Vaginal dryness in perimenopause and menopause: what helps and when to ask for more
Hot flashes get the headlines. Vaginal dryness, itching and discomfort during sex get a whispered conversation, if that. Yet they are among the most common changes of midlife, and they are very treatable. If this is happening to you, you are not broken, you are not alone, and you do not have to just put up with it. Here is a calm, practical overview of what the major medical organizations say.
This is not medical advice. Vaginal and vulvar symptoms have several possible causes, so please talk with your doctor or other healthcare professional about what you are experiencing and which treatments suit you. No affiliate links. Disclosure.
What is going on
The Menopause Society describes a group of symptoms called the genitourinary syndrome of menopause (GSM). It includes bothersome vaginal, vulvar and urinary symptoms that can affect quality of life, sexual satisfaction and even your relationship with a partner.
The cause is a drop in estrogen. According to the Society, loss of estrogen at menopause may make the vaginal tissues thinner and drier, with less elasticity and lubrication. That can lead to:
- dryness, burning, itching or irritation of the vulva (the outer lips of the vagina)
- discomfort or pain with sex, or with pelvic exams
- urinary symptoms such as urgency, burning, or more frequent urinary tract infections
The Office on Women’s Health adds that you may also have less interest in sex or need more time to feel aroused.
One point is worth underlining. The Menopause Society says that unlike hot flashes, which typically improve with time, GSM usually worsens over time without treatment. That is not meant to alarm you. It is a good reason not to wait it out. If you are in perimenopause and notice changes, it is a perfectly good time to mention them to your clinician.
First steps many people start with
The Menopause Society says there are many effective treatment options, including over-the-counter and prescription therapies, and that milder symptoms are often addressed with non-hormone over-the-counter products. Two are easy to mix up, and they do different jobs.
Lubricants: for use during sex
Lubricants reduce friction, which cuts discomfort and can make sex more pleasurable. The Society lists water-, silicone- and oil-based options and offers a few cautions:
- Oil-based lubricants may damage condoms and may increase the risk of vaginal infections.
- Avoid products with flavors (sugar), warming properties, or solvents and preservatives such as propylene glycol and parabens, which may cause irritation in some women.
The Office on Women’s Health specifically mentions water-based personal lubricants during sex. If you use condoms, check the label of any lubricant for compatibility.
Moisturizers: for everyday comfort
Vaginal moisturizers work differently. They are used regularly, often several times a week, to maintain moisture and reduce daily symptoms, rather than only at the moment of sex. The Office on Women’s Health describes using them every few days. If you are not sure how often is right for you, ask your pharmacist or clinician.
If a product stings or irritates, stop using it and tell your clinician. Because vulvar and vaginal skin can be sensitive, a gentle approach is wise.
Other approaches that can help
The Menopause Society lists several other non-hormone strategies:
- Regular sexual stimulation. It promotes blood flow and natural secretions, and it can be with a partner, on your own or with a device such as a vibrator.
- Broadening what intimacy means. Extended touching, massage and other forms of closeness can keep intimacy going while intercourse is uncomfortable.
- Pelvic floor physical therapy. Pelvic floor exercises can strengthen weak muscles and help relax tight ones, and trained physical therapists can guide you. This is a good option to ask about if sex hurts or you notice involuntary tightening.
- Vaginal dilators. These can stretch the vagina if it has become too short or narrow, or if involuntary tightening gets in the way of comfortable sex. The Society suggests using them with guidance from a sexual medicine specialist, physical therapist or sex therapist.
Talking with your partner can help too. The Office on Women’s Health suggests sharing what feels good and what does not, and asking for more time to feel aroused. A sex therapist can be a welcome third party if the conversation feels hard.
When to ask about prescription options
If over-the-counter products are not enough, there are effective prescription treatments. The Menopause Society notes that non-hormone lubricants and moisturizers can also be used alongside prescription therapies when symptoms are more severe. We are not going to recommend any of these, because the right choice depends on your health history, and it is a conversation for you and your clinician.
It is especially worth speaking up if:
- symptoms are interfering with your life, your sleep or your relationship
- sex is painful, or you have started avoiding it
- you have urinary symptoms, such as burning or repeated infections
- you have had both ovaries removed, have been through chemotherapy, or take medicines used to prevent or treat breast cancer, since the Society says symptoms may be more severe in these situations
- over-the-counter products are not helping
The Society also points out that vaginal and vulvar symptoms are not always related to menopause. Yeast infections, allergic reactions and some skin conditions can cause similar symptoms, so see your clinician if symptoms do not improve with treatment. It also notes that compounded vaginal hormone products are not government regulated and are not recommended in most cases, so it is worth asking your clinician before using one.
What to be careful with: energy-based and laser treatments
You may see clinics advertising laser or radiofrequency “vaginal rejuvenation.” The Menopause Society says these devices are FDA cleared for vaginal use but not specifically for treating GSM, and that the evidence does not support their use for dryness, discomfort, irritation or pain with sex. The Office on Women’s Health is blunter: avoid energy-based vaginal treatments, because they have not been shown to work and can cause vaginal pain and scarring.
If someone is promising dramatic results from a device, that is a good moment to pause and get a second opinion from your own clinician.
Safe sex still matters
It is easy to assume that after menopause, STIs are no longer a concern. The Office on Women’s Health says menopause does not protect you from sexually transmitted infections, and that thinner vaginal tissue can tear during sex, which raises the risk of infection. They recommend using a condom or dental dam unless you and your partner have sex only with each other and have both tested negative.
The bottom line
Vaginal dryness is common, it is a medical issue and not a personal failing, and it usually does not resolve on its own. Regular moisturizers, a suitable lubricant, pelvic floor care and open communication can make a real difference, and if they are not enough, your clinician can talk with you about prescription options. Be skeptical of costly device treatments, and please speak up early.
For more on this topic, visit our Intimacy & Hormones page.