Why Do I Have Vaginal Dryness, and What Helps?

It began as a sting after sex. Then it was an itch at your desk, and a burn when you wipe. You’ve been blaming the laundry detergent.

What it feels like

The NHS¹ describes it as feeling sore or itchy in and around the vagina, or pain and discomfort, including during sex. Unusual discharge and needing to pee often can come with it.

The National Institute on Aging (NIA)² adds a tightening of the vaginal opening, burning, itching and dryness, which together it calls vaginal atrophy.

A 2022 review³ of genitourinary syndrome of menopause, the medical name for this cluster, gives a sense of the scale. It reports the condition affects between 36% and almost 90% of peri- and postmenopausal women. Among the symptoms, vaginal dryness was reported by 55%, painful intercourse by 44% and genital irritation by 37%.

The same review³ says 64% of postmenopausal women reported loss of libido and 58% avoided any sexual intimacy. If you’ve been avoiding it, you’re in large company.

Why the tissue dries

The review³ defines the syndrome as a set of signs and symptoms from estrogen deficiency in the genitourinary tract, and it names four places: the vagina, the labia, the urethra and the bladder. That’s why dryness can arrive with urinary urgency, frequent peeing, burning when you pee, and recurrent urinary tract infections.

MedlinePlus⁴ lists menopause and low estrogen as a cause of dryness.

The NIA² says some women have vaginal dryness when their bodies go through the menopausal transition.

The other causes

Hormones aren’t the only story, and it’s worth knowing the rest.

The NHS¹ lists pregnancy and breastfeeding, certain medicines, including hormonal contraceptives and antidepressants, cancer treatments, and not enough arousal. It also lists perfumed soaps, washes or douches used in and around the vagina, and conditions such as diabetes and Sjögren’s syndrome.

MedlinePlus⁴ names irritants as well: detergents, fabric softeners and feminine sprays.

So the laundry theory wasn’t silly. It’s one of the items on the list.

It doesn’t fade like hot flashes

Many menopause symptoms ease with time. This one doesn’t. The 2022 review³ says that, unlike other symptoms of menopause that are temporary and tend to decrease over time, genitourinary syndrome of menopause tends to get worse with age if it isn’t treated properly.

That’s the reason to act early, not to wait it out.

What helps

Start with the two over-the-counter options, which do different jobs. The NIA² says many women find relief from dryness during sex with a nonprescription, water-based lubricant, found at most grocery and drug stores. Others use over-the-counter vaginal moisturizers, which are used regularly, not only during sex, to replenish moisture and relieve dryness.

Lubricant is for the moment. Moisturizer is for the week.

The review³ calls lubricants and moisturizers the initial first-line treatment for mild-to-moderate symptoms.

If that isn’t enough, it ranks vaginal estrogen therapy as the top standard treatment. The NIA² says local estrogen creams, rings or tablets are often used, and they provide lower hormone doses to the rest of the body than a pill or a patch. The NHS¹ mentions hormone replacement therapy as a treatment for hormone-related cases.

The NIA² adds that the FDA has approved two other medicines for moderate to severe painful sex caused by menopausal vaginal changes. Your doctor can tell you about the risks and benefits. The review³ also lists laser and radiofrequency treatments as alternative options.

One caution matters if you’ve had breast cancer. The review³ says lubricants and moisturizers are the first-line choice there and that vaginal estrogen should be avoided. Ask your own team before using anything hormonal.

And a rule from the NHS¹: don’t use creams, lotions or moisturizers that aren’t made for the vagina, because they can cause more irritation or an infection. It also suggests switching to unperfumed soap.

The play

Try this: a two-product routine

Keep a water-based lubricant by the bed.

Use a vaginal moisturizer on a regular schedule, the way you’d moisturize your face, not only before sex.

Switch to unperfumed soap and detergent, and skip anything scented near the vagina.

When to get checked

The NHS¹ says to see a GP if symptoms last for weeks despite self-treatment, if they affect your daily life, or if you have unusual discharge or bleeding after menopause. The NIA² says severe pain with sex that keeps you from having sex without pain is worth bringing to your doctor.

See a clinician if any of these fit:

• Over-the-counter products haven’t helped after several weeks
• Sex is painful enough that you avoid it
• You keep getting urinary tract infections
• You have unusual discharge
• You bleed after menopause, even a little

Switch the detergent if you like, then ask about the rest.