What is vaginal dryness (vaginal atrophy)?

Vaginal dryness is something that affects a lot of women at some point in their lives. Vaginal dryness happens when the walls of the vagina become thinner (atrophic) and produce less natural lubrication.

Vaginal dryness can affect all women. But, it’s most common if you’ve gone through the menopause. More than one in two women who have gone through the menopause get vaginal dryness.

It’s not a very serious health problem. However, getting vaginal dryness can be unpleasant because it can affect your comfort, day to day activities, sex, and relationships with partners.

Back to top

What causes vaginal dryness?

Vaginal dryness is most commonly caused by hormone changes. Hormones like oestrogen help the body to make the right amount of natural lubrication around the vagina. So, if there’s not the right balance of oestrogen in your body, there won’t be enough lubrication. Vaginal dryness caused by hormone changes can happen if you:

• are going through the menopause

• are breastfeeding

• take certain medications, like the contraceptive pill or some types of antidepressants

• take medications to reduce your level of oestrogen, e.g. to treat fibroids or endometriosis

• have had your womb and ovaries removed

• have had treatment for any cancer, like chemotherapy or radiotherapy

There are also causes of vaginal dryness that aren’t related to hormones:

• douching (cleaning inside the vagina) or having very hot baths – this can strip the vagina of its natural oils and lubrication which causes dryness and irritation

• Sjögren’s Syndrome – a rare autoimmune problem where the body attacks its own cells that make fluids

Some women notice vaginal dryness when they’re having sex which can cause discomfort or pain. Vaginal dryness during sex can be caused by not being turned on enough before having sex.

Back to top

What are the symptoms of vaginal dryness?

If you get vaginal dryness, you might notice:

• soreness or itching around the lower vagina

• soreness or itching around the opening of the vagina (vulva)

• pain or discomfort during sex

• light bleeding after sex

• getting water infections (urinary tract infections or ‘UTIs’) more often

• not getting a lot of warning before you need to pee (urgency)

• needing to pee more often

• thinner vaginal lips (labia)

Back to top

Why does vulval itching get worse at night?

Out of the women that have itching because of vaginal dryness, one in ten say that the itch gets worse at night.

There can be a few reasons for this – for one thing, when you lie still to go to sleep, you’ll get less distractions than you would during the day. So, you’re more likely to notice an itch at night. 

You also have an internal clock (circadian rhythm) which causes your body to go through small changes throughout the day:

• At night, your body temperature goes up and the heat can make you feel more itchy.

• Your body also releases chemicals that can cause more irritation at night.

• Also, you lose more water during the night. This can dry out your skin and make you feel itchy.

If you itch during the night, you can take antihistamines before you go to sleep. Certain antihistamines like Piriton can even make some people feel sleepy, which might help if your sleep is disturbed because of your itch.

Back to top

Can vaginal moisturisers like Vagisan help?

Vaginal moisturisers can improve vaginal dryness. Improving dryness can stop symptoms like:

• soreness or discomfort

• pain, dryness, or discomfort during sex

It’s a good option if you can’t or don’t want to use any treatment that contains hormones. And, you can get vaginal moisturisers without a prescription, so it’s also a good option if you don’t want to have a consultation with a doctor about your symptoms.

Make sure you find the right vaginal moisturiser that’s made for internal use. Using the wrong moisturiser could make things worse.

Back to top

When should you try oestrogen creams?

You can order oestrogen creams for vaginal dryness if you think you might have vaginal dryness, your symptoms are bothering you, and you’ve been through the menopause. You can also order oestrogen pessaries (vaginal tablets). Oestrogen medications available for vaginal dryness include:

• Creams:
  

• Estriol

• Ovestin

• Pessaries – Vagifem

If you’ve been through the menopause, you can order oestrogen creams or pessaries from Superdrug Online Doctor. Just follow these steps:

• Fill in a short online questionnaire about your symptoms and about your general health.

• Place an order for your treatment and make a payment.

• A doctor will review your questionnaire to see whether the treatment you’ve chosen is the right choice and it’s safe for you.

• Your treatment can be sent to your preferred address by post. Or, you can choose to collect it from a local Superdrug Store.

• If treatment isn’t right for you, you’ll be refunded and your doctor will send you a message through your account with advice.

You shouldn’t use oestrogen creams or pessaries if:

• you have a higher than normal risk of clots in your arteries, for example if you have angina or you’ve recently had a heart attack

• you have a higher than normal risk of clots in your veins, for example if you’ve had a deep vein thrombosis or pulmonary embolism in the past

• you have thrombophlebitis, which is inflammation and blood clotting in your blood vessels – this condition normally happens during pregnancy or with varicose veins

• you’ve ever had breast cancer

• you have any other health conditions which affects how your blood clots

• you’ve had bleeding from your vagina before but your doctor hasn’t diagnosed a cause

• you have a condition called endometrial hyperplasia and you’re currently not on any treatment for it

We can’t offer vaginal dryness treatment to you if you’ve not been through the menopause. If this is the case for you, it’s a good idea to see your GP for advice and treatments.

Back to top

What’s the best treatment for menopause-related dryness?

The best treatments for menopause-related dryness are oestrogen creams or pessaries (vaginal tablets). Oestrogen medications can improve the following symptoms:

• dryness

• pain, dryness, or discomfort during sex

• not getting a lot of warning before you need to pee (urgency)

• needing to pee more frequently

• getting water infections (urinary tract infections or UTIs) more frequently

If you can’t or don’t want to use any treatments that contain oestrogen, you can try vaginal moisturisers, like Vagisan.

If you get pain, dryness, or discomfort during sex, you should use lots of lubrication during sex to improve these symptoms.

If you’re bothered by itching due to vaginal dryness, you can try taking antihistamines just before you go to bed.

There are also general lifestyle changes you can make to improve blood flow around your whole body which can help improve vaginal dryness. You should make sure you get regular exercise and eat a healthy, balanced diet.

Back to top

Sources

Edwards, D. and Panay, N. (2016). Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric; 19(2): 151-161.

Joint Formulary Committee. Estriol. British National Formulary. London: BMJ Group and Pharmaceutical Press. [online] Available from: https://bnf.nice.org.uk/drug/estriol.html#contraIndications [accessed on 12th July 2019].

Kaur, J. and Kalsy, J. (2017). Study of pruritus vulvae in geriatric age group in tertiary hospital. Indian Journal of Sexually Transmitted Diseases and AIDS; 38(1): 15-21.

Lavery, M. J. et al (2016). Nocturnal Pruritus: The Battle for a Peaceful Night’s Sleep. International Journal of Molecular Sciences; 17(3): 425.

The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society (2017). Menopause, Jul; 24(7): 728-53.

NHS. Vaginal dryness. [online] Available at: https://www.nhs.uk/conditions/vaginal-dryness/ [accessed 22nd July 2019].

Thorstensen, K. A. and Birenbaum, D. L. (2012). Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus and lichen simplex chronicus. Journal of Midwifery and Women’s Health; 57: 260–75.

Vagisan (2019). Vaginal Dryness. [online] Available at: https://www.vagisan.com/en-gb/symptoms/vaginal-dryness/ [accessed on 12th July 2019].

Wilhite, M. (2018). Vaginal dryness. Integrative Medicine 4th edition. Amsterdam: Elsevier Inc. 592-99. [online] Available at: https://www.sciencedirect.com/science/article/pii/B9780323358682000591 [accessed on 12th Jul 2019].

Back to top