Treatment for Vaginal Dryness
Non-hormonal moisturizers and lubricants are the first-line treatment for vaginal dryness, with a combination of both providing optimal relief for most women. 1
First-Line Treatments: Non-Hormonal Options
Vaginal Moisturizers
- Apply 2-3 times weekly for ongoing maintenance 1
- Work by hydrating the vaginal tissue and providing longer-term relief
- Should be pH-balanced and physiologically similar to vaginal secretions 2
- Effects typically last 2-3 days per application
- Can be used regardless of sexual activity
Vaginal Lubricants
- Apply during sexual activity as needed 1
- Different types available:
- Water-based: Most compatible with condoms, but may dry quickly
- Silicone-based: Last longer than water-based products 1
- Oil-based: Not compatible with latex condoms
Application Recommendations
- Moisturizers: Apply regularly as preventive maintenance
- Lubricants: Apply immediately before sexual activity
- For optimal relief, use both: moisturizers for ongoing comfort and lubricants specifically for sexual activity 1
Second-Line Treatments: Hormonal Options
If non-hormonal measures are ineffective after adequate trial (typically 4-6 weeks):
Low-Dose Vaginal Estrogen
- Available as creams, tablets, or rings
- Results typically take 6-12 weeks to become noticeable 1
- Minimal systemic absorption compared to oral hormone therapy 1
- Contraindicated in: Women with history of hormone-sensitive cancers, active thromboembolic disorders, undiagnosed abnormal genital bleeding 3
Ospemifene (Osphena)
- Oral tablet (60mg) taken once daily with food 3
- FDA-approved for moderate to severe vaginal dryness due to menopause 3
- Shown to significantly improve vaginal dryness compared to placebo 3
- Contraindications: Undiagnosed abnormal genital bleeding, estrogen-dependent neoplasia, active DVT/PE or history of these conditions, active arterial thromboembolic disease 3
- Warning: Potential increased risk of endometrial cancer and cardiovascular disorders 3
DHEA (Prasterone)
- Vaginal insert option for women who cannot use estrogen
- Contraindicated in women with history of breast cancer 1
Additional Interventions
Physical Interventions
- Pelvic floor physical therapy: Beneficial for women with concurrent pelvic floor dysfunction 1
- Vaginal dilators: Consider for vaginal stenosis 1
- CO₂ laser therapy: Promising for vaginal atrophy when other options fail 1
Lifestyle Modifications
- Avoid irritating products (scented soaps, douches)
- Regular sexual activity may help maintain vaginal health
- Physical training and yoga may improve overall wellbeing and sexual function 1
Treatment Algorithm
Start with non-hormonal options:
- Regular use of vaginal moisturizers (2-3 times weekly)
- Lubricants during sexual activity
- Trial for 4-6 weeks
If inadequate relief after adequate trial:
- Consider low-dose vaginal estrogen if no contraindications
- Alternative: Ospemifene 60mg daily with food if vaginal estrogen is not suitable
- DHEA for women who cannot use estrogen
For persistent symptoms:
- Consider pelvic floor physical therapy if concurrent pelvic floor dysfunction
- Evaluate for other causes of symptoms
- Consider CO₂ laser therapy in treatment-resistant cases
Monitoring and Follow-up
- Regular follow-up to assess symptom improvement
- Monitor for abnormal vaginal bleeding, which warrants further investigation 1
- Annual clinical review to assess ongoing need and compliance 1
- For hormonal therapies, use for shortest duration consistent with treatment goals 3
Common Pitfalls to Avoid
- Undertreatment due to embarrassment or normalization of symptoms
- Using products with unphysiological pH or high osmolality that may worsen irritation 2, 4
- Failure to recognize when symptoms are due to other conditions (infection, dermatological conditions)
- Not addressing psychological aspects of sexual dysfunction that may accompany vaginal dryness
- Discontinuing treatment prematurely before full benefits are realized (especially with hormonal options that may take 6-12 weeks for full effect)