Dry vagina
Vaginal lubrication
The natural moistness of the vagina prevents its sides from rubbing against each other as you move about during the day. The vaginal moisture is also slightly acidic, and this helps to keep infections such as thrush at bay. This acidity is caused by the friendly bacteria that live in the vagina and help to keep it healthy.
Vaginal moisture is mainly produced by the cervix (neck of the womb) at the top of the vagina and eventually oozes out of the vagina – some vaginal discharge is normal. This means that there is a very slow flow of moisture through the vagina, and this keeps it clean, as it moves dead cells and the remains of the menstrual period to the outside. On average, a woman discharges 2 grams of dead cells and 3 grams of mucus through the vagina each day.
During sex. When you are sexually excited, two special glands at the entrance of the vagina, called Bartholin's glands, produce extra secretions. The moisture from these glands is more slimy than the moisture from the cervix, because its purpose is to provide good lubrication during intercourse. Its musky smell is the result of millions of years of evolution to increase female attractiveness to the male of the species, and signals that the woman is ready for sex.
Vaginal dryness before the menopause
Vaginal dryness before the menopause is mostly a problem during sex. It may mean that you are not sufficiently aroused which can occur for all sorts of reasons such as inadequate foreplay, feelings of guilt, fear or relationship problems. Also remember that men generally get aroused sooner than women, so your partner may be attempting penetration before you are ready, before good lubrication has occurred. Lack of lubrication is also common in breastfeeding women, because oestrogen levels are low, and in women with diabetes.
Vaginal dryness during or after the menopause
Vaginal dryness can be a particular problem at and after the menopause, because of a lack of oestrogen (the female hormone). Oestrogen is responsible for the plumpness of the lining of the vagina, for the elasticity of the tissues round the vagina and for the production of the moisture from the cervix.
Oestrogen levels fall at the menopause, so the vagina loses some of its elasticity, its lining becomes thinner and it feels dryer. Because there is less moisture, there are fewer of the ‘friendly’ bacteria that help to keep the vagina acidic. When the vagina becomes less acidic, infections such as thrush can take hold, which cause further irritation and discomfort.
All these changes can make intercourse uncomfortable, so it is not surprising that about 40% of women report painful intercourse after the menopause. Another factor is that after the menopause, the Bartholin's glands are less efficient they take longer to produce the lubricating juices for sex, and produce less than in younger women. The American sex researchers Masters and Johnson showed that whereas younger women may become sufficiently aroused for penetrative sex in as short a time as a few seconds, menopausal women may take 5 minutes or more.
What to do about vaginal dryness before the menopause
A dry vagina can be lubricated easily. For additional lubrication for intercourse, use a water-soluble lubricant (for example, KY jelly) or a vaginal moisturizer (for example, Yes, Sylk, Replens or Senselle) rather than a petroleum-based product like Vaseline, which may interfere with your natural secretions. Apart from Sylk (available by mail order and from some stockists) and Yes (available by mail order) (see Useful contacts), these products can all be bought from a pharmacy you do not need a prescription. Sylk is a lubricant derived from an extract of kiwi fruit; obviously you should not use it if you are allergic to kiwi fruit. It has a non-sticky texture very similar to natural vaginal lubrication. Some lubricants damage condoms; Sylk, KY jelly, water-based formulation of YES, Replens and Senselle do not.
Sylk, Yes and KY jelly are used just before intercourse. Smear the product liberally over the vulval area, particularly round the opening of the vagina.
Replens and Senselle are moisturizers that you use two or three times a week. They coat the inside of the vagina with a non-hormonal moisturizer, which lasts for a day or two, so they do not have to be used immediately before intercourse.
What to do about vaginal dryness during and after the menopause
Leisurely sex with lots of foreplay. Taking time during sex is particularly important for the older woman. This allows the Bartholin's glands to produce the maximum amount of lubrication before penetration.
Simple lubricants, such as KY jelly, or moisturizers, such as Replens or Senselle, can be used if you need additional lubrication for intercourse.
Hormone replacement therapy (HRT) will increase vaginal lubrication and thicken the vaginal lining, but has risks. Therefore, HRT is not appropriate if vaginal dryness is your only problem; there are safer ways of dealing with dryness.
Vaginal oestrogen creams can be prescribed by your doctor if you prefer not to take HRT. For the first 2 or 3 weeks you use it every night, and it may be a few weeks (or even months) before you notice any improvement. After that, twice a week will be enough.
The creams can be messy. Some come with a special syringe (applicator) to help you insert the cream into the vagina. In fact, the applicators are more trouble than they are worth, because they have to be washed in warm soapy water after each use. More importantly, they tend to give you too much cream. Some of the oestrogen will then be absorbed through the vaginal wall into the bloodstream, where it could be harmful. It is better to smear the cream inside your vagina with your fingers, and not to be over-lavish. If you are not used to touching the inside of your vagina you may find this peculiar at first, but you will very soon become quite relaxed about doing so.
Unless you have had a hysterectomy, oestrogen in the bloodstream needs to be balanced by progesterone tablets, otherwise there is a slight risk of cancer of the uterus (womb). Hormone replacement tablets provide both oestrogen and progesterone, but vaginal cream contains only oestrogen. Some of the oestrogen from the cream will enter the bloodstream through the walls of the vagina. Therefore, to be on the safe side, some doctors prescribe progesterone tablets for women using oestrogen vaginal cream.
Because some oestrogen from a vaginal preparation (whether it is a cream, tablets or ring) may enter the bloodstream, there have been worries that it could cause health risks like HRT. So far, there is no evidence for this (Climacteric 2008; Dec 31:1–15), but research is ongoing.
Vaginal oestrogen tablets are another possibility. They need a doctor’s prescription. Each tablet comes in an applicator, which is about the size of a pencil. You insert the applicator into the vagina and press the end to release the tablet into the vagina. For the first 2 weeks you use one tablet a day, but later only two a week are needed.
Oestrogen-containing vaginal ring. This type of ring may be suggested by your doctor. The ring gradually releases oestrogen into the vagina. It has to be replaced every 3 months, and you must not use it for more than 2 years in total. It is not painful or uncomfortable, but you might feel a slight irritation at first. Some people find that it gets in the way during intercourse, in which case you can remove it beforehand and put it back afterwards. It is easy to take in and out – your doctor will show you how.
Black cohosh capsules can be bought from health food stores. Black cohosh comes from the root of a plant. It is commonly used for menopausal symptoms in Germany. A study in 1987 in Germany found that black cohosh had an oestrogen-like effect on the lining of the vagina, which might translate into better vaginal lubrication. However, this study has been criticized because, surprisingly, it also showed that oestrogen had little effect; scientists therefore think that the study may not be reliable. Black cohosh may cause liver damage; more research is needed.
Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated:
Friday, February 26th 2010
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Comments on this article
Posted by NIKKIl on 14/03/2010 at 04:54:10 pm
HAVE BEEN ON HRT 9YRS NOW HAD A FULL HYSTRECTMI. LAST 3 MONTHS VIGINA SMEEL AFTER BATHS
Posted by Optional on 10/03/2010 at 11:52:06 pm
good. informative.
Posted by Anonymous on 28/01/2010 at 08:16:00 pm
ploblems with dry vagina. please advise supplements or gels ect. not HRT
Posted by Anonymous on 25/01/2010 at 04:49:00 pm
m 25 n m experiencing the problem of vaginal dryness during intercourse and think this is disturbing to my partner as it appears as though m rejecting him.m dry even wen m excited.wat can i do n wat could be causing the problem?
Posted by blessing on 12/01/2010 at 09:20:00 pm
what is the causes of not having the feeling to have sex
Posted by sky on 03/01/2010 at 09:02:00 am
Hi I (female), 34 and married in year 2004 and tried to have intercourse. I have found that mu husband actually has problem of penetartion as my vargina very dry. after 6 years, i still cant get pregnant as penetration some only hakf way, how to get conceive. Please advise whether I can apply any cream into the vargina. Any food can help to improve the varigna dryness? Thank you. Regrad SKY
Posted by Susan Torry on 16/12/2009 at 11:31:00 pm
I had a hysterectomy 1977, and was put on HRT until 6 years ago. Hve suffered with a sore vagina, no discharge, and no particular itching, just very sore. Have been going back and forwards to GP. Sometimes they have given me canestan pessaries, and at first they worked, but then they said that my oestrogen levels were low, and they have now given me Vagifem for twice a week, and if I get sore in between then they have given me Elocon Cream to use. I am only getting relief for a few days at a time, and sometimes if I am lucky then a week. Is my GP prescribing me with the correct medication, or is there something that I can buy as well.
Posted by kristi on 13/12/2009 at 10:42:00 pm
I tried the Liquid Goddess and was happy with it, but it is strange to melt it first before use. very effective on the yeast issue though, have any of you tried the other one they make? not sure what the name is
Posted by Lebo on 10/12/2009 at 08:07:00 am
I started using the birth control injection (Depo Provesa) in May this year but didnt go for the second time because i had headacheas all the time and felt naucious because of it.My problem is that since getting the injection,i am expirencing vaginal dryness and my period is now iregular.It comes after 2months for two whole weeks.Is this normal?
Posted by Anonymous on 18/11/2009 at 02:07:00 pm
I've been using Starglide Bio Sensitive for a few months and love the stuff, it's all natural and has Aloe Vera which has really helped since going through the menapause. They've got a website www.starglide.co.uk
Posted by Anonymous on 18/10/2009 at 04:07:00 pm
had hysterectomy at 31. now have lost my sex drive,cant have hrt because of history of breast cancer and scares,any advice please.
Posted by Leah on 03/06/2009 at 12:05:00 am
I too have tried various lubricants which have not helped at all. I recently came across an interesting website which might be helpful to others as well. The website is www.vaginismus.com. After reading some of the information on this site I'm beginning to feel that this could be my problem. You also might be able to relate to their information.
Posted by ohlalal on 24/05/2009 at 10:08:00 am
im am having a vaginal problem, when my husband and i having a sex its really painful because of the dryness, im only 21, what should i do, so we can enjoy our sex activity?
Posted by Maria on 18/05/2009 at 10:38:00 pm
The directions on Replens says that a white looking discharge is normal as it is the old cells coming away from the vaginal wall. I have persevered but the white stuff is still coming even after a month. This is so embarrasing when being intimate I have decided to stop using it and give Yes a go instead.
Posted by CAROL on 27/04/2009 at 06:08:00 pm
After using Replens I now have a horrible thick green/yellow discharge which fortunately has no smell but I am having to use pads as it is so bad. Could anyone please advise? Thank you
Posted by Anonymous on 20/04/2009 at 09:47:00 pm
I have had breast cancer and am now experiencing vaginal dryness. I would like to use a vaginal lubricant with a dispenser to insert before having sex which is now painful for me. It must not give off hormones that would likely increase my chances of breast cancer returning.
Posted by Mommyof7 on 16/04/2009 at 08:39:00 pm
I use a product I found on amazon, called Liquid Goddess. it the best natural lube i have tried. no chems, lasts forever and it also fights candida. check their site out www.liquidgoddess.net
Posted by Anonymous on 05/04/2009 at 09:51:00 am
im having a problem of vaginal dryness during sex, my body does not respond to being romanced. im so scared of sex, it does real hurts and horrible but my boyfriend enjoys it a lot. i was sexually abused several times by men as a little girl, thats why im scared of sex. what i know is that it hurts! i really need help.
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