VAGINAL DRYNESS: CAUSES, TREATMENTS, AND NATURAL REMEDIES

Understanding the root causes of vaginal dryness is the first step in effectively addressing the issue and finding relief. Vaginal dryness is typically caused by a decrease in levels of estrogen, a hormone that helps keep the tissues of your vagina and urethra lubricated and healthy. A decrease in estrogen can happen at any age, but is most often linked to stages in life when women naturally produce less estrogen, such as perimenopause, menopause, or while breastfeeding. Some women may also experience a drop in estrogen with some types of birth control pills.

Lifestyle factors such as smoking, excessive alcohol consumption, and not drinking enough water can also contribute to vaginal dryness. Other potential causes of vaginal dryness include prescription drugs, autoimmune disorders, and medical treatments like chemotherapy.

THE ESTROGEN LINK: PERIMENOPAUSAL, MENOPAUSAL, AND POSTPARTUM VAGINAL DRYNESS

As women reach the perimenopausal stage, levels of hormones, particularly estrogen, fluctuate and eventually decline. Estrogen plays a vital role in maintaining skin moisture by promoting the production of certain substances, like hyaluronic acid and oils. Hence, as estrogen levels decrease during perimenopause and menopause, vaginal dryness often intensifies.

Menopause, the next stage after perimenopause, begins when a woman has gone a year without having a menstrual cycle. With the onset of menopause, an accelerated decrease in estrogen levels results in more symptoms of dryness, such as dry and/or itchy skin, chapped lips, brittle nails, lifeless hair, and, of course vaginal dryness. This hormonal shift may lead to a lack of essential fluids and increasing levels of systemic (body-wide) dryness.

After giving birth, about 43 percent of women are affected by postpartum vaginal dryness.¹ Hormonal changes during pregnancy and after delivery play a significant role in the development of postpartum vaginal dryness. During pregnancy, estrogen and progesterone levels increase, causing, among other things, increased blood flow to the pelvic area and the production of cervical mucus. After delivery, these hormone levels drop sharply, often leading to a decrease in vaginal lubrication. In addition, the hormone prolactin, responsible for lactation, can suppress the production of estrogen, causing vaginal dryness in women who are breastfeeding.

WHAT ARE VAGINAL ATROPHY AND ATROPHY OF THE URETHRA?

No one likes to talk about it, but many women experience vaginal atrophy, especially as we age.

Vaginal atrophy is characterized by the thinning and drying of the vaginal walls due to decreased estrogen production, causing various health and practical consequences. The main symptoms are dryness, burning, itching, discharge, pain during sex (at the vaginal opening and/or deeper within the pelvis), and urgency with urination. Vaginal atrophy can make routine activities uncomfortable and significantly impact your sex life, reducing libido or sexual desire.

Estrogen is pivotal for maintaining the structure and function of the vaginal walls, keeping tissues elastic and robust, and promoting lubrication. Lower estrogen levels cause the tissues of the vagina to become less elastic and more prone to inflammation. As a result, the vagina contracts and the vaginal opening narrows. This contraction and narrowing of the vagina, together with thinning tissues, a reduction in vaginal secretions, and other changes, may make sex painful.

A decrease in estrogen levels also changes the pH of the uterus, causing it to be predominantly less acidic and more alkaline. This destabilizes healthy vaginal flora, making bacterial and fungal infections more likely.

In addition, when vaginal tissue becomes increasingly dry, the tissue of the urethra may become inflamed and irritated, making women more prone to repeated bacterial urinary tract infections due to the inflamed tissue's exposure to urine. Heightened sensitivity of the tissues of the urethra can result in a feeling of urgency and more frequent trips to the bathroom. In women with an inflamed urethra, the direction of urine's flow may even be affected, so the urine does not always go straight down, as it normally does.

WHAT CAN YOU DO TO REDUCE VAGINAL DRYNESS?

There are many natural remedies, commonsense habits, and lifestyle changes that are helpful for maintaining vaginal health and relieving vaginal dryness. In some cases, traditional medical treatments may also be advised by your health care provider.

NATURAL REMEDIES TO RELIEVE VAGINAL DRYNESS

The long-term use of natural remedies like botanicals and herbs to support healthy moisture levels is a great way to increase essential bodily fluids and combat vaginal dryness. The mucosal tissues of the vaginal area are maintained through a complex system of hormonal regulation and nutrient absorption. This is where botanical remedies can make a big difference, as many plants contain phytoestrogens or plant-derived compounds that attach to hormonal receptors in the cells to address hormonal imbalances without the risk of synthetic hormones (HRT).

By using botanical remedies on a daily basis in the form of tinctures, alcohol extracts, and/or herbal teas, it may be possible to improve your body's own hydration and to slow all the common signs of dryness that come with aging.

For example, in the Ayurvedic tradition, Shatavari Root (Asparagus racemosus) is used as a long-term rejuvenating and moisturizing tonic for both women and men. In Traditional Chinese Medicine, Peony Root (Paeonia lactiflora) is used to replenish deficient bodily fluids throughout the body. And Indigenous people in North America have a long tradition of using Black Cohosh Root (Actaea racemosa) as a restorative and hormone-regulating remedy for the female reproductive system.

These three botanicals and others are the foundation for Tributary Renew Hydration's proprietary formula, designed to be used as a long-term moisture-replenishing tonic for anyone experiencing vaginal dryness, dry skin and hair, chapped lips, brittle nails, or other symptoms of systemic dryness. However, Tributary is contraindicated for women who are pregnant or breastfeeding. The product is also not for women with hypertension.

Remember, natural doesn't always mean safe. Therefore, when starting any new botanical or supplement, start with small amounts and observe how your body reacts, or better yet, consult a health care practitioner with training in herbs and supplements for advice.

Learn more about Tributary Botanicals and the Benefits of Botanicals.

USE A LUBRICANT AND/OR PERSONAL MOISTURIZER

One of the fastest ways to relieve symptoms of vaginal dryness is to use a lubricant during sex and/or a personal moisturizer.

Lubricants can reduce vaginal friction and potential vaginal tears and make sex more comfortable and enjoyable. Using a lubricant and/or moisturizer regularly may help reduce day-to-day discomfort. Some women even apply a moisturizer several times a day for relief. However, because lubricants and moisturizers are topical, they only provide relief from vaginal dryness while the product is in place.

Be sure to choose a lubricant and personal moisturizer that is free of irritants and additives, and consider avoiding chemical or petroleum-oil-based products that may cause irritation. Many excellent organic lubricants are now available. Please take a look at some of our favorite lubes and vaginal moisturizers.

Learn more about How to Relieve Dryness.

SEX KEEPS THE VAGINA FIT

It is perfectly normal for women to be sexually active well into their 80s. Having regular sex and/or manual stimulation of the vagina and clitoris increases oxygenation of these tissues to increase blood flow to the area, help maintain tone and elasticity, and stimulate the glands in the vagina responsible for essential secretions. Women tend to have less vaginal atrophy if they are sexually active three or more times a month.²

For women who have not been sexually active in a while, you may find that your vaginal opening has contracted, making penetration painful. In case you don’t know, there are actual dilators designed just for this issue. Use of them before engaging in sex, along with vaginal lubricants, can help to stretch the vaginal tissue. These manual dilators are typically made with medical-grade plastic or silicone and come in sets of different sizes. There are also electronic, expandable versions, such as the Milli Vaginal Dilator. If sized appropriately, sex toys may be a useful alternative as well. You may want to ask your gynecologist for dilater and toy recommendations.

STAY HYDRATED AND AVOID REFINED SUGARS

Drinking plenty of water can help keep your entire body, including vaginal tissues, well hydrated. In addition, consuming a diet rich in fruits and vegetables is key to relieving vaginal dryness, as the types of fluids you absorb from eating juicy fresh fruits and vegetables are more complex and vital than those from water.

It may be surprising to learn that your diet affects your vaginal health. A whole foods diet, with multiple sources of protein, foods with a low glycemic index, minimal amounts of sugar and processed foods, and moderate amounts of carbohydrates, should also be part of your plan to address vaginal dryness. Remember, high-sugar diets feed bacteria and can make vaginal itching worse.

Learn more about why hydration matters in What Causes Dryness and the role of your diet in How to Relieve Dryness. For more information on the glycemic index values of various foods, visit https://glycemicindex.com/.

EXERCISE FOR VAGINA LAND URINARY HEALTH

Embracing a regular exercise routine is a reliable way to help maintain vaginal health and vitality. Engaging in 30 minutes or more of moderate exercise, five to six times a week, can significantly enhance vaginal lubrication.

Regular exercise oxygenates cells throughout the body, drawing more blood into the pelvic area. Exercise can also strengthen the pelvic floor muscles.

In addition to regular exercise, Kegel exercises, also known as pelvic floor exercises, can bring about additional benefits. These exercises focus on strengthening your pelvic floor muscles, which can lead to an enhanced sexual experience and improved control over incontinence. Dr. Marilyn Glenville, PhD, a leading expert on nutritional health for women, suggests a simple yet effective way to practice Kegels. When you're in the midst of urinating, make an effort to stop midstream by contracting your pelvic floor muscles. Hold the contraction for five seconds, then relax. Repeat this process ten times and practice this routine five times a day.

To learn more about remedying dryness, please see What Causes Dryness and Benefits of Botanicals.

PRACTICE GOOD VAGINAL HYGIENE

Any substance that comes in contact with your labia, the outer tissues surrounding your vaginal opening, can irritate your skin, leading to dryness. Avoid scented soaps, bubble baths, douches, vaginal “freshener” sprays and scented wipes, and any product with harsh chemicals. They can impact your vaginal pH or acid/alkaline balance and contribute to dryness and irritated tissues. A better choice is washing with mild, unscented soap, warm water, and a soft washcloth.

Alternatively, you could try a vaginal wash that is specifically formulated to balance pH levels. If sex toys are something you enjoy, be sure to wash them well between uses. And, of course, when wiping after using the toilet, be sure to wipe from front to back. As noted above, if you are very dry, you may want to use a daily personal moisturizer in the vaginal area. It’s the same concept as applying a moisturizer to dry skin anywhere on your body.

CAREFULLY CONSIDER HORMONE REPLACEMENT THERAPY (HRT)

In some cases, when vaginal dryness symptoms caused by hormonal changes such as those women experience during perimenopause and menopause seem to be otherwise untreatable, hormone replacement therapies (HRT) may be recommended by your doctor. These hormonal drugs include topical estrogen creams, patches, rings, and other pharmaceuticals to help restore moisture to the vagina and relieve other symptoms women often experience as they move through menopause. While they may seem almost miraculous in suppressing many of the symptoms associated with menopause, they do come with their own set of potential issues.

HRT has been linked to an increased risk of uterine, endometrial and breast cancers, heart disease, and other serious health issues. A recent study also suggests that cognitive issues such as dementia and Alzheimer’s Disease may be linked to HRT. And as women age, the risks of long-term use of HRT and bioidentical hormones can take their toll. But when women stop using these drugs, they may tend to experience rapid aging symptoms and an increase in symptoms associated with menopause.

 A frank discussion with your health care provider will help you decide if these risks are worth the benefits. Many women find that making lifestyle changes, using botanical and nutritional supplements, and taking steps to reduce the causes of dryness may work just as well.

BIRTH CONTROL AND VAGINAL DRYNESS

Hormonal birth control methods — such as the combined oral contraceptive pill, progestin-only pill, hormonal IUDs, contraceptive patch, and vaginal ring — work by altering levels of estrogen and progesterone in your body. This alteration in hormones can impact your body's natural hydration processes. Specifically, these forms of contraceptives can reduce natural oil production in the skin, resulting in dry, flaky skin and chapped lips. Hormonal effects can cause reduced scalp oil production, leading to hair that looks and feels dry and brittle. However, the most significant symptom for many women is vaginal dryness.

Hormonal contraceptives also cause a decrease in natural vaginal lubrication. Lower estrogen levels, a common side effect of contraceptives, can lead to vaginal atrophy, where vaginal tissues become thin, dry, and more delicate (see above). This can lead to uncomfortable and even painful sex, as well as an increase in the risk of vaginal infections.

If you suspect your birth control method is causing symptoms of vaginal or other types of dryness, consult with your health care provider for guidance about other contraceptive options in order to alleviate vaginal dryness symptoms. You may not have to sacrifice your comfort and health for effective birth control.

LASER VAGINAL REJUVENATION

Laser vaginal rejuvenation may be recommended for women with severe vaginal dryness symptoms that don't respond to less invasive therapies. Non-cosmetic vaginal rejuvenation treatments use a therapeutic approach that addresses medical symptoms, including vaginal dryness that makes sex painful, vaginal atrophy, imbalance in the pH levels in the vagina that contribute to infections, stress incontinence (urination that occurs when you laugh, cough, or sneeze), and prolapse of the pelvic floor.

Laser therapies may offer some real hope to women who experience these symptoms. Some physicians feel this procedure may help women who have already tried lifestyle and diet changes as well as botanicals and other supplements known to relieve these symptoms.

There are various types of laser treatments. One type is CO2 lasers, also used in plastic surgery and dermatology, which cause microscopic damage to the tissues to generate wound healing that results in healthier tissues with more collagen, elasticity, and natural lubrication. MonaLisa Touch, FemiLift, DiVa, and Juliet are brands that use lasers to explicitly address vaginal dryness.

ThermiVa is an alternative treatment that uses a radiofrequency device instead of lasers.

However, laser treatments have not yet received FDA approval as a treatment for vaginal atrophy or other symptoms noted above. Again, consult your health care practitioner to see if vaginal rejuvenation is the right choice for you.

To learn more about remedying dryness, please see What Causes Dryness, How to Relieve Dryness, Benefits of Botanicals, and Tributary Botanicals.

Notes:

1. https://www.healthline.com/health/postpartum-vaginal-dryness
2. Leiblum S, Bachman G, Kemmann E, et al. Vaginal atrophy in postmenopausal woman JAMA 1983; 249:2195; https://jamanetwork.com/journals/jama/article-abstract/386220