Vaginal Dryness: What It Is, What Causes It & How To Treat It.
By Jessica Leith & Fiona O'Farrell
By Jessica Leith & Fiona O'Farrell
Like many things related to sexual health, vaginal dryness is very common and yet very uncommon to talk about. It’s rarely the topic of conversation among friends and even more uncommon to discuss with a healthcare provider.
However, vaginal dryness is a part of being a vulva-owner, and things like fluctuating hormones, life events and even how we bathe can all contribute to vaginal moisture levels. For everything you need to know about vaginal dryness, from its causes to its treatments, read on.
Vaginal dryness is when the self-lubricating processes of the vagina decrease its production, which ultimately results in less lubrication.
However, to understand this common uncomfortable issue, we first need to understand the vagina. Well, actually the vulva, which is the better word to describe the whole package of down-there for people assigned female at birth (AFAB).
For now, we will be focusing on the internal canal that connects the uterus to the external parts of the vulva, which is the vagina. It's important to know this distinction as understanding vaginal dryness requires you to know exactly what the vagina is and where it is located.
To understand vaginal dryness we should first discuss how the vagina stays moist in the first place. There are two separate systems that help keep the vagina lubricated. The first is at the cervix which secretes lubrication throughout the day and travels down the vaginal canal, the second is activated typically (although not always) during sexual arousal from the Bartholin’s glands (two glands at the entrance of the vagina) to help make extra moisture to aid in sexual intercourse. It’s important to understand that both of these functions are a part of a complex network and are not simply a function of the body that turns on and off.
So, how do you know if you are experiencing dryness? With symptoms of vaginal dryness, women report discomfort such as burning, itching, and scratching of the vagina (this could be internal towards the cervix or external around the inner and outer labia).
It can be difficult and sometimes painful to insert anything into the vagina like a tampon, menstrual cup, penis or dildo. During penetrative sex, a dry vagina may take more time with insertion, or tense up further due to the anticipation of discomfort. If you are having sex with a penis-owning partner, they may also report discomfort with insertion.
With prolonged dryness, the vagina can begin to atrophy (which is where the other name for vaginal dryness comes from: urogenital atrophy) and become less elastic. This is a chicken-egg type of situation. All vagina’s decrease in lubrication and atrophy as we age. Actually, all of the plump juicy bits of our body atrophy (why do you think lip fillers are a thing?) and hormone levels change as we age. So vaginal dryness and vaginal atrophy go hand in hand.
The only time it is considered to be a problem is when there is reported discomfort or pain. The less elastic the vagina, the more difficult it can be to insert objects. More seriously, when the vagina is dry, the membrane of the skin is less elastic and more prone to micro-tearing which can result in higher rates of STI transmission, prolonged discomfort and possible scarring or infection.
Now that we know there are multiple ways the vagina stays lubricated, it's important to understand that there are also many potential causes for vaginal dryness.
The most common vaginal dryness cause is time. As we age, our bodies go through changes such as pregnancy or menopause. Our body’s hormonal landscape, specifically levels of estrogen, also change, and this in turn impacts the systems that help produce vaginal lubrication.
The second most common cause of vaginal dryness is lack of arousal. When our minds are not aligned with the activity we are getting into, it won't signal to the body to activate the arousal network, including an increase in vaginal lubrication.
There are a number of other vaginal dryness causes, which may include things like using too much soap or scents on your vulva which disrupts the pH balance, diet that may be an irritant to bladder function and subsequently vaginal health, or in rare cases, dermatological disorders that can change the delicate skin of vagina, labia and vulva.
Additional vaginal dryness causes include natural processes (e.g. childbirth, breastfeeding) and medical conditions (e.g. hysterectomy, cancer) that can impact the ovaries and therefore estrogen production in the body. There are certain medications, especially those which are anti-estrogen based, that can also impact estrogen levels.
Yes. Vaginal dryness is extremely common because a fluctuation in hormones is common, menopause is common, and not being aroused in a snap is common. The vagina is a very well designed organ - think of it as a thermostat, when adjustments are made in the outside environment, the vagina will adjust naturally, including levels of lubrication. So periods of less lubrication is just your body adjusting to the environment or context of your life.
Like many other things that are commonly understood in the world of sexual health, vaginal dryness is a lot more common than people think. The Women’s Health Concern reports that 17% of women 18-50 years old experience some form of vaginal dryness.
For women who are pre-menopausal, the lack of natural lubrication is the result of not enough foreplay before penetration, and/or stress, meaning they aren’t really able to become fully aroused and therefore jumpstart the natural mechanisms to produce lubrication. About a third of women going through menopause report experiencing some vaginal dryness, and this number escalates to most women dealing with those post “the change”.
All this to say that vaginal dryness is probably more common than you think at any age, and more of the norm when you get to post menopausal stages.
The main concern related to vaginal dryness is when it is accompanied by discomfort, irritation or pain with penetrative sex. A less lubricated vulva will be more sensitive to tight fabrics (think of underwear or the seam of your leggings that rub against your labia), it may be more difficult to use a tampon or menstrual cup, and generally be distracting from your everyday activities.
Our first suggestion is to stop using all products that may be increasing potential irritation. Only use warm water when cleaning your vagina and vulva. Avoid scented soap, wipes or highly scented laundry detergent.
Next, try to figure out the source. If you are only experiencing discomfort during sexual activity but seem to be fine the rest of the time, then it is most likely that you are not taking your time to get into the mood before starting penetrative activity.
If you are experiencing dryness during certain times of the month or day, then it may be linked to your menstrual cycle, estrogen levels, or daily activities (for example, if you go to a spin class at 7am sitting on a bike seat, wearing synthetic leggings that you washed in highly scented detergent, then you use soap on your vulva in the shower, it may flare up after those series of events).
If the dryness seems to be chronic, then it's time to check with your primary care provider or gynecologist just to check to make sure there isn't a simple medical explanation (including yeast infections or bacterial vaginosis). Finally, consider that this may be a change that goes along with a certain stage of life, it might take some management but does not have to be the end of the world.
If you are one of the many people who experience vaginal dryness, the good news is that there are a lot of treatment options to help with the discomfort. These range from over the counter to prescription based by a medical provider.
The two most common over the counter remedies for vaginal dryness include lubricants and vaginal moisturizers. Lubricants just mimic the body’s natural lubrication and can be easily applied to the area around the vulva (lips) of the vagina just before you are about to engage in penetrative sexual activity.
Vaginal moisturizers, on the other hand, can be used for increased comfort overall at any time. They are typically applied 2-3 times a week and can last for up to 3 days before reapplication is needed. They both have the same action, but the difference is in timing and amount of application.
In addition to lubrication, massage can help increase circulation and encourage elasticity. Using your fingertips, you can press and use a circular motion on every part of your inner and outer labia to generate more blood flow to the area. Internal massage wands like the Pamper Massage Wand can also help with relaxation, blood flow and elasticity.
Depending on your symptoms, your medical provider might also suggest prescriptive based treatments that enhance estrogen in the body in order to combat vaginal dryness. These can include:
A topical estrogen therapy (hormone replacements)
Most of the research that has been done (which is not terribly robust) suggests these treatments are safe, however, there are certain conditions which would contraindicate use such as being pregnant, breastfeeding, having endometrial or breast cancer, vulvar dermatological disorders and vaginal bleeding. Additionally, side effects such as vaginal bleeding can also occur.
Similar to other issues of sexual variance, most women who experience vaginal dryness feel too embarrassed to actually tell their doctor and ask for help. This is especially concerning because for many people, it may require simple changes to your arousal process during sexual activity, like increasing foreplay.
For more stress induced dryness, finding ways to relax and attune with your body and the experience can be helpful in engaging your mind’s capacity to become aroused and start the lubrication process. And even if it is not a simple solution, talking with your primary care provider is the perfect next step towards ruling out more serious medical conditions, so it’s important to work through any embarrassment that may come up.
Menopause is probably the most commonly associated term with vaginal dryness. It refers to a natural process that all people assigned female at birth experience 12 months following their last period.
The onset of menopause varies for each person, but most commonly occurs between the ages of 45 and 55. Menopause results in varying levels of hormone production for the two primary hormones related to the ovaries; estrogen and progesterone - and as we’ve previously mentioned, estrogen is responsible for keeping the vagina soft and moist.
Although not all people will experience vaginal dryness as a result of menopause, about half will, which is a pretty high rate of occurrence. There is a lot of good information out there on menopause, but there is also a lot of misinformation. Dr. Jen Gunter’s book, The Menopause Manifesto: Own Your Health with Facts and Feminism, offers a refreshing look at the experience that can help guide you in your own process.
Pepper Together has a number of products that can help you work through vaginal dryness and be on your way to sexual satisfaction again. Try slowing down the experience by immersing yourself in some foreplay before penetrative sex by using the Roll Massager, which can also help to reduce any stress that may impact your ability to get aroused.
When you’re ready for touch and/or penetration, use a water-based lubricant such as the Pepper Water-Based Lube to get things nice and wet. If you want a product that can do it all, the Hintz Massage Candle has both a relaxing scent as well as oil and lubricant qualities all in one package.
So take it from us, vaginal dryness is not something to be shy about, and the more you talk about it, the more you’ll create an open and affirming atmosphere from others who are experiencing the same.
Vaginal dryness is totally common and completely treatable. When in doubt, always reach out to your healthcare provider to talk it through and get sound advice when figuring out what the best approach is for you. But comfort and relief can be as simple as trying out a few simple products.