So dry, you wanna cry? Though it’s much more common after menopause, dryness and thinning of the vagina is the most common cause of discomfort and painful sex in midlife.
Changes to your vagina usually occur both during perimenopause and menopause, when periods slow or stop in response to decreased reproductive hormone levels. Dryness is also likely to occur a year or two after your periods cease.
Why am I experiencing vaginal issues during menopause?
When your body produces less estrogen, there’s a reduction in blood circulation to the vulva, the clitoris, and the vagina. Essentially, your vagina goes into a dormant state. This makes it more difficult for the vagina to produce natural lubricants. In short, while you may be aroused or full of desire, you may find you’re not as wet as you had been.
Dry, fragile vulvovaginal tissues are susceptible to injury, tearing, and bleeding during sex. Vaginal dryness can make sexual activity painful, especially if you haven’t had sex in a while.
So what is vaginal atrophy, anyway? It’s a term in dire need of a rebrand, and it happens when the vaginal canal becomes dry, thin, and inflamed. The vaginal canal can also narrow and shorten, while the drop in estrogen changes the acid balance of the vagina.
“Atrophy is characterized by the vaginal tissues becoming thinner, less elastic, and less moist,” says Linda M. Nicoll, a New York–based gynecologist and surgeon. “This can cause discomfort, especially during sex.”
Vaginal atrophy may also cause you to see some yellow-ish discharge. This is not to be confused with the discharge that comes with a yeast infection, which also causes itchiness and dryness, but is white-ish gray, thick, and odorless.
According to the Mayo Clinic, menopausal women age 50 and over are the most likely to experience vaginal atrophy. Other contributing factors include:
Never having had a vaginal birth
Breast cancer treatment
Decreased ovarian function due to chemotherapy or radiation therapy
Oophorectomy (removal of the ovaries)
Postpartum loss of placental estrogen
What you need to know about Genitourinary Syndrome of Menopause (GSM)
Genitourinary syndrome of menopause (GSM) is an umbrella term for a variety of sexual and urinary health problems that can go hand-in-hand with menopause.
In addition to dryness and atrophy, vaginal dryness, burning, itching, sexual discomfort, pain during sex, pain during urination, urinary tract infections, dysuria, and urinary urgency are all symptoms of GSM. The Mayo Clinic estimates that at least half of women who enter menopause suffer from aspects of genitourinary syndrome.
Can vaginal atrophy and dryness be reversed?
The good news is that there are many things you can do without medication to soothe, lubricate, and moisturize your vagina. Here are some treatments to try.
Have sex with a partner, or with yourself: Being sexually actively on a regular basis can keep the vagina more supple and elastic, says Nicoll. Use a lubricant during sex to decrease discomfort and to perhaps also add fun and variety in the bedroom. Shy about putting lube in your grocery cart? Nicoll suggests going online, where you’ll find a world of options.
Not sexually active these days? Women who aren’t sexually active (and women who are sexually active but seek relief at other times) can use a vaginal moisturizer to hydrate and maintain moisture.
Consider low-dose hormone replacement: Estrogen alone can be used as a cream, capsule, or a pill inserted into the vagina; or women can use combination hormone therapy with pills, patches, gels, and other formulations. For vaginal dryness, a local solution is the most effective.
When should I talk to my doctor about vaginal dryness?
Your gyno or healthcare provider can give you guidance toward relief. If you experience pain, itching, or burning when urinating, definitely mention it. Don’t be shy about asking for treatments and therapies.
Also, and this is important: If you’re experiencing vaginal dryness, irritation, burning, itchiness, or pain, don’t automatically chalk it up to menopause. Talk to your doctor to rule out other health issues, such as vaginitis or a urinary tract infection.
Your vaginal health deserves top priority, especially if you’re experiencing discomfort or bleeding, or if it’s impacting your sex life or interfering with intimacy. Relief is out there. You (and your vagina) deserve to feel relief and at home in your body.