Vaginal Dryness, Demystified

Written by Emma Loewe: Writer, author, and editor of Cultured. Her writing explores the intersection of nature, climate, and human health. Emma is the author of “Return to Nature” and “The Spirit Almanac.”
Reviewed by Jennie O’Grady: Senior SciComms Specialist at Seed Health

What are three words that describe your vagina? If any variation of itchy, scratchy, and sore comes to mind, you could be dealing with vaginal dryness—a disruptive condition that renders clothing uncomfortable, makes sex painful, and increases the risk of certain infections. 

Many women write vaginal dryness off as normal or impossible to treat, leaving them to face symptoms in silence.¹ That needs to change. Let’s explore what vaginal dryness is, trace its hormonal and microbial causes, and pick up an integrative gynecologist’s tips for finding lasting relief. 

What Is Vaginal Dryness?

Vaginal dryness occurs when the vaginal tissue becomes thin and dry (often as a result of low circulating estrogen), which can lead to itching, burning, soreness, and in some cases, recurrent vaginal infection.

Vaginal discharge is responsible for keeping the vagina moist, clean, and comfortable. It also contains Lactobacillus, a type of lactic-acid-producing bacteria that’s native to the vaginal microbiome (VMB). These lactobacilli create acidic conditions that are inhospitable to pathogens, so vaginal environments that are dry and low in discharge may be more vulnerable to certain bacterial and yeast infections.² 

There’s also an association between vaginal dryness and painful intercourse (although it’s worth noting that vaginal discharge is not the same as the vaginal lubrication produced during sex, which comes from small ducts called the Bartholin’s glands located on either side of the vaginal opening).³

To diagnose vaginal dryness, practitioners will usually perform a physical exam and test hormonal and/or pH levels. 

Vaginal Dryness vs. Vaginal Atrophy

The terms “vaginal atrophy” and “atrophic vaginitis” are related to (but not exactly synonymous with) vaginal dryness. Vaginal atrophy is a medical condition caused by low estrogen that usually occurs during menopause.⁵ It involves several structural and functional changes in vaginal and urogenital tissue that can be accompanied by dryness but also burning, itching, and incontinence.

This means that it’s possible to have vaginal atrophy without vaginal dryness, and vice versa. 

What Causes Vaginal Dryness?

Let’s explore a few of the most common causes of vaginal dryness, depending on age and menopausal status. 

During Perimenopause and Menopause:

Menopause causes a whopping 95% reduction in estrogen production, helping explain why more than half of postmenopausal women over 51 years old experience vaginal dryness.^2,6

Hormonal changes during menopause can also decrease collagen production and make the vaginal walls shorter and narrower, contributing to painful sex. Due to a reduction in Lactobacillus species, menopausal women also tend to run a higher risk of bacterial infections like bacterial vaginosis and UTIs.⁷ 

Just because these symptoms are common during menopause doesn’t mean that they’re inevitable or untreatable. Vaginal atrophy does not have to be a “normal” side effect of menopause or aging.

Before Menopause:

Although it’s more common during menopause due to natural reductions in estrogen, vaginal dryness can happen at any age. If you’re noticing it in your 20s and 30s, you’re not alone—and you’re not “broken.” 

Roughly 15% of pre-menopausal women experience symptoms of vaginal atrophy (including dryness), and nearly 20% of women over 18 report vaginal dryness during sex.^2,6 

Here are a few factors that can contribute to estrogen loss and dryness before you hit menopause:

• Chronic stress: Chronic stress can set off a cascade of hormonal changes, including reductions in estrogen that may cause dryness.⁸ In addition to psychological stress and anxiety, physical stressors like undereating and overexercising can also suppress estrogen and impact ovulation.^9,10 
• Hormonal birth control: Oral contraceptive pills suppress natural hormone production and have been associated with vaginal dryness in some cases.¹¹
• Childbirth and breastfeeding: Pregnancy and childbirth transform the vaginal environment in many ways—including by spurring a dramatic drop in estrogen by up to 100 to 1000 times following delivery.¹²
• Cigarette smoking: Some smokers experience menopausal symptoms earlier, potentially due to cigarette’s toxic effects on ovarian cells.¹³ 
• Certain medications: Some anti-depressants, antihistamines, and antibiotics may dry out the vagina and/or cause changes in the vaginal microbiome that promote discomfort and infection. Anti-estrogen medications prescribed for PCOS, endometriosis, and uterine fibroids can also contribute to dryness.² This isn’t to say these medications are “bad;” they should just be taken mindfully.
• Ovarian complications: Ovarian insufficiency, ovarian failure, and the surgical removal of one or both ovaries (oophorectomy) can contribute to low estrogen levels and dryness.²
• Menstruation: Pre-menopausal women also may notice the changes in vaginal dryness throughout the month. Estrogen levels peak in the days leading up to ovulation, causing a temporary increase (and subsequent decrease) in vaginal discharge during this period.

How to Ease Vaginal Dryness Symptoms 

Given the connections between the vaginal microbiome, hormonal estrogen, and vaginal dryness, any successful long-term remedies will consider all three. 

Seed spoke with integrative gynecologist Tara Scott, M.D. to learn about the most promising non-hormonal tools for easing vaginal dryness and maintaining a healthy and comfortable vaginal environment.

She notes that the most common treatments for postmenopausal vaginal atrophy are estrogen-based therapies—which use creams, rings, or tablets to restore estrogen levels and alleviate symptoms.¹⁴ Applying the hormone precursor DHEA also shows promise for relieving vaginal atrophy symptoms in menopausal women.¹⁵ However, it’s unclear how these treatments impact the vaginal microbiome in the long term. Try the following hormone-free solutions as a first line of defense, and consult with your doctor if you’re still interested in medication.

1. Use a (microbiome-friendly) moisturizer.

Moisturizers can help relieve mild to moderate vaginal dryness, according to research on postmenopausal women.¹⁶ Choose a moisturizer that closely matches your natural vaginal secretions in terms of thickness, acidity (pH), and ingredients in order to reduce the risk of VMB disruption. Table 1 of this study ranks a few popular brands on their pH and osmolality (concentration) compatibility with the vagina.¹⁷

Dr. Scott usually recommends applying moisturizer daily for 14 straight days to start, then finds that many women can switch to 1-2 times a week. 

2. Avoid douching and harsh cleansers.

Despite what (low-key sexist) women’s hygiene ads might lead you to believe, douching your vagina can do more harm than good.¹⁸ Flooding the vaginal environment with water or harsh cleansers can harm its protective mucus layer and disrupt the VMB, increasing your susceptibility to pain and infection. When it comes to cleaning the vagina, less it more: Just wash the vulva (external area) with water or mild soap.

3. Experiment with ways to make sex more comfortable.

The pain of vaginal dryness causes many women to avoid intercourse entirely (understandably so!). However, research shows that as the frequency of sex decreases, vaginal lubrication only declines further. Sex improves blood circulation to the vagina, and for women who have unprotected sex with men, seminal fluid can also provide sexual steroids, prostaglandins, and essential fatty acids that further support vaginal tissue.^19,20 To make sexual activity more comfortable and enjoyable for you, try using a lube that ticks the following VMB-friendly boxes:⁶

• Free of synthetic fragrances
• Free of chlorhexidine gluconate (Pre-clinical research has found that this antiseptic ingredient harms the vaginal microbiome by reducing the growth of beneficial Lactobacillus species.)²¹
• Moisturizing (Many commercially available lubes are hyperosmotic, meaning they actually drain and dehydrate moisture from cells, potentially causing vaginal tissue to shrink further. Look for one that is moisturizing and designed to promote healthy bacterial balance in the vagina.)²²

You can also play around with getting toys involved—just be sure to clean them regularly to minimize the chance of vaginal disruption.

4. Reduce inflammatory foods.

Dr. Scott notes that diet plays an important role in hormonal health, and what you eat has the potential to impact your vaginal environment as well.²³ She recommends prioritizing anti-inflammatory foods and limiting processed foods, excessive sugar, and alcohol.

5. Eat more phytoestrogens.

Emerging research suggests that eating phytoestrogens (plant foods that contain compounds that act similarly to estrogen in the body) might help reduce vaginal dryness.²⁴ Examples include certain nuts, seeds, tofu, and other soy products. Some fruits, including apples, pomegranates, and grapes are also sources of phytoestrogens.

A study involving 731 premenopausal women found that those who ate an apple a day reported better sexual function, particularly in terms of overall satisfaction and lubrication, compared to those who did not eat apples.²⁵ 

Studies on the effects of phytoestrogens on sexual health in larger groups are limited, so more comprehensive research is needed. But considering that phytoestrogen foods are also sources of heart- monounsaturated fats, gut-healthy fiber, and antioxidant-rich polyphenols, there’s no harm in trying to eat more of them. (Here’s more on how the state of your gut might impact your sex life.)

The Key Insight

Vaginal dryness has been a silent epidemic for too long.¹ It affects women of all ages and can have real and reverberating impacts on mental and physical health. Acknowledging the condition’s relationship to the vaginal microbiome—and the way it shifts over time—can provide a roadmap to effective treatments that make the vagina feel more like the breath: a strong and steady force you forget is even there.