Vaginal Dryness and Sex: What Every Woman Needs to Know!

Like the popular 90’s song says, “Let’s talk about sex, baby! Let’s talk about you and me! Let’s talk about all the good things and the bad things…” Unfortunately, 10-50% of women can experience pain with sex or vaginal dryness as they move through the menopausal transition. It falls under the umbrella term, Genitourinary Syndrome of Menopause. This includes vaginal dryness (not just with sex but all the time), vulvar atrophy (becomes thin/dry), urinary incontinence (urge to go), and pain with sex. It’s not fair and no fun but there are definitely things you can do!

First, if you’re noticing itchiness, dryness or pain, please get evaluated by your practitioner!

Second, I’m aware there are other sexual health or relationship experts out there whose focus is on pleasure, natural lubrication production, arousal, etc. My goal with this article is to give you additional support options should you need them. Besides, if you experience vaginal dryness or vulvar atrophy all the time in your day, that can be quite painful and might have nothing to do with sex or your relationship.

While there are other causes of vulvar or vaginal dryness such as breast feeding, certain medications, or cancer treatments, I’m talking about the shift towards dryness as a whole that is due to the loss of the estrogen known as estradiol with aging. Estradiol is lubricating to several areas of your body - your joints, your eyes, your ear membranes (itchy ears, anyone?), and your vagina.

Estradiol plays a big role in the healthy bacteria that live in your vagina known as your vaginal microbiome. When estradiol declines, it can throw things off and create symptoms. This may also include vaginal itchiness or urinary tract infections.

A patient once said to me, “Why does my vaginal area have to be so dramatic right now?!” I get it!

Here are some options to consider:

Moisturizers:

These are longer term options that help create hydration to the thinning vulrar and vaginal tissues. They often have hyaluronic acid, oils, and other beneficial ingredients. When applied externally or inserted regularly, it can help restore some of the elasticity plus reduce inflammation and dryness. They are not meant to be used during sex per se. Instead, think of them like you would moisturize your face or hands regularly. Some moisturizers are external only, some are both internal/external. Check the label!

External moisturizers like Plum are helpful when your vulvar/labial area feels dry, irritated or “off.” Tight yoga pants or even underwear might start to feel restrictive as you age and that tissue thins. It’s also helpful to use an external moisturizer for the skin after waxing, if it feels irritated after sexual play, or in certain scenarios such as hypothyroidism or the birth control pill drying out the vulvar tissue.

Lubricants:

These are short term internal options used during sexual play to help keep things slippery (so to speak). There are many forms such as water based, silicone based, and oil based. Be aware of their ingredients as you don’t want harsh chemicals, colors or fragrance throwing off your pH down there. Be aware water based lubricants tend to dry out quickly but can be safely used with latex condoms. Silicone based lubricants tend to stay slippery longer and can also be used with latex condoms.

Oil based lubricants include coconut oil, olive oil, and Vitamin E oil. Be aware they should NOT be used with a latex condom as they can degrade it.

Can you do both?

Yes! You can absolutely use moisturizers as part of your regular care AND lubricants for sex.

What about vaginal hormones?

Also a big yes!

Vaginal estradiol, estriol, and DHEA are options to support the tissue in that area. They can be used externally and internally.

Please be aware - do not use hormones as a vaginal lubricant during sexual play. Your partner does not need to come in contact with these hormones!

Low dose vaginal estradiol is FDA approved for moderate to severe vulvar and vaginal atrophy. It usually comes in various microgram dosages and as a vaginal cream, suppository tablet, or ring. Often times there is a loading dose of daily use for 2 weeks then 1-3 times per week as needed to maintain everything. It should not be used with unexplained uterine or vaginal bleeding.

Thankfully, women with a history of breast cancer can usually use vaginal estradiol according to breastcancer.org and several studies including this study. Talk with your doctor about your options.

Vaginal estriol is a different form of estrogen. There is no FDA approved commercially available forms of it in the United States. This is quite different in Europe where estriol is readily available and used regularly. It must be compounded at a compounding pharmacy in the US and is often used specifically for vaginal dryness. Again, a loading dose of daily use for 2 weeks is commonly done followed by a maintenance period of 1-3 times per week. It should not be used with unexplained uterine or vaginal bleeding.

Vaginal DHEA is available as the prescription known as Intrarosa (prasterone) however it’s also available over the counter at the same dose of 6.5mg. Vaginal DHEA is FDA approved for pain with intercourse. This write up also states that vaginal DHEA could be considered with a history of breast cancer. As usual, talk with your doctor. It should also not be used with unexplained uterine or vaginal bleeding.

Can you do all three options or some combination?

Yes! I have had many women over the years use vaginal hormones and lubricants. Or they would use moisturizers and lubricants. Or they would alternate moisturizers and vaginal hormones with lubricants when needed. Always talk with your health care practitioner about what might work best for your situation but don’t continue to suffer!