DEAR MAYO CLINIC: I am 48 and the mother of two children, both teenagers. I have had an active sex life with my partner for more than 20 years, but recently I have been experiencing pain and increased vaginal dryness. I know I'm of the age that I might be going into menopause, but should I consult with a physician? Is there anything I can do other than abstain from intercourse or use additional lubrication?

ANSWER: Vaginal dryness can cause painful intercourse and persistent pelvic pain, among other symptoms. While it's more common in menopausal women, it also affects younger women, including those in perimenopause, which you may be experiencing.

A handful of factors can affect vaginal dryness. Estrogen is the most important hormonal influence on the health of the vulva and vagina. Low estrogen can contribute to dryness. Diet and the use of certain medications also are important factors. You can expect any medications that cause dry eyes and dry mouth to have a similar effect on the vagina.

Estrogen levels in the blood vary during the month and follow a common pattern to each menstrual cycle. For women who are not on hormonal birth control, levels are lowest in the days just before and after the start of menstrual bleeding. This low level sometimes can contribute to vulvar and vaginal dryness. Very low-dose hormonal birth control can contribute to dryness.

My recommendation is that women bothered by vaginal dryness should have a thorough exam and discussion with their primary health care provider or gynecologist to determine the most likely cause for these symptoms. Other causes of vulvovaginal pain and irritation may be responsible for the symptoms.

A physical exam will ensure the correct diagnosis is made and that less common, but more serious, conditions are not missed. Your health care provider will help you determine the best course of treatment. While painful intercourse may limit your desire for sexual intercourse, you should not feel avoiding intercourse is your only course of action. In fact, regular intercourse can maintain vaginal health, and avoiding it may allow the problem to get worse.

To remedy vaginal dryness and painful intercourse in the meantime, consider using vaginal moisturizers, such as Trimo-san or Replens, applied every few days — or about two to three times per week — to moisturize and keep vaginal tissues healthy.

You also may try vaginal lubricants, like Astroglide or K-Y Jelly, applied at the time of sexual activity to alleviate pain during intercourse. A small amount of pure vegetable oil or olive oil can be more helpful than over-the-counter lubricants.

Many times, women inadvertently worsen their symptoms by using multiple creams or other home treatments before seeing their provider. Consider the following tips to avoid exacerbating symptoms:

• Avoid bath soaps, lotions or gels that contain perfumes.
• Avoid all bubble baths, bath salts and scented oils.
• Do not use hot water while bathing or showering. Aim for lukewarm or cool water, and ensure that you rinse the genital area very well to remove all soap.
• Avoid all feminine hygiene sprays and perfumes.
• Do not use adult or baby wipes on the area.
• Avoid tight-fitting clothing and pantyhose. Wear white, 100% cotton underwear.
• Avoid all over-the-counter creams and ointments, except A+D Ointment. But do not use A+D Ointment if you have a wool allergy.

While these recommendations can be helpful for many women, if symptoms persist despite these changes, your health care provider can suggest treatment options for vaginal dryness. A low-dose vaginal estrogen cream, tablet or ring also may help reinvigorate vaginal tissues.

Vaginal dryness is frustrating, but it is a manageable condition for most women, and treatment can be life-changing for those with severe symptoms. — Dr. Kristina Rauenhorst, Obstetrics and Gynecology, Mayo Clinic Health System, Faribault, Minnesota

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Related Articles 

• Mayo Clinic Q and A: Treatment for vaginal dryness for menopausal women published 7/14/21
• Consumer Health: Treating vaginal dryness after menopause published 5/4/21
• Women’s Wellness: How to treat vaginal dryness after menopause published 8/6/20

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