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Marcia J Oliveira, MD, PA

Obstetrics & Gynecology

Proudly Part of Privia Health

Vaginal Dryness

Vaginal dryness (atrophic vaginitis) is a common symptom for menopausal women and those that had both ovaries removed during their hysterectomy. This presents as vaginal itching or burning, pain with sex, abnormal discharge, and sometimes no symptoms at all. If you suspect you have this, talk to your doctor because several options are available.

What causes this?

  • This too is a result of a decreased amount of estrogen. Estrogen normally keeps the vagina moist and the lining a certain thickness.
  • Decreased estrogen levels can be seen:
    • After having a baby (mom’s that are breastfeeding)
    • Your ovaries are surgically removed
    • During Menopause
    • With certain medication use; such as leuprolide (Lupron), danazol, medroxyprogesterone (Depo-Provera or Provera), or nafarelin. If these medications are discontinued and the woman is not in menopause then estrogen production can resume.

Treatments

  • Treatment options include vaginal estrogen, vaginal lubricants or moisturizers, dehydroepiandrosterone (DHEA), or a pill called ospemifene (Osphena).These can provide relief but will only work with continued use. If these treatments are stopped then the vaginal dryness will return.
  • Vaginal estrogen – This is the most effective option. It comes in the form of creams, inserts (tablets), or a ring. It is given in very low doses so only a small amount is absorbed into the bloodstream. The amount absorbed is about 100 times less than that of estrogen pills/tablets, so there is a much lower risk of blood clots, heart attack, or breast cancer. If you have breast cancer or a history of it consult with you doctor about this option.
  • Vaginal lubricants/moisturizers – This option requires no prescription and little to no side effects. Lubricants are primarily to reduce the discomfort and friction associated with vaginal dryness during sexual intercourse. Vaginal moisturizers are used only a few times a week and allow the vaginal tissue to retain water. Avoid use immediately prior to sex because they could cause irritation.
    • Water or silicone-based lubricants are made to be used with latex condoms and diaphragms. Oil-based lubricants (petroleum jelly, mineral oil, baby oil, olive oil etc.) can damage latex condoms and diaphragms making them less effective. If oil-based lubricants are preferred, polyurethane condoms can be used.
  • DHEA – Prasterone comes in a suppository form to be used daily. Consider this option if you are unable to take estrogen or choose not to use it.
  • Ospemifene (Osphena) – This pill acts like estrogen in the vaginal tissue. This is a good option if you want similar relief of the vaginal dryness without using a vaginal medication.