Recently, I found ourselves discussing the TMI topic of vaginal lubrication. (No overshare is off limits for me, whether you’re a friend or a stranger who reads Well+Good.) I had become concerned about some changes in that department—AKA it was suddenly as dry as the Sahara (or California) down there at, shall we say, inopportune times—and needed to know if I was the only one. I wasn’t. My friends assured me that what I was experiencing was happening to them, too, which had to mean it was “normal.”
But after a visit to my Speciaslist resulted in the opposite verdict—a “Hmm, that’s weird for your age” shrug and a recommendation for what I considered to be an extreme treatment—I decided to investigate. When should dryness raise a red flag? And what, besides stocking up on lube, can you do about it?
Good news: Regular fluctuations in moisture are normal
First and foremost, the idea that healthy women can “get wet” at the drop of a hat (or trousers) is a ridiculous one, says women’s health and hormone expert Alisa Vitti. “Pornography would have us believe that we should be wet constantly, and that is not biologically accurate or possible and doesn’t factor in the myriad hormonal transitions a woman goes through,” she tells me.
Astroglide's Sexologist Jess O’Reilly likewise assures me that “normal” wetness has a range. “You’ll likely find that your lubrication not only varies according to mood and arousal, but also your menstrual cycle, diet, sleep, and hydration,” she says. With respect to the cycle piece of the puzzle, Vitti explains that the ovulatory and luteal phases are wetter while the menstrual and follicular phases are drier. So, any fluctuations in moisture that occur within these parameters are normal.
“Pornography would have us believe that we should be wet constantly, and that is not biologically accurate or possible.” —Alisa Vitti, hormone expert
Jess adds that some people believe your hydration levels affect your lubrication—meaning, you can stave off dryness if you drink enough H20. So, while this is anecdotal rather than science-backed evidence, if you’re finding yourself uncharacteristically dry in this hot season, you may want to up your water intake.
And here’s something you may find surprising regarding the connection between randiness and wetness: “Lubrication isn’t a sure-fire sign of arousal,” says Jess. “Sometimes we’re intensely turned on and we’re as dry as the desert, and other times we’re just riding the bus and find ourselves soaking wet.” Worrying about your moisture situation, however, can kill arousal (and potentially exacerbate the situation), so Dr. Jess suggests you and your partner focus on pleasure—whether or not whatever you’re doing feels good—rather than fluid levels. “You can always use your favorite lube,” she says. (To this end, Sara Twogood, MD, an OB/GYN at USC Keck School of Medicine, recommends store-bought lubricants such as Astroglide instead of oils you find in your kitchen. “Some vegetable oils, like olive oil and coconut oil, shouldn’t be used with latex condoms,” she says.)
Chronic dryness is also considered “normal”…in certain phases of life
What if you experience chronic dryness, whether sudden in onset or as a more gradual change? According to Dr. Twogood, this condition, known as “atrophic vaginitis,” is considered normal when it occurs during the transition into menopause (perimenopause) or during menopause itself. (This doesn’t mean it’s a universal change, however. “In one study, about one in five perimenopausal women complained of vaginal dryness and about one in three menopausal women,” says Dr. Twogood.) The average age for menopause is 51, and perimenopause can occur months or years (even fifteen years) prior.
Changes in lubrication are also common during other times hormones are disrupted, Dr. Twogood says, including postpartum (especially during breastfeeding) and when both ovaries are removed in a process known as surgical menopause.
If it’s happening outside of these circumstances, this might be why
If chronic vaginal dryness occurs outside of these circumstances, Dr. Twogood recommends a visit to the doc for further investigation. “Your gynecologist will review medical problems, surgical history, and medications that may contribute to your vaginal dryness complaints, including autoimmune disorders, a history of ovarian or vaginal surgery, or the use of certain types of contraception, like birth control pills or Depo-Provera,” she says.
Yep, she said that birth control could be a factor. “Contraception methods that suppress ovulation can affect the changes in vaginal discharge that are usually associated with ovulation,” Dr. Twogood explains. “For some women, these changes are described as altering lubrication or feeling dry—especially with the progesterone-only forms of birth control.”
Vitti also notes that synthetic hormones such as birth control can cause changes in sex-hormone-binding hemoglobin—even after you’ve ceased taking the pill—which can also decrease moisture.
Other possible culprits for dryness you should talk to your gyno about include:
Endometrosis: Some treatments for endometriosis, like Lupron Depot, push women into a temporary artificial menopause state, which results in dryness, says Dr. Twogood.
Autoimmune disorders: Primary ovarian insufficiency (which some experts put in the autoimmune disorder bucket) is a cause of early menopause and, therefore, dryness, Dr. Twogood says. Also, severe lupus and rheumatoid arthritis are sometimes treated with medications that can have vaginal dryness as a side effect, such as high dose steroids or methotrexate.
Surgeries: It’s not just removal of your ovaries that can cause lubrication issues. Dr. Twogood tells me that if you’ve had your Bartholin glands—the glands located near the vagina that secrete moisturizing mucus—removed due to cysts or recurrent abscesses, you may experience less severe dryness as well.
Lube is great! But it’s not the only answer
Balancing your hormones
If you’re suffering from estrogen-related dryness, Vitti offers a potential solution: Balance your hormones. “If you’re dry during the ovulatory phase, for example, you may not have actually ovulated, even though you may still menstruate,” she says. “Supporting insulin, cortisol, and estrogen hormones will help you regain ovulation and lubrication.” Diet and exercise are critical components of any hormone-balancing regimen, so you may want to start there. Or, you could try something called seed cycling.
Supplements
Vitti also tells me you can biohack your vaginal moisture through dietary changes and supplements. She recommends adding phytoestrogenic foods such as flaxseed meal, oil, soy, and miso to improve dryness. Maca, which raises estradiol levels, can help, too, as can vitamin E, which Vitti says increases blood supply to vaginal tissue.
A company called Femininity also makes a supplement specifically geared towards vaginal dryness. It’s made with sea buckthorn, which founder Bruce McMullin explains is a uniquely-rich source of Omega-7. He tells me that studies have shown the nutrient to be beneficial for those who suffer dryness of mucous membranes, including those of the urogential tract.
Over-the-counter treatments
Over-the-counter topical ointments referred to as “vaginal moisturizers”—like Replens or Vagisil—are another treatment option for women dealing with dryness, says Dr. Twogood. And you know that super-hydrating ingredient, found in moisturizers, called hyaluronic acid? Apparently, there’s an OTC vaginal version, which Dr. Twogood says may be helpful for some women as well (research backs her up).
Estrogen and DHEA
For perimenopausal and menopausal women, estrogen is considered the best treatment for vaginal dryness, according to Dr. Twogood; however, she notes that women should consult with their doctors before taking any sort of estrogen treatment because it may not be advised if they have a history of breast cancer, blood clots, or abnormal/unexplained vaginal bleeding, among other reasons. Estrogen treatments come in many forms, but Dr. Twogood tells me that if atrophic vaginitis is the main complaint, most experts will recommend vaginal-based estrogen, which comes in cream, suppository, and ring form.
When I went in complaining of dryness, my doc prescribed a sexy estrogen suppository. I was surprised, and hesitant to take it.
When I went in complaining of dryness, my doc prescribed a sexy estrogen suppository. I was surprised, and hesitant to take it because I’d heard about a connection between estrogen therapies and certain kinds of cancers. When he waved away my concerns, I did my own research. Apparently, applying estrogen directly to the vagina in this way—as opposed to taking pills or using patches, which is what’s often been done in traditional menopausal hormone therapy—allows for lower dosages, which reduces the cancer risk; however, there have been no clinical studies of low-dose vaginal estrogen treatments that look at the effects more than a year later. (One observational study does suggest its extended use is safe.) If you’re wondering: I ultimately opted against the suppository for now in favor of holistic therapies (and lots o’ lube) because I’m nowhere near menopausal and didn’t see how this treatment could sustain if I wasn’t assured of its safety over time.
According to Vitti, there may be an alternative for those who can’t take or who are hesitant to take estrogen. Studies are showing that treatment via another type of hormone called dehydroepiandrosterone (DHEA), which was recently approved by the FDA for the treatment of painful sex in postmenopausal women, is proving to be effective as well.
Vaginal rejuvenation lasers
Another new treatment—vaginal rejuvenation lasers—has found itself at the center of controversy. Recently, the FDA issued a statement saying such lasers were not approved for the conditions they were treating, e.g. vaginal dryness and pain during intercourse; however, Dr. Twogood tells me doctors are fighting back.
“There’s an outcry against the FDA warning—gynecologists are complaining that the warning against lasers is too generalized,” she says. “There is consensus that [the concept of] ‘vaginal rejuvenation’ should not be marketed towards women, but that lasers can be an effective treatment option for the right candidate after counseling.” Patients who have seen success, Dr. Twogood continues, are mostly postmenopausal or haven’t had luck with—or aren’t able to pursue—other treatment options, including estrogen. In other words, while vaginal rejuvenation as an idea is problematic—um, our aging vaginas are just fine y’all—the use of lasers to treat the painful effects of atrophic vaginitis might not be.