Vaginal dryness can occur at any stage of a woman’s life. Dryness may cause discomfort and difficulty with sexual intercourse and increase the risk of urinary tract infections. Itchiness, pain, and burning are also common.
Approximately 15% of premenopausal and up to 57% of postmenopausal women experience vaginal dryness.1Experiencing Vaginal Dryness? Here’s What You Need to Know. American College of Obstetricians and Gynecologists. Published October 2020. Accessed September 3, 2023. https://www.acog.org/womens-health/experts-and-stories/the-latest/experiencing-vaginal-dryness-heres-what-you-need-to-know Many women suffer from these issues for years before seeking medical help. Naturopathic doctors strive to improve a woman’s quality of life, identifying the root causes of dryness and recommending natural treatments for symptom relief.
What Causes Vaginal Dryness?
Estrogen levels have the greatest impact on the level of vaginal moisture. During her reproductive years, a woman experiences a cyclical rise and fall of vaginal wetness in her menstrual cycle as estrogen levels fluctuate. Vaginal dryness related to lower estrogen levels is one of the most commonly reported menopausal symptoms. Women may also experience dips in estrogen levels at other times — for example, after having a baby or while breastfeeding, taking birth control pills, or experiencing other hormonal imbalances. Regardless of age, low estrogen means less vaginal moisture. Other non-estrogen–related causes include Sjögren’s syndrome (an autoimmune disorder), antidepressant use, stress, and chemotherapy.2Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?. Climacteric. 2016;19(2):151-161. https://doi.org/10.3109/13697137.2015.1124259
Symptoms Associated with Vaginal Dryness
Low estrogen levels and menopause are associated with various genital, sexual, and urinary symptoms. These changes can significantly affect a woman’s quality of life:3Kim HK, Kang SY, Chung YJ, Kim JH, Kim MR. The recent review of the genitourinary syndrome of menopause. J Menopausal Med. 2015;21(2):65-71. https://doi.org/10.6118/jmm.2015.21.2.65
- Reduced lubrication during sexual arousal
- Loss of sexual desire
- Changes in fertility4Curlin M, Bursac D. Cervical mucus: from biochemical structure to clinical implications. Front Biosci (Schol Ed). 2013;5(2):507-515. Published 2013 Jan 1. https://doi.org/10.2741/s386
- Painful intercourse
- Reduced blood flow and vaginal sensation, making pleasure more difficult
- Thinning vaginal tissue, leading to more tearing, bleeding, and irritation (vaginal atrophy)
- Increased vaginal itching and infections
- Urgency, pain with urination, and recurring urinary tract infections
Lifestyle Changes
When it comes to vaginal health, the well-known phrase “use it or lose it” applies. However, women often experience less sexual desire when vaginal dryness is a concern. Staying sexually active can promote blood flow to the vaginal canal and reduce dryness. The resulting increase in blood flow also helps maintain a healthy pH.
When estrogen decreases in menopausal women, there is a risk of vaginal atrophy, which may alter the vaginal microbiome.5Saraf VS, Sheikh SA, Ahmad A, Gillevet PM, Bokhari H, Javed S. Vaginal microbiome: normalcy vs dysbiosis. Arch Microbiol. 2021;203(7):3793-3802. https://doi.org/10.1007/s00203-021-02414-3 Lactobacilli are abundant in the vaginal microbiome. They protect the vagina from other pathologic bacteria, preventing infections. Some scientific evidence suggests that probiotics with lactobacilli reduce symptoms associated with vaginal dryness. In one randomized controlled trial, postmenopausal women were divided into two groups. One group received oral probiotic lactobacillus strains. The other received a placebo. Patients who took the probiotics reported more improved vaginal symptoms than those given the placebo.6Petricevic L, Unger FM, Viernstein H, Kiss H. Randomized, double-blind, placebo-controlled study of oral lactobacilli to improve the vaginal flora of postmenopausal women. Eur J Obstet Gynecol Reprod Biol. 2008;141(1):54-57. https://doi.org/10.1016/j.ejogrb.2008.06.003
To increase lactobacilli levels, naturopathic doctors often recommend foods such as fermented vegetables and dairy products.7Muhleisen AL, Herbst-Kralovetz MM. Menopause and the vaginal microbiome. Maturitas. 2016;91:42-50. https://doi.org/doi:10.1016/j.maturitas.2016.05.015
Natural Remedies for Vaginal Dryness
Alternatives to hormonal treatment are especially vital for women with breast cancer and those for whom hormone replacement therapy poses challenges. Before committing to hormone therapy or other medications, patients can try natural remedies that support optimal vaginal health.
Natural personal lubricants, including vaginal suppositories, are widely available. Look for green, organic products and formulas with a pH similar to natural vaginal secretions.8Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?. Climacteric. 2016;19(2):151-161. https://doi.org/10.3109/13697137.2015.1124259 Synthetic ingredients and chemicals in scented soaps and creams can easily irritate the sensitive vaginal area.
Water-based lubricants and vitamin E oil suppositories may improve vaginal tissue quality, relieving dryness and discomfort during sexual activity.
Hyaluronic Acid
Produced naturally by the body, hyaluronic acid binds to water, preserving the skin’s natural moisture. One study of 144 postmenopausal women under 70 found hyaluronic acid gel relieved dryness without altering pH levels, similar to results with estriol gel.9Stute P. Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief? Arch Gynecol Obstet. 2013 Dec;288(6):1199-201. https://pubmed.ncbi.nlm.nih.gov/24178484/ PMID: 24178484,10Donders GG, Ruban K, Bellen G, Grinceviciene S. Pharmacotherapy for the treatment of vaginal atrophy. Expert Opin Pharmacother. 2019 May;20(7):821-835. doi:10.1080/14656566.2019.1574752. Epub 2019 Mar 21. PMID: 30897020. https://pubmed.ncbi.nlm.nih.gov/30897020
Although water-based lubricants and moisturizers have their place in treating vaginal dryness, few products compare to estrogen cream or topical estrogen therapy when vaginal atrophy is the concern. Low estrogen causes inflammation, thinning, and possible loss of vaginal tissue and walls.
DHEA Suppositories
DHEA vaginal suppositories are another option for treating hormone imbalance. DHEA converts to estrogen and testosterone in vaginal tissue without affecting other hormones. In a randomized, double-blind clinical trial, women who experienced mild to severe pain during intercourse reported improvement with DHEA suppositories.11Donders GG, Ruban K, Bellen G, Grinceviciene S. Pharmacotherapy for the treatment of vaginal atrophy. Expert Opin Pharmacother. 2019 May;20(7):821-835. doi:10.1080/14656566.2019.1574752. Epub 2019 Mar 21. PMID: 30897020. https://pubmed.ncbi.nlm.nih.gov/30897020
Vitamin D
Low vitamin D levels are common among postmenopausal women. Vitamin D stimulates proliferation of the vaginal epithelium by activating the vitamin D receptor. More clinical research is needed to support vitamin D as a nonhormonal treatment for vaginal health.12Rad P, Tadayon M, Abbaspour M, Latifi SM, Rashidi I, Delaviz H. The effect of vitamin D on vaginal atrophy in postmenopausal women. Iran J Nurs Midwifery Res. 2015 Mar-Apr;20(2):211-5. PMID: 25878698; PMCID: PMC4387645. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387645
Hormone Replacement Therapy for Vaginal Atrophy
Guidelines from the North American Menopause Society have shifted in recent years, with more favorable recommendations for hormone replacement therapy (HRT). In a 2022 statement, the organization suggests the benefits may outweigh the risks for some women.13The 2022 Hormone Therapy Position Statement of the North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. https://doi.org/10.1097/GME.0000000000002028 HRT is typically not prescribed for people who have had liver disease, estrogen-sensitive cancer (including breast cancer), coronary heart disease, stroke, or a history of blood clots. A trusted specialist will work with patients to identify safe and effective strategies.
Footnotes
- 1Experiencing Vaginal Dryness? Here’s What You Need to Know. American College of Obstetricians and Gynecologists. Published October 2020. Accessed September 3, 2023. https://www.acog.org/womens-health/experts-and-stories/the-latest/experiencing-vaginal-dryness-heres-what-you-need-to-know
- 2Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?. Climacteric. 2016;19(2):151-161. https://doi.org/10.3109/13697137.2015.1124259
- 3Kim HK, Kang SY, Chung YJ, Kim JH, Kim MR. The recent review of the genitourinary syndrome of menopause. J Menopausal Med. 2015;21(2):65-71. https://doi.org/10.6118/jmm.2015.21.2.65
- 4Curlin M, Bursac D. Cervical mucus: from biochemical structure to clinical implications. Front Biosci (Schol Ed). 2013;5(2):507-515. Published 2013 Jan 1. https://doi.org/10.2741/s386
- 5Saraf VS, Sheikh SA, Ahmad A, Gillevet PM, Bokhari H, Javed S. Vaginal microbiome: normalcy vs dysbiosis. Arch Microbiol. 2021;203(7):3793-3802. https://doi.org/10.1007/s00203-021-02414-3
- 6Petricevic L, Unger FM, Viernstein H, Kiss H. Randomized, double-blind, placebo-controlled study of oral lactobacilli to improve the vaginal flora of postmenopausal women. Eur J Obstet Gynecol Reprod Biol. 2008;141(1):54-57. https://doi.org/10.1016/j.ejogrb.2008.06.003
- 7Muhleisen AL, Herbst-Kralovetz MM. Menopause and the vaginal microbiome. Maturitas. 2016;91:42-50. https://doi.org/doi:10.1016/j.maturitas.2016.05.015
- 8Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?. Climacteric. 2016;19(2):151-161. https://doi.org/10.3109/13697137.2015.1124259
- 9Stute P. Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief? Arch Gynecol Obstet. 2013 Dec;288(6):1199-201. https://pubmed.ncbi.nlm.nih.gov/24178484/ PMID: 24178484
- 10Donders GG, Ruban K, Bellen G, Grinceviciene S. Pharmacotherapy for the treatment of vaginal atrophy. Expert Opin Pharmacother. 2019 May;20(7):821-835. doi:10.1080/14656566.2019.1574752. Epub 2019 Mar 21. PMID: 30897020. https://pubmed.ncbi.nlm.nih.gov/30897020
- 11Donders GG, Ruban K, Bellen G, Grinceviciene S. Pharmacotherapy for the treatment of vaginal atrophy. Expert Opin Pharmacother. 2019 May;20(7):821-835. doi:10.1080/14656566.2019.1574752. Epub 2019 Mar 21. PMID: 30897020. https://pubmed.ncbi.nlm.nih.gov/30897020
- 12Rad P, Tadayon M, Abbaspour M, Latifi SM, Rashidi I, Delaviz H. The effect of vitamin D on vaginal atrophy in postmenopausal women. Iran J Nurs Midwifery Res. 2015 Mar-Apr;20(2):211-5. PMID: 25878698; PMCID: PMC4387645. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387645
- 13The 2022 Hormone Therapy Position Statement of the North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. https://doi.org/10.1097/GME.0000000000002028
