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Vaginal Dryness


1. Low Estrogen levels in the blood - Atrophic changes.
low estrogen levels can reduce the natural elasticity and lubrication of the vaginal tissue. The walls of the vagina can become thin and fragile, making them less resistant to injury and “trauma.” This loss of estrogen is common during peri-menopause, menopause, after childbirth, and during breastfeeding. Cancer treatments such as radiation and chemotherapy or surgery that includes removal of the ovaries can lead to an abrupt loss of estrogen. Another common lifestyle cause of vaginal dryness is smoking, which can cause earlier menopause and low estrogen levels.

2. Medication side effects 

Many medications can cause vaginal dryness.
» Birth Control Pills can cause an increase in Sex Hormone Binding Globulin (SHBG), a carrier protein made by the liver that binds up excess estrogen and testosterone. This can cause symptoms of vaginal dryness, painful sex and a drop in libido.
» Anti-histamines found in allergy and cold medications can also have a drying effect on inner lining tissue (mouth, nose, vagina) and can decrease natural lubrication.
» Certain medications for high blood pressure, like diuretics and anti-ulcer drugs can have a drying effect.
» Tamoxifen and Evista are estrogen receptor blockers. These medications can cause vaginal dryness by blocking estrogen receptors in the vaginal tissue. Arimidex prevents the conversion of testosterone to estrogen throughout the body and can affect the vagina in particular.
» Chemotherapy medications can also cause dryness by shutting down the release of estrogen from the ovaries.


3. Vaginal irritants
» The vaginal tissues are easily irritated by chemicals and additives in soaps, perfumes, hygiene products, lubricants, laundry detergents and gels. Even dyes on clothing and underwear could result in an allergic reaction.


4. Other skin conditions

 — Sometimes vaginal dryness or vulvar discomfort may be related to the presence of other skin conditions such as:

» Lichen sclerosis – a skin condition that can create thickened, itchy skin that easily cracks or fissures.
» Precancerous growths on the outer labia and vaginal tissue.
» Fissuring or “cu
ts” on the skin related to infections like yeast or herpes.



 Aside from the obvious feeling of dryness, many women report:

  • Vaginal burning

  • Painful sex

  • Pain and burning with urination

  • Light Bleeding after sex

  • Fissures (tiny cuts or lacerations)

  • Swelling or soreness during and after sex

  • Slight or abnormal vaginal discharge

  • General discomfort or itching

  • Unusual odor or increased risk of vaginal infections


Vaginal Moisturizers

-these are all available online. You do NOT need a prescription. 

Hyalo Gyn: Vaginal moisturizer that contains hyaluronic acid, aloe and vitamin E. Hyaluronic acid is naturally present in the vaginal lining (and other body tissues) and helps to maintain hydration. These compounded formulations can stick to the vaginal mucosa to provide hydration and protection.

Vmagic Organic Vulva Cream: Vaginal moisturizer is another great option.

Replens: Popular brand that many Ob/Gyn's recommend. It is the least expensive option and is widely available in most drug stores. The ingredient list for Replens is not great: there are parabens (controversial regarding health risks), glycerin (upsets ph balance), and sodium hydroxide (essentially lye, that can mess with a good ph balance) to name a few.  

Yes VM: Water-based vaginal moisturizing gel that is formulated with natural and organic ingredients. Guaranteed pure by its certified organic status, it is designed to be side-effect-free and delivers outstanding rehydration.

Revaree: Hormone-free relief from vaginal dryness.

Lubricants just for sex

-these are all available online. You do NOT need a prescription.

Good Clean Love— This vegan-friendly water-based lubricant is free of parabens.

Wet Platinum Premium Lubricant — Silicone-based lubricant with minimal chemical additives. Be aware that silicone-based lubricants will stain sheets.

Überlube Luxury Lubricant --- Silicone-based lubricant with Vitamin E.

Organic Glide — Oil-based lubricant made with olus oil, olive fruit oil, argania kernel oil and resveratrol ferment extract. Very popular with my patients because it lasts a long time and works well. 


Zestra Essential Arousal Oil --- Blend of botanical oils and extracts with no chemicals, hormones, parabens, or drugs. Peaks in just 10 minutes and lasts up to 45 minutes.

Check your pantry — olive oil and coconut oil are often great go-to’s that are natural and work well. Oils can be a little messy but can be effective and are less likely to cause an irritating reaction.


Vaginal estrogen therapy

-Replacing vaginal estrogen topically actually restores what the tissue is missing.

This works well if your vaginal dryness or pain with sex is related to low estrogen levels. 

Is vaginal estrogen safe?

Some women are concerned about the idea of using vaginal estrogen. They fear it's the same as other types of hormone therapies that have been associated with a higher risk of cardiovascular disease and breast cancer. The Women's Health Initiative, a 15-year study that began in 1991, found a threefold increase in the risk of breast cancer and stroke among women who took ORAL estrogen for a sustained period after menopause.

But vaginal estrogen is not the same thing. It's a lower-dose topical treatment that comes in a cream, tablet, or ring that is applied to the vagina. Some of the estrogen gets absorbed into the bloodstream, but the amount is much less than oral estrogen. For this reason, experts believe it is generally safe and doesn't pose the same health risks.

However, if you're a breast cancer survivor, you should check with your oncologist before using vaginal estrogen.  


FDA-approved non-hormonal oral drug for painful intercourse due to estrogen deficiency is currently on the market. This could appeal to women who wish to avoid using any estrogen therapy at all or wish to avoid using vaginal treatments. Osphena (brand name) is an estrogen agonist/antagonist. Similar to other drugs in the same family like tamoxifen and Evista, this drug acts like estrogen on some tissues (such as the vagina and uterus) and like anti-estrogen in others (such as the brain and breast). You need to take one pill daily for 12 weeks to see an improvement in symptoms.


Prescription medicine for women after menopause to treat moderate to severe pain during sexual intercourse caused by changes in and around the vagina that happen with menopause. Vaginal DHEA.  

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