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DEAR MAYO CLINIC: I am 52 years old and have been menopausal for the last two years. I am experiencing some vaginal dryness. Is this normal? Is there anything that can be done for it? I have tried using over-the-counter lubricants and they don’t seem to help much.
ANSWER: Vaginal dryness is very common in women who are approaching menopause, as well as those who have gone through menopause. Over-the-counter products can be helpful. But when they are not, prescription medications are often a useful alternative.
Before menopause, a thin layer of moisture coats the vaginal walls. When a woman is sexually aroused, more blood flows to the pelvic organs. That produces more lubricating vaginal fluid. But hormonal changes can affect the amount and consistency of the moisture. For middle-aged women, those changes are frequently triggered by aging and menopause.
As a woman ages, her body makes less of the hormone estrogen. In the time just before, during and after menopause, estrogen decline becomes more rapid. As a result of the loss of estrogen, blood flow to the vagina decreases, the walls become thinner and less elastic, and moisture decreases.
Several types of nonprescription products that you can buy over-the-counter are available to help relieve vaginal dryness. Water-based lubricants can be effective, but they are designed to work for only a few hours. Moisturizers that mimic your body’s natural lubrication can work for up to three days with one application. For the greatest effect, they need to be used consistently. You may need to try a few varieties of these products to find the one that works best for you.
You also may be able to help decrease vaginal dryness by not using products on or near the vaginal tissue that could cause irritation, such as antibacterial or fragrant soaps, bubble baths, bath oils and hand lotion. Avoid perfumed or scented toilet paper and laundry detergent, too. Do not use douches or flavored or warming lubricants.
Make sure your partner knows what’s happening, too. Talk about what feels good during sex and what doesn’t. When you are intimate with your partner, give yourself plenty of time to become adequately aroused. That can help with lubrication. Having intercourse regularly also may help reduce vaginal dryness.
If those steps are not enough to overcome dryness, make an appointment to see your doctor. He or she may suggest a prescription medication that contains estrogen. In many cases, a topical form of estrogen is most effective for treating vaginal dryness. The medication places the hormone directly in your vagina. It comes in several forms, including a cream, a tablet and a ring, and can be used long term without concern for serious side effects.
In some cases, dryness and thinning of the vaginal walls can result in pain during sex. Vaginal estrogen can be an effective treatment for this problem as well. If pain during intercourse persists despite estrogen therapy, tell your doctor and have the condition evaluated. A variety of other causes could be contributing to it. Sexual intercourse should not be painful.
Although vaginal dryness is a common problem for women your age, it is not a condition that you just have to learn to live with. Effective treatments are available that can help women reduce dryness and remain sexually active long past menopause. — Stephanie Faubion, M.D., Women's Health Clinic, Mayo Clinic, Rochester, Minn.