DEAR MAYO CLINIC: What causes vaginal dryness, and how is it treated?
ANSWER: Vaginal dryness, or inadequate vaginal lubrication, can occur at any age. However, the problem is most common for women during and after menopause.
Symptoms of vaginal dryness can include itching and stinging around the vaginal opening and inside the vagina. It can also make sexual intercourse uncomfortable or painful and may be associated with urinary frequency or urgency.
Reduced estrogen levels are the main cause of vaginal dryness. When estrogen levels decrease, vaginal tissue becomes thinner, drier, less elastic and more fragile. The most common cause of low estrogen levels is menopause, which can occur naturally or after the ovaries are surgically removed. Estrogen levels can drop at other times as well, such as after childbirth and when breast-feeding. There also are cancer therapies - such as chemotherapy, pelvic radiation and anti-estrogen hormone therapy - that can damage the ovaries and cause low estrogen.
Some diseases, medications or feminine hygiene products also can cause vaginal dryness. For example, Sjogren's syndrome is an autoimmune disease that attacks healthy tissue and causes dryness in the eyes, mouth and vagina. Allergy and cold medications containing antihistamines also can decrease moisture in many parts of the body, including the vagina. Douching or the overzealous use of other feminine hygiene products can change the vagina's chemical balance and cause dryness.
The treatment of vaginal dryness depends on the cause. Estrogen is the best treatment for vaginal dryness caused by low estrogen levels - as long as there are no contraindications to using estrogen. Vaginal estrogen - in the form of a cream, ring or tablet - is usually preferred because it can be effective when given locally and estrogens inserted into the vagina release only a small amount of estrogen into the body.
For women who have low estrogen and other symptoms besides vaginal dryness, such as hot flashes, systemic estrogen therapy might be best. This type of estrogen is released throughout the body and can be taken orally as a pill, or transdermally as a skin patch, spray, emulsion or gel. A vaginal ring with both systemic and local effects is also available.
An over-the-counter vaginal moisturizer or lubricant is another treatment option for vaginal dryness. Moisturizers can relieve dryness for up to three days with a single application. They should be used on a regular basis over time to get the maximum benefit. A lubricant is more of a short-term treatment. It's used with sexual intercourse and can help if vaginal dryness makes sex uncomfortable.
Sexual activity itself can help with lubrication by increasing the blood supply to the genital area. Studies have also shown that after aerobic exercise, women have a significant increase in the blood flow to the genital area and become more receptive to sexual stimulation. In fact, I tell my patients that exercise is much like a natural Viagra, without the side effects.
Anytime a woman has symptoms associated with vaginal dryness, she should see her doctor to find out what might be causing the problem. This is particularly true when vaginal dryness occurs during menopause. Unlike hot flashes, which may resolve within five years in most women, vaginal dryness associated with menopause will continue and progress. Yet there's no reason to suffer. Vaginal dryness is common, but effective treatments are available. - Rosalina Abboud, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota>
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