What causes a dry vagina?

Causes of Vaginal Dryness

Vaginal dryness is primarily caused by declining estrogen levels during menopause, affecting over 50% of postmenopausal women, but can also occur at any age due to various hormonal, medication-related, and lifestyle factors. 1, 2

Primary Causes

Hormonal Factors

• Menopause and perimenopause

  • Declining estrogen levels lead to thinning of vaginal tissues and reduced natural lubrication 1
  • Part of genitourinary syndrome of menopause (GSM) 2
  • Progressive condition that worsens over time without treatment 3

• Other hormonal changes

  • Postpartum period and breastfeeding
  • Surgical menopause (removal of ovaries) 4
  • Hormonal contraceptives with low estrogen content

Cancer Treatments

• Radiation therapy to the pelvic area
  • Can cause vaginal stenosis and fibrosis 5
• Chemotherapy
  • May induce premature menopause
• Endocrine therapy
  • Aromatase inhibitors for breast cancer 1

Medications

• Antihistamines and decongestants
  • Reduce mucous secretions throughout the body
• Antidepressants
  • Particularly SSRIs and SNRIs
• Anti-estrogen medications
  • Used for endometriosis or fertility treatments

Other Medical Conditions

• Autoimmune disorders
  • Sjögren's syndrome (part of Sicca syndrome) 6
  • Systemic lupus erythematosus
• Diabetes
  • Poor glycemic control affects vaginal blood flow and secretions
• Flammer syndrome
  • Associated with delayed wound healing and vaginal dryness 6

Contributing Factors

Lifestyle Factors

• Insufficient arousal during sexual activity
  • Inadequate foreplay
• Stress and anxiety
  • Psychological factors affecting natural lubrication
• Smoking
  • Reduces blood flow and affects estrogen levels
• Excessive hygiene practices
  • Douching
  • Harsh soaps or feminine hygiene products

Environmental Factors

• Certain laundry detergents
• Scented toilet paper or pads
• Swimming pool chemicals

Clinical Impact

• Causes itching, burning, and discomfort 2
• Leads to painful intercourse (dyspareunia) 5
• Significantly impacts quality of life and relationships 7
• Often underreported and undertreated due to embarrassment 2, 7
• May increase risk of vaginal infections due to pH changes

Management Considerations

Non-Hormonal Options (First-Line)

• Vaginal moisturizers
  • Apply 2-3 times weekly for ongoing relief 1
  • Should have pH and osmolality similar to vaginal secretions 7
• Lubricants during sexual activity
  • Water-based products preferred 1
  • Avoid products with glycerin, parabens, or fragrances

Hormonal Options

• Vaginal estrogen therapy
  • Available as creams, tablets, or rings 1
  • Minimal systemic absorption with local application
  • Contraindicated in certain conditions (undiagnosed vaginal bleeding, estrogen-dependent cancers) 1
  • Estriol formulations have lower systemic absorption 1

Lifestyle Modifications

• Increased fluid intake 1
• Regular sexual activity (improves blood flow)
• Avoiding irritants (harsh soaps, douches)

Vaginal dryness is a common but often overlooked condition that can significantly impact quality of life. Early identification and appropriate management can help alleviate symptoms and prevent complications.