Updated: Jul 20
Vulva and vaginal dryness and irritation is a common complaint that can be described differently by each person experiencing it. It may be described as burning, itching, dry sandpaper like feeling between the labia, pain, or decreased lubrication during arousal. Dryness of the tissue can also contribute to a lot more than just irritation and discomfort. It can contribute to painful sex, painful or frequent urination, discomfort during gynecological exams, and even cause an increased risk of developing urinary tract infections.
There are a few reasons why vaginal dryness occurs and it’s not all related to menopause. However, it is very common to experience dryness during menopause due to declining estrogen levels and up to 78% of women report vaginal dryness in menopause. Below are some other reasons why vaginal dryness can occur:
Breastfeeding: Estrogen and progesterone levels drop significantly soon after giving birth to allow prolactin levels to rise. Prolactin is a hormone that allows for the production of milk during pregnancy and after birth. Prolactin levels tend to remain elevated during postpartum, as long as breastfeeding continues, which can cause vaginal dryness and tenderness.
Cancer treatment: A very common side effect of cancer chemotherapy is generalized dryness throughout the body. In women, this can lead to vaginal dryness as well. Hormone therapy, which is one of the treatments utilized for breast and uterine cancer, blocks or reduces the amount of estrogen in the body. Some common hormone therapy drugs include tamoxifen, anastrozole, exemestane, letrozole, fulvestrant, and raloxifene. Lack of estrogen during and after cancer treatment can cause the vagina to become dry and less elastic, which may make sex or intimacy painful.
Birth control: Birth control pills, patches, shots, the ring, and hormonal IUDs (Mirena) decrease the production of testosterone by the ovaries and increase the production of sex hormone binding globulin (SHBG) in the liver. SHBG binds to testosterone and prevents it from circulating through the body by making the molecule inactive. The vagina contains both estrogen and testosterone receptors, which contribute to lubrication, so low testosterone levels will make tissue dryer. Synthetic progesterone that is used in newer birth control pills also blocks the testosterone receptors at high doses.
Surgeries that affect pelvic organs: Pre-menopausal women who have their ovaries removed (oophorectomy) or a radical hysterectomy (total hysterectomy with removal of ovaries and fallopian tubes) are likely to experience vaginal dryness as a result of decreased estrogen. Estrogen is primarily produced in the ovaries and without the ovaries estrogen levels significantly drop.
Certain autoimmune disorders: Sjogren’s syndrome is a systemic autoimmune disease that can affect the entire body. It is typically characterized by inflammation and dysfunction of the glands that produce saliva and tears, but can also impact vaginal lubrication. Women with Sjögren’s syndrome report vaginal dryness 2-3 times more often than comparably aged women without Sjögren’s syndrome.
Over the counter moisturizers that can help combat vaginal dryness:
Intimate Rose Enchanted Rose $20
V Magic Vulvar Balm $26
Hyalo Gyn $25
Desert Harvest Releveum Skin Repair Cream $27
Organic Coconut Oil
Revaree Vaginal Suppositories
Since everybody and every vagina is different, it may take a few tries to find the best product for you. Talking with your healthcare provider or pelvic floor PT can be very helpful to answer any questions you may have or for recommendations based on your symptoms.