A healthy young vagina is moist and slightly acidic. As estrogen levels dip during menopause, it tends to grow dryer. By the time we reach our middle years, almost half of women report the sensation of dryness in the vagina some of the time, and a quarter deal with it “most” or “all of” the time.
But that sensation doesn’t have to interfere with your sex life. Research backs up what you may have heard from close friends: even after dryness sets in, many middle-aged women don’t experience pain during intercourse and continue to have sex. An over-the-counter lubricant will often do the trick, and the vagina tends to get moister when intercourse is more frequent.
Severe dryness, however, is uncomfortable and also indicates an alkaline vagina, which will be more prone to yeast and bacterial infections (vaginitis). This isn’t an issue you should ignore out of embarrassment.
Your first step might be to identify aggravating factors:
Douching. Don’t! It’s unnecessary at best and can be harmful.
Medication. Allergy and cold medications containing antihistamines as well as asthma drugs can dry out mucous membranes throughout the body, including the vagina. If you are taking medications for cancer, an ulcer, depression, or high-blood pressure, ask your doctors whether they may be contributing to dryness in the vagina and ask about other options. Never just abandon a medication on your own.
Irritants. Chemicals in soaps, gels, bubble baths, and perfumes may cause allergic reactions. Experiment with unscented products and, if you’re using a lubricant or condom, you might try switching brands.
Illness. Diabetes, endometriosis, and other illnesses can cause dryness, so if you’re under treatment for an ongoing problem mention a dry vagina as a possible symptom. Although you may be embarrassed to mention your vagina to anyone but a gynecologist, it’s part of the complete picture.
Sexual or relationship issues. Anxiety or difficulties with your partner can make it harder to produce your normal lubrication. Anxiety literally slows down blood flow. What to do? You might think of your vagina as a friend, reminding you of your needs, even when you’d rather not hear her out.
Perhaps you’re anxious in general. Remember that sex is a good way to lower stress and resist the temptation to retreat.
Many couples let the sex wind down and connect in other ways. Just be sure that you’re not assuming too much about your partner. Ask the tough questions. Listen to the answers. If he sounds wistful or angry, put yourself in his shoes. It’s possible that he’s feeling chronically deprived and fighting lust every day. Unless both partners find peace within a sexless marriage, it will be vulnerable.
While you identify and deal with causes, look into remedies. Over-the-counter moisturizers such as Replens and Lubrin can help. A moisturizer is used regularly, unlike a lubricant, which is just for use during intercourse.
You may hear claims that taking soy supplements, which contains estrogen-like substances, or eating soy foods will help menopausal symptoms. Some people swear by black cohosh. Neither claim is yet backed by good science, according to the prestigious Cochrane Review and others. That’s also true of homeopathic preparations — you’ll hear that Belladonna, Bryonia, and Lycopodium will relieve a dry vagina — and the herbals dong quai and motherwort. Among herbs, the best bet may be ginseng, which has limited support.
If none of this helps, don’t rule out estrogen. It makes sense for your doctor to prescribe a suppository or a cream before you take a pill. You also might take a moisturizer at the same time. But the bad news we’ve heard about hormone replacement therapy shouldn’t make you dismiss this option completely if you’re having significant symptoms. The North American Menopause Society, for example, argues that people have overreacted and are opting out of needed treatment. There are risks and benefits to every course of treatment, and risks from avoiding treatment. Have an open-minded discussion with your gynecologist. That goes for women ages 65 and older as well, according to the Society.
June 02, 2016
Janet O’Dell, RN