What is the best way to treat vaginal dryness?

Best Treatment Options for Vaginal Dryness

Non-hormonal moisturizers and lubricants are the preferred first-line treatment options for vaginal dryness, applied 2-3 times weekly for ongoing relief. 1

First-Line Treatment: Non-Hormonal Options

Vaginal Moisturizers

• Apply 2-3 times weekly for ongoing relief
• Work by hydrating the vaginal tissues and maintaining moisture between applications
• Choose products with physiological pH and osmolality to minimize irritation
• Should be used regularly, not just during sexual activity 1

Lubricants

• Use during all sexual activity to reduce friction and discomfort
• Types:
  • Water-based: Recommended for most women, less irritating
  • Silicone-based: Last longer than water-based products, may be better for extended sexual activity
  • Avoid products with potentially harmful additives (glycerin, parabens, propylene glycol) 1, 2
• Select products that are "body-similar" to vaginal secretions in terms of pH and osmolality 2

Second-Line Treatment: Hormonal Options

If inadequate response to non-hormonal options after 4-8 weeks, consider:

Vaginal Estrogen Therapy

• Available as creams, rings, or tablets
• Effectively treats vaginal dryness, itching, discomfort, and painful intercourse
• Estriol formulations preferred due to lower systemic absorption
• Also reduces recurrent UTIs in postmenopausal women
• Women with intact uterus should be monitored for abnormal vaginal bleeding 1

Ospemifene (Osphena)

• Oral selective estrogen receptor modulator (SERM)
• FDA-approved for moderate to severe vaginal dryness due to menopause
• Take one 60 mg tablet with food once daily
• Important safety considerations:
  • Contraindicated in women with history of thromboembolic disorders, undiagnosed abnormal genital bleeding, or estrogen-dependent neoplasia
  • Not recommended for women with breast cancer
  • Use for shortest duration consistent with treatment goals due to potential risks
  • Potential increased risk of endometrial cancer in women with a uterus 1, 3

Alternative Treatment Options

Hyaluronic Acid Vaginal Gel

• Effective alternative to estrogen-based treatments
• Studies show comparable efficacy to estriol cream in relieving vaginal dryness
• Good option for women who cannot or prefer not to use hormonal treatments 4

Topical Vitamins

• Vitamin D or E may alleviate vaginal dryness and discomfort
• Particularly helpful for symptoms of burning in the vagina
• Hyaluronic acid with vitamins E and A can reduce inflammation and dyspareunia 1

Pelvic Floor Physical Therapy

• May improve sexual pain, arousal, lubrication, and satisfaction
• Particularly beneficial for women with concurrent pelvic floor dysfunction 1

Treatment Algorithm

1. Start with non-hormonal moisturizers (2-3 times weekly) and lubricants (during sexual activity)
2. If inadequate response after 4-8 weeks, consider:
   • Vaginal estrogen therapy (if no contraindications)
   • Ospemifene (if no contraindications)
3. For women who cannot use estrogen:
   • Hyaluronic acid vaginal gel
   • Topical vitamins
4. Add pelvic floor physical therapy if concurrent pelvic floor dysfunction

Monitoring and Follow-up

• Reassess treatment effectiveness every 3-6 months
• Monitor women using vaginal estrogen with intact uterus for abnormal vaginal bleeding
• Women on ospemifene should use it for the shortest duration consistent with treatment goals 1, 3

Common Pitfalls to Avoid

1. Using lubricants with unphysiological pH and high osmolality, which can cause irritation
2. Failing to distinguish between lubricants (for sexual activity) and moisturizers (for ongoing relief)
3. Underestimating the impact of vaginal dryness on quality of life and sexual function
4. Not considering hormonal options when non-hormonal treatments are insufficient
5. Prescribing ospemifene without considering contraindications and risks 1, 2, 5