For many women, a particularly stressful and uncomfortable side effect of menopause is vaginal dryness. Since both chemotherapy and hormonal therapy can cause sudden menopause, this is an issue for this blog. I have written before about some studies that suggest that women who experience chemically-induced menopause (and that means us) may have more intense side effects than those who go through a more gradual natural process. I think those studies have most often looked at hot flashes, but I suspect that vaginal dryness and accompanying diminished libido are similar.
This is a helpful Meno Note from the North American Menopause Society about the causes, natural history, and treatments for this problem. It does not suggest the two products that I have been recommending for years: canola oil and Albolene. Both are inexpensive, totally non-embarrassing to purchse, and effective. For women who experience pain with intercourse, Albolene is especially effective.
Here is the essay:
Bothersome symptoms of the vagina and vulva (outer lips of the vagina) are common in women of all
ages, but increase with menopause. The decrease in estrogen with menopause is a major contributor
to vaginal dryness, itching, burning, discomfort, and pain during intercourse. Vaginal atrophy is the
medical term that describes these changes after menopause. Symptoms of vaginal atrophy may
significantly affect your quality of life, sexual satisfaction, and relationship with your partner.
Menopause-related vaginal symptoms may be bothersome early in the menopause transition, or start
after several years of decreased estrogen levels. Unlike hot flashes, which generally improve with
time, vaginal symptoms typically worsen with time due to both aging and a prolonged lack of estrogen.
Menopause and aging can affect the vagina in the following ways:
Vaginal tissues become thin, dry, and less elastic
Vaginal secretions decrease with reduced lubrication
Vaginal infections increase (as the healthy acidic pH of the vagina increases)
Discomfort with urination and increased urinary tract infections can occur
Fragile, dry, inflamed vaginal tissues may tear and bleed
Women with menopause induced by cancer treatments may have additional injury to the
vaginal tissues from chemotherapy or pelvic radiation
Aromatase inhibitors taken by many women with breast cancer result in extremely low
estrogen levels, often causing severe symptoms of vaginal dryness and decreased
Vaginal changes often result in pain during intercourse or pelvic exams
Women with discomfort from vaginal atrophy often engage in less frequent intercourse,
which can cause the vagina to become shorter, narrower, and less elastic
For some women, pain, narrowing of the vagina, and involuntary tightening of vaginal
muscles (vaginismus) can intensifyto the point that sexual intercourse is no longer
pleasurable or even possible
While symptoms of vaginal dryness and atrophy can be very bothersome, the good news is that
effective treatment options are available. These include different forms of low-dose estrogen applied
directly to the vagina, as well as nonhormonal treatments. You may combine nonhormonal and
hormonal treatments for optimal symptom relief.
Vaginal lubricants reduce discomfort with sexual activity when the vagina is dry by
decreasing friction during intercourse. Water-soluble products are advised because the oil in
some products may cause vaginal irritation. There are many effective brands available without
a prescription, including K-Y Jelly, Astroglide, K-Y Silk-E, Slippery Stuff, and Just Like Me.
Vaginal moisturizers line the wall of the vagina and maintain vaginal moisture. Like your face
or hands, the vagina should be moisturized on a regular basis, for example, several times
weekly at bedtime, including Replens and K-Y Liquibeads.
Regular sexual stimulation promotes blood flow and secretions to the vagina. Sexual
stimulation with a partner, alone, or with a device (such as a vibrator) can improve vaginal
Expanding your views of sexual pleasure to include such “outercourse” options as
Vaginal dilators can stretch and enlarge the vagina after many years of severe vaginal
atrophy, especially if sexual activity is infrequent and the vagina has become too short and
narrow for intercourse. Involuntary tightening of vaginal muscles (vaginismus), a learned
response to pain, often contributes to uncomfortable intercourse. In addition to regular use of
vaginal estrogens, lubricants, and moisturizers, several months of daily “exercises” with
lubricated vaginal dilators can help. Dilators can be purchased from pharmacies and medical
supply stores and used with the guidance of a gynecologist, physical therapist, or sex
therapist. Remember, the vagina can diminish in size and its supporting muscles can weaken,
so “use it or lose it”!
Pelvic floor exercises can both strengthen weak vaginal muscles and relax tight ones.
Vaginal estrogen therapy: (NOTE FROM HESTER: TALK WITH YOUR DOCTOR ABOUT ANY OF THESE OPTIONS AS THEY ARE OFTEN CONTRAINDICATED FOR WOMEN WITH A BREAST CANCER HISTORY)
An effective and safe treatment available by prescription, low-dose local estrogen is applied
directly to the vagina to increase the thickness and elasticity of vaginal tissues, restore a
healthy vaginal pH, increase vaginal secretions, and relieve vaginal dryness and discomfort
with sexual activity. Improvements usually occur within a few weeks, although complete relief
may take several months.
Short-term treatment may even be an option for women with a history of breast or uterine
cancer, but only after careful consideration of risks and benefits with a healthcare provider.
Government-approved low-dose vaginal estrogen products are available by prescription
as vaginal creams (used 2 or 3 nights weekly), a vaginal estradiol tablet (used twice weekly),
and an estradiol vaginal ring (changed every 3 months). All are highly effective. You may wish
to try several different forms and choose the one you prefer.
Higher doses of estrogen therapy provided to treat hot flashes also treat vaginal dryness,
although some women still need additional low-dose vaginal estrogen treatment. If only
vaginal symptoms are present, low doses of estrogen applied to the vagina are recommended.
This MenoNote, developed by the Consumer Education Committee of The North American Menopause Society,
provides current general information but not specific medical advice. It is not intended to substitute for the
judgment of an individual’s healthcare provider. Additional information can be found at www.menopause.org.