What is the treatment for vaginal dryness?

Treatment for Vaginal Dryness

The first-line treatment for vaginal dryness should be regular use of vaginal moisturizers for daily maintenance of vaginal tissue health, applied 3-5 times per week, along with water-based or silicone-based lubricants specifically during sexual activity. 1

Step-wise Approach to Treatment

First-Line: Non-Hormonal Options

• Regular use of vaginal moisturizers provides relief from dryness and discomfort by maintaining vaginal tissue health when applied 3-5 times per week to the vagina, vaginal opening, and external vulvar folds 1
• Water-based lubricants should be used specifically during sexual activity to reduce friction and discomfort, while silicone-based lubricants may be more effective as they last longer and provide extended relief 1, 2
• Topical vitamin D or E can be considered as additional options for symptom relief 1, 3
• These products should be selected based on pH and osmolality that most closely resembles natural vaginal secretions to avoid irritation 4

Second-Line: Physical Interventions

• Pelvic floor muscle training can improve sexual pain, arousal, lubrication, orgasm, and overall satisfaction 5, 1
• Vaginal dilators may benefit women with vaginismus, sexual aversion disorder, vaginal scarring, or vaginal stenosis, particularly those who have undergone pelvic surgery or radiation therapy 5, 1
• Topical anesthetics such as lidocaine can be applied to the vulvar vestibule before sexual activity to reduce pain 1

Third-Line: Prescription Options

• Low-dose vaginal estrogen therapy (creams, tablets, or rings) is the most effective treatment for vaginal dryness and dyspareunia when non-hormonal treatments are ineffective 1, 3
• Vaginal estrogen has been shown to effectively treat vaginal dryness, itching, discomfort, and painful intercourse in postmenopausal women 5
• Vaginal DHEA (prasterone) is an alternative for women who cannot use estrogen, improving sexual desire, arousal, pain, and overall sexual function 1, 3
• Ospemifene (60 mg daily with food), a selective estrogen receptor modulator, is FDA-approved for moderate to severe vaginal dryness and dyspareunia in postmenopausal women 6

Special Considerations

• For women with a history of hormone-sensitive cancers (especially breast cancer), non-hormonal options should be tried first 3
• If vaginal estrogen is needed for cancer survivors who don't respond to non-hormonal treatments, a thorough discussion of risks and benefits should occur 3
• Women on aromatase inhibitors should generally avoid vaginal estrogen, with DHEA being a potentially better option 1, 3
• Estriol-containing preparations may be preferable for women with contraindications to stronger estrogens as estriol is a weaker estrogen that cannot be converted to estradiol 3

Complementary Approaches

• Psychoeducational support, sexual counseling, or therapy may be beneficial, especially when psychological factors contribute to sexual dysfunction 1
• Cognitive behavioral therapy can improve sexual functioning and should be considered as part of a comprehensive approach 5, 1
• Partner communication should be encouraged throughout treatment 5

Monitoring and Follow-up

• Patients should be re-evaluated periodically to assess treatment effectiveness and adjust therapy as needed 6
• For women using hormonal treatments, use should be for the shortest duration consistent with treatment goals and risks 6
• Women with undiagnosed persistent or recurring abnormal genital bleeding should undergo appropriate diagnostic measures before starting hormonal treatments 6