applying a water-based lubricant (Astroglide, K-Y) beforehand. Also take your time before having sex to make sure that you are fully relaxed and aroused.

Avoid using douches, bubble baths, scented soaps, and lotions around the sensitive vaginal area. These products can worsen dryness.

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