Gynaecology Leaflet: Vaginal Dryness

Leaflet Details

Patient Information

Introduction

Vaginal dryness, often called atrophic vaginitis, is a common condition that affects many women, particularly after menopause. Nowadays, the term genitourinary syndrome of menopause (GSM) is typically used. GSM describes a group of chronic, progressive, low-oestrogen conditions, which include vaginal dryness, vulvovaginal atrophy, and issues with bladder and urethral function. This leaflet will focus specifically on understanding and managing vaginal dryness.

What is vaginal dryness?

Vaginal dryness occurs when there isn’t enough natural lubrication in the vagina, leading to discomfort, irritation, and sometimes pain, especially during sexual activity. It can affect women of any age, although it is more common in postmenopausal women. Vaginal dryness is often due to the thinning of the vaginal lining, which makes the mucosa feel drier, less stretchy, and more fragile. This can also lead to inflammation, alter the vagina’s natural pH balance, and disrupt healthy bacteria, making women more susceptible to urinary tract and vaginal infections.

What is the cause of vaginal dryness?

Vaginal dryness is linked to hormonal changes, particularly a drop in oestrogen, which is essential for maintaining vaginal moisture, elasticity, and thickness.

There a several things which can cause this:

• Menopause
   
• The years leading up to menopause (perimenopause)
   
• After having a baby
   
• Breastfeeding
   
• Certain medications (e.g. Antihistamines, contraceptives)
   
• Hormonal cancer treatment such as anti-oestrogen medications
   
• Radiotherapy
   
• Chemotherapy
   
• Removal of both ovaries (Surgical menopause)
   
• An underlying condition like diabetes or Sjogren’s syndrome

What are the symptoms of vaginal dryness?

The following symptoms can occur:

• Itching, burning, or irritation in the vaginal area.
   
• Discomfort or pain during sexual intercourse (known as dyspareunia).
   
• A feeling of tightness or tenderness.
   
• Light bleeding after sex or other physical activities that involve friction.
   
• Vaginal discharge (usually white or yellow)
   
• Frequent urinary tract infections (UTIs) or vaginal infections
   
• Urinary symptoms - e.g. Increased frequency, waking up at night to go to the toilet (nocturia), painful urination (dysuria), stress incontinence and urgency
   
• Decreased arousal, desire and orgasms

Managing and Treating Vaginal Dryness

There are several ways to manage and relieve vaginal dryness:

1. Vaginal Moisturizers

These are over-the-counter products designed to provide ongoing hydration. These can be used to keep your vagina moist and to relieve the ongoing discomfort experienced with vaginal dryness. Insert into vagina daily at night for best absorption, for up to 2 weeks and then use every 1 to 3 days. It can take 3 to 4 weeks to see an effect. However, vaginal moisturisers do not reverse the changes experienced with lowered oestrogen levels, therefore ongoing use of these products is advised.

Preparations include: Replens MD, Regelle ,Yes VM.

2. Lubricants

Use during sexual activity to reduce discomfort. It is applied to the vulva and vagina right before sexual intercourse. Look for water-based options that are less likely to cause irritation.

3. Emollients

Preparations including Zerocream, Zerobase and Cetraban are suitable to wash with, instead of using soaps and shower gels, which can cause dryness and irritation to the genitals and vagina.

4. Topical Oestrogen Therapy

Vaginal oestrogen has the benefit of being effective at lower doses, meaning less oestrogen enters your bloodstream and limits your overall exposure. It can also provide more direct relief for vaginal symptoms compared to oestrogen tablets. It can be used in conjunction with HRT therapy.

There are several types of vaginal estrogen therapy available, and you might try a few to find the one that works best for you.

• Vaginal oestrogen cream (Ovestin, Gynest): This cream is applied directly into the vagina with an applicator, typically at bedtime. Many women use it daily for one to three weeks, then one to three times per week afterward. Your doctor or nurse will guide you on the right amount and frequency. Some women find creams messy, so they may prefer the suppository form.
   
• Vaginal oestrogen tablet (Vagifem): This tablet is inserted into the vagina using a disposable applicator. Your doctor will advise on how often to use it, which may involve daily use for the first two weeks, followed by twice-weekly use.

Helpful Tips

• Always choose gentle, unscented products for the vaginal area
   
• Try engaging in more foreplay to encourage natural lubrication
   
• Wear breathable, cotton underwear to allow airflow and reduce irritation
   
• Doing regular pelvic floor exercises increases blood flow and relaxes the pelvic muscles.
   
• Drinking plenty of water will keep your body, including your vagina, hydrated
   
• Stop smoking, as this reduces blood flow to the genital area and vagina
   
• Vaginal dryness / irritation can be caused by infection, so please get this checked by your doctor

Remember, vaginal dryness is common and treatable. You don’t have to live with discomfort - talk to your healthcare provider to find the best solution for you.