Most Common Causes of Vaginal Dryness — How to Treat It

We associate youth with a lot of sweet physical perks — from being bright-eyed and raring to go after a night of margaritas with your BFFs to recovering speedily from a brutal sweat session. The other perk? Never having to deal with the frustrating and uncomfortable issue of vaginal dryness.  

But although the condition is frequently attributed to a dip in estrogen that could come with perimenopause and menopause, it's not necessarily always due to simply getting older. Causes of vaginal dryness include everything from medications to irritants like fragranced body wash. 

And while it might initially seem like an issue that's NBD, persistent vulva and vaginal dryness can lead to an array of unpleasant downstream effects, such as itching, swelling, burning, UTIs, pain with sex, and yeast and bacterial infections, notes ob-gyn Sherry Ross, M.D., author of she-ology and co-founder of URJA Intimates skincare. And needless to say, these ailments can lead to emotional and physical disruptions in your daily activities, especially in the bedroom. In fact, research shows around 17% of premenopausal women aged 17-50 report problems with sexual intercourse due to vaginal dryness.

For that reason, if you're experiencing vaginal dryness, it's a must to pinpoint the root cause. Here, what Dr. Ross and other experts say are the most common culprits and how to identify the best treatment.

If you're dealing with vaginal dryness, it's important to know first and foremost that the female anatomy is a delicate region and is susceptible to subtle hormonal shifts and life stressors, points out Alexis May Tran Kimble, DO, Medical Director of Women's Center for Pelvic Wellness in Pasadena, California.  

A few possibilities that could be at the root of the issue: 

Whether you're dealing with the precursor to menopause or the real deal, which generally occurs between ages 40 and 58, you'll experience a loss of estrogen. Premenopausal stores of the female hormone help to nourish and hydrate the delicate tissue of your ladyparts, allowing for lubrication, elasticity, and thickness, explains Dr. Ross. But with lower levels of the hormone comes thinning, drying, and inflammation of the vaginal walls. 

The issue is so common that, according to research published in Menopause, up to 67% of women experience vaginal dryness the year after they've gone through menopause. 

If you're premenopausal and have been experiencing vaginal dryness over the past year and a half especially, it's quite possible that stress is the root cause. 

And if you're struggling with vaginal moisture in the heat of the moment, it's important to remember that sex is truly a mind-body experience, points out Suzanne Gilberg-Lenz, M.D., an ob-gyn and integrative medicine practitioner in Beverly Hills, California. "We need to normalize that dryness in the context of sex may be your body telling you something," she notes. "Do you need more sleep? Are you needing another form of affection or self-care or self-love?" 

Just like a new laundry detergent could cause a rash to spread across any part of your body, a variety of bath and body and household products could trigger vaginal dryness by disrupting the delicate pH balance of the area, explains Dr. Ross. Common irritants you may or may not realize are problematic include:

• Fragrant soaps, bubble bath liquids, bath salts, talcum powder
• Detergents, fabric softeners, and dryer sheets
• Sanitary wipes and pads
• Warming gels and scented lubricants
• Nylon underwear or bathing suits
• Rubber or latex products like diaphragms and condoms
• Saliva or semen
• Spermicides like foams, creams, and jellies
• Feminine hygiene sprays, tampons, or deodorant pads
• Shaving or waxing 
• Douches

For women in their 20s and 30s, vaginal dryness could be linked to low estrogen birth control pills or a progesterone-only implant or injection, all of which suppress ovulation and production of estrogen, explains Yvonne Bohn, M.D., ob-gyn and Cystex Chief Medical Correspondent..

Other meds like antihistamines, which dry up mucus membranes, and antidepressants, which can affect libido, might also curb vaginal moisture, adds Dr. Ross. 

Vaginal dryness could be another reminder to never underestimate the sneaky side effects of living through a global lockdown. Dr. Gilberg-Lenz says she saw more pelvic and vaginal complaints than ever before over the past year and a half, attributing the uptick to her patients sitting on Zoom all day on the couch in yoga pants. 

Your vulva and vagina's health requires movement, she says. The reason: "Lack of air flow can lead to an overgrowth in bacteria and possibly infection, which can cause inflammation and dryness. Additionally, if the muscles of the pelvic floor aren't moving regularly they can become tight; this referred pain can feel like burning and dryness," explains Dr. Gilberg-Lenz.

The best treatment for vaginal dryness will depend on the exact root cause, notes Dr. Bohn. Once you've identified and confirmed the culprit with your physician, you might try:

If your contraceptive method is leading to low estrogen, talk to your doctor about a nonhormonal option like a copper IUD, condoms, or the new prescription contraceptive gel Phexxi, suggests Dr. Bohn.

And if vaginal dryness is linked to breastfeeding, menopause, or perimenopause, estrogen creams or tablets can be placed in the vagina can boost levels of the hormone locally, she notes.

"Stress doesn't have to be associated with a negative physical or mental outcome especially under the sheets," notes Dr. Ross. To rein in the negative impact chronic stress could be having on your sex life, she suggests relaxation techniques like:  

• Biofeedback
• Guided imagery
• Tai Chi
• Massage
• Acupuncture

"If you believe this dryness is due to stress or a lack of interest in sex, it is important to pinpoint if the difficulty is psychological, with your partner or their performance, with your relationship, or a combination of these factors," adds Jill Maura Rabin, M.D., professor of obstetrics and gynecology at the Zucker School of Medicine at Hofstra Northwell in Hempstead, New York. 

She recommends seeing a therapist — either solo or with your partner — to tackle any of these issues, adding, "If you are participating in sexual activities that are making you uncomfortable or are in a potentially abusive relationship, it is extremely important to get help as soon as possible." 

Keeping the body hydrated helps keep the vagina hydrated too, explains Dr. Ross. After all, water makes up 60% of our body weight, so constant replenishing is key. 

The amount of water you should be consuming depends on how active you are, if you have any medical problems, and the climate you live in, but in general you need to drink at least eight 8-ounce glasses or about two liters of water a day, she notes. And you'll want to be sure you're consuming alcohol and caffeine in moderation since both cause dehydration of the skin and cause dryness of the vagina, says Dr. Ross. 

If you're experiencing dryness during sex — even after you've enjoyed plenty of arousal-boosting foreplay — consider reaching for a water-based lubricant (such as Astroglide). "Water-based lubricants are a safe and simple place to start when trying to troubleshoot the sensation of vaginal dryness," explains Patricia Lenihan, M.D., assistant professor of obstetrics and gynecology at McGovern Medical School at UTHealth. "If the cause of the vaginal dryness is a low estrogen state, the lubricant provides an extra layer of protection from friction against thinner vaginal mucosa."

But if you're looking for a product that will offer relief outside of the bedroom, she recommends against reaching for over-the-counter vaginal moisturisers. "They may contain ingredients that have not been well studied for long-term safety," says Dr. Lenihan. "Additionally, some of these treatments may have ingredients that could cause reactions with sensitive skin." For those reasons, she advises discussing use of these products with your physician first. 

Experts we spoke with emphasized the importance of making an appointment with your physician to ensure you're addressing the issue in an individualized way. "Track your symptoms with a symptom diary and bring it to your physician," suggests Dr. Rabin. "This is so that you can have a physical exam and share with them your complete history. Don't forget to write down your questions, because it's important to make sure that all of your issues get addressed."

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