Vaginal dryness

Symptoms and various manifestations

Possible symptoms include tightness, a burning sensation, stinging, itching and sensitivity. During intimate contact, there may be friction or pain. Some women experience discomfort when walking, exercising or wearing certain types of underwear. Symptoms may be constant or occur only in specific situations.

It is important to clarify whether the discomfort is inside the vagina or on the outer skin of the vulva. A product suitable for one area is not automatically suitable for the other. Describing the exact location is more helpful than the general term ‘intimate irritation’.

Menopausal changes may lead to reduced elasticity, increased sensitivity and urinary discomfort. Pain during intercourse may also involve a muscular reaction, rather than simply a lack of lubrication. A profuse discharge, an unpleasant odour, sores or clearly defined skin changes indicate the need for further assessment.

Spotting is sometimes associated with sensitive tissue, but should not be assumed to be harmless. Any post-menopausal bleeding, as well as recurrent bleeding following intercourse, warrants medical investigation before a course of treatment is chosen.

Causes and risk factors

A common cause is the decline in oestrogen levels around and after the menopause. Similar changes may occur during breastfeeding or following certain medical treatments. Oophorectomy and anti-cancer therapies may also play a role. Hysterectomy alone does not necessarily result in the loss of all hormonal functions.

Certain medicines may contribute to dryness or alter sexual response. Discuss these with your doctor without stopping them yourself. Certain general medical conditions may also be involved, particularly if dryness is present in other areas or if there are additional symptoms.

Scented intimate products, douches and aggressive washing can cause irritation. Vulvar skin conditions can be mistaken for dryness. Insufficient arousal is another possibility, but it should not automatically be assumed to explain every instance of painful intercourse.

A lack of sexual activity is no cause for guilt and does not mean that treatment is unnecessary. Care is also focused on everyday comfort, urination and quality of life. In cases of long-standing symptoms, there may be several overlapping causes, which are assessed together.

When should you see a doctor?

Seek a gynaecological assessment in cases of persistent dryness, pain, recurrent burning, or when symptoms affect your daily life. You do not need to accept these as an inevitable part of ageing. A check-up is particularly important if your usual gentle remedies do not help.

Bleeding after the menopause, bleeding after intercourse, unusual discharge, sores or new growths require investigation. Severe pelvic pain, a temperature or general malaise require urgent medical attention. Repeated self-medication for ‘yeast infections’ may delay the identification of another cause.

The doctor will determine the onset, location and triggering factors. The examination and any necessary tests are selected according to the symptoms. Not every woman needs a comprehensive hormonal panel to receive treatment for localised symptoms.

Share your personal history of breast cancer or other hormone-sensitive conditions, as well as your current treatment. This does not mean there are no options, but rather that the choice must be agreed with the appropriate specialists. The intimate examination is carried out with an explanation and your consent, and can be stopped if necessary.

Daily care and home remedies

Limit the use of scented products and vaginal washes. Clean the external area gently, without rubbing too hard. Do not use ordinary body creams or other products not intended for this purpose inside the vagina.

A vaginal moisturiser is used to maintain moisture as directed. A lubricant reduces friction during intercourse. These serve different purposes. Choose a well-tolerated formula and check compatibility with condoms and other products used. Oily products can damage latex.

During intimacy, it is helpful to allow sufficient time and to communicate openly about what feels comfortable. Do not persist through pain with the idea that the tissues need to ‘get used to it’. If necessary, temporarily opt for forms of intimacy that do not cause discomfort.

Why should we avoid home remedies?

Yoghurt, herbal washes, vinegar, bicarbonate of soda and essential oils are not reliable treatments and may cause irritation. Do not insert foods or products with unclear ingredients into the vagina. Drinking more water is no substitute for treatment of established menopausal tissue changes.

If a ready-made product causes a burning sensation, stop using it and discuss an alternative. A more complex regimen is not necessarily better. It is helpful to introduce one remedy at a time and monitor its actual effect, rather than constantly switching between several products simultaneously.

Modern treatment options

For menopausal genitourinary symptoms, local vaginal oestrogen is one of the established options following assessment. It is available in various forms and can be combined with non-hormonal moisturisers or lubricants. The choice and follow-up are individual.

For certain indications, other medicines are also discussed, depending on contraindications and availability. Systemic hormone therapy has specific indications and is not necessary for every case of localised dryness. In the case of a personal history of breast cancer, the treatment plan requires special consideration, particularly when aromatase inhibitors are being taken.

If the cause is an infection, dermatosis or contact irritation, treatment is directed at the underlying cause. Recurrent urinary symptoms are also assessed, rather than automatically being assumed to be due to an infection or dryness without further investigation.

How should we approach device-based procedures?

Not all advertised methods have the same level of evidence. NICE recommends that vaginal laser therapy for menopausal genitourinary symptoms should only be used within the context of a randomised clinical trial. Before undergoing an energy-based procedure, discuss the evidence, risks and established alternatives.

If you are interested in Skin Line’s ‘Intimate Health’ programme, first clarify which specialist you need and what assessment is required. Follow-up should take into account pain, day-to-day comfort and tolerability. The aim is to provide appropriate long-term care, without promising that a single procedure will resolve all intimate complaints.

Medical sources: NHS — vaginal dryness; NICE — menopausal symptoms; Office on Women’s Health — the menopause and intimate comfort.