01

What vaginal dryness actually is

Vaginal dryness, medically known as vaginal atrophy, is a common condition that many women experience, especially during and after menopause. This condition occurs when the vaginal tissues become thinner, drier, and less elastic due to a decrease in oestrogen levels. As oestrogen levels drop, the vaginal lining loses its natural moisture and suppleness, leading to discomfort and pain.

The symptoms of vaginal dryness can be more than just a nuisance. Women may experience pain and bleeding during sexual intercourse, making intimacy a challenge. Additionally, the lack of moisture can increase the risk of vaginal infections and urinary tract infections, further complicating your health and well-being. Understanding the underlying changes in vaginal tissues can help in recognising and addressing this condition effectively.

Oestrogen is a crucial component of vaginal health. It keeps the vaginal tissue thick, elastic, and well-lubricated. But during menopause, oestrogen levels plummet, and with it, the vagina’s natural moisture and suppleness disappear². This can lead to what’s known as genitourinary syndrome of menopause (GSM)—a frustrating mix of vaginal dryness, irritation, and even urinary issues³.

Without enough oestrogen, the vaginal walls thin, making everything from sitting to sex uncomfortable. You might experience:

• Burning or itching that just won’t go away⁴.
• Painful intercourse, making intimacy something to avoid⁵.
• Changes in vaginal discharge, or none at all⁶.
• Frequent urinary tract infections, leaving you frustrated and uncomfortable⁷.

The longer vaginal dryness goes untreated, the worse it can get. But the good news? There are plenty of effective solutions—let’s explore them.

02

Causes and risk factors

Vaginal dryness can stem from various causes, with the most common being a decrease in oestrogen levels during menopause. However, other factors can also contribute to this condition:

• Medications: Certain medications, such as antidepressants and blood pressure medications, can lead to vaginal dryness.
• Hormonal imbalances: Fluctuations in hormone levels, whether due to aging or medical conditions, can affect vaginal moisture.
• Postpartum hormonal changes: After birth and during breastfeeding, natural hormonal changes can lead to decreased vaginal lubrication. See Vaginal Dryness After Birth for the postpartum-specific picture.
• Smoking: Smoking can impair blood flow and reduce oestrogen levels, exacerbating vaginal dryness.
• Medical treatments: Treatments like chemotherapy and radiation therapy, especially for breast cancer, can impact oestrogen levels and vaginal health.
• Vaginal discharge or infections: Conditions that affect vaginal discharge or lead to urinary tract infections can also contribute to dryness.

Risk factors for vaginal dryness include:

• Age: Women over 40 are more likely to experience vaginal dryness.
• Menopause: This is a significant period when vaginal dryness occurs due to hormonal changes.
• Medical conditions: Conditions like diabetes and thyroid disorders can increase the risk.
• Medications: Certain drugs, including those for depression and high blood pressure, can contribute to dryness.

03

Symptoms and diagnosis

The symptoms of vaginal dryness can vary, but common signs include:

• Dryness or itchiness in the vaginal area.
• Pain during sexual intercourse, often leading to avoidance of intimacy.
• Bleeding or spotting during or after sexual intercourse.
• Increased risk of vaginal infections and urinary tract infections.
• Decreased libido due to discomfort and pain.

Diagnosing vaginal dryness typically involves a physical examination and medical history review. A pelvic exam may be performed to assess signs of vaginal atrophy, and vaginal discharge samples may be taken. In some cases, further tests such as a Pap test or biopsy may be recommended.

It’s crucial to seek medical attention if you experience severe vaginal dryness, pain during intercourse, vaginal bleeding, or recurrent infections.

04

How to treat vaginal dryness

The first step to relief is knowing that help is out there. From simple lifestyle changes to medical treatments, effective options exist.

Vaginal moisturisers and lubricants

• Vaginal moisturisers provide long-lasting hydration and support vaginal tissue health⁸.
• Lubricants offer immediate relief during sex, reducing friction and discomfort⁹.
• Hyaluronic acid-based moisturisers can be as effective as oestrogen creams¹¹. For more on this hormone-free option, see Hyaluronic Acid for Vaginal Dryness.

Local oestrogen therapy

• Replenishes moisture and elasticity.
• Strengthens the vaginal lining.
• Improves sexual function and reduces pain⁵.

Available forms include creams, tablets, and rings offering sustained relief⁹. Local application minimises systemic side effects⁵.

Lifestyle adjustments

• Stay hydrated to support overall moisture levels⁸.
• Avoid scented soaps and douches¹⁰.
• Maintain regular sexual activity to promote blood flow⁵.

05

When to see your GP

Most cases of vaginal dryness do not get better on their own, and most do not need to. There are effective treatments, and a GP can sort through which one fits your situation. Bring it up if any of the following apply⁴:

• Dryness, burning, or itching that has lasted more than a few weeks
• Painful or bleeding sex
• Recurrent urinary tract infections or persistent urinary urgency
• Changes in vaginal discharge or odour that are new for you
• Symptoms that started after starting a new medication (antidepressants, blood pressure medication, antihistamines)
• Symptoms after cancer treatment, including chemotherapy, radiation, or aromatase inhibitor therapy

Any bleeding after menopause is a red flag. If you have gone 12 consecutive months without a period and then notice any bleeding, this needs investigation. It is usually not cancer, but it always needs to be checked.

What to bring to the appointment

A short list goes a long way. Note when symptoms started, what makes them worse (sex, exercise, time of day, certain soaps), what you have already tried, and any medications and supplements you are currently taking. If sex is part of the picture, say so directly. GPs cannot offer treatments they do not know you need.

What a GP can offer

Australian clinical practice guidelines support a menu of evidence-based options: vaginal moisturisers and lubricants for first-line relief, hyaluronic acid-based products for tissue hydration, and local oestrogen therapy (creams, pessaries, or rings) for women whose symptoms are not adequately controlled with non-hormonal options⁷. Local oestrogen is a small dose that acts at the tissue and is suitable for many women, including those who cannot take systemic hormone therapy⁹. The Australasian Menopause Society and Own Your Menopause Appointment: 5 Tips from a GP both have practical scripts for advocating for what you need.

06

Why early treatment matters

Untreated vaginal dryness tends to worsen, not stabilise². The vaginal tissue becomes progressively thinner, less elastic, and more vulnerable to micro-tears, infection, and pain the longer low oestrogen goes unaddressed. That progression matters clinically. Atrophic tissue is harder to rehabilitate the more advanced it gets, and the symptoms that begin as occasional discomfort can settle into chronic pain that interferes with sex, exercise, and even sitting comfortably.

The corollary is the load-bearing point: women who begin treatment early, whether with a moisturiser, a lubricant, hyaluronic acid, or local oestrogen, generally see faster and more complete relief than those who wait years to bring it up⁹. Regular use of the vaginal tissue, including comfortable sexual activity, also helps maintain blood flow and elasticity once treatment has restored baseline comfort.

The other reason early treatment matters is psychological. Many women describe the silent erosion of intimacy and confidence that comes with untreated dryness as worse than the physical symptoms themselves. Treatment is not just about the tissue. It is about not losing months or years of your life to a problem that has well-established solutions. For a deeper look at the full treatment landscape, see Vaginal Dryness Treatments.