What Causes Vaginal Dryness, and How Can You Treat It?

Dryness down below can happen to anyone with a vagina — and at any age. It can be uncomfortable and embarrassing. The good news is that you don’t have to live with it. There are steps you can take and treatment options that can help ease vaginal dryness.

What are some symptoms of vaginal dryness?

A healthy vagina produces natural lubricant to keep it moist, protected from infections, and free of friction. The amount of lubrication varies depending on your age, hormone levels, and sexual arousal. 

When you have less of this natural lubricant, you may experience symptoms of vaginal dryness, such as: 

• Pain, burning, and discomfort during penetrative sex

• A dry, itchy, or irritated vulva (the external genitals) 

When a low level of estrogen causes vaginal dryness, such as around the time of menopause, you may also experience urinary symptoms, like:

• Urinating more than normal

• Getting frequent urinary tract infections (UTIs)

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What causes vaginal dryness?

Vaginal dryness happens to over half of women after menopause. The most common cause is a drop in estrogen levels that comes at this time of life. Estrogen keeps your vaginal lining thick, lubricated, and healthy. When your estrogen levels go down, your vaginal lining thins, stiffens, and dries out. This is vulvovaginal atrophy, or atrophic vaginitis.

Aside from natural menopause, there are other causes of low estrogen levels, such as:

• Childbirth

• Breastfeeding

• Cancer treatment, like chemotherapy and pelvic radiation

• Surgical menopause (when the ovaries are removed surgically)

• Anti-estrogen medications 

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Less common causes of vaginal dryness include:

• Sjögren’s disease (formerly known as Sjögren’s syndrome), an autoimmune disease that can cause dry eyes, dry skin, and a dry vaginal lining

• Medications, like some antihistamines and antidepressants 

• Dehydration

• Rashes on the vulva, like lichen sclerosus and lichen planus

• Using certain hygiene products (like feminine sprays or harsh soaps)

• Frequent exposure to swimming pool and hot-tub chemicals 

What causes vaginal dryness during sex?

Vaginal dryness during sex is common. In fact, up to 1 in 4 women may experience it at some point in their life. 

Vaginal dryness during sex may be caused by more than just decreased estrogen levels. For many women, it may happen because they aren’t sexually aroused. This could be due to not enough foreplay or feeling stressed about things like work or something else. 

Treatments for vaginal dryness

There are several treatment options for vaginal dryness. If you think a medication you take is causing it, talk with your healthcare professional about stopping it or switching to an alternative. 

If a low level of estrogen (usually as part of menopause) is the cause of your vaginal dryness, then menopausal hormone therapy (MHT) might be an option. MHT comes in different forms, including pills and patches as well as gels and creams that you apply directly to the vagina. Here’s an overview of the types of MHT that can treat vaginal dryness. Then we’ll dive into more detail on each type.  

Which is best for you depends on what other symptoms of menopause you have, and your risk of side effects. 

Estrogen pills 

Because estrogen pills need to be digested and absorbed into the body through the gut, the doses tend to be higher than the estrogen that you apply to the skin or directly to the vagina. As a result, estrogen pills have a higher risk of certain side effects, like blood clots and increased triglycerides. 

If you’ve had a stroke in the past or have other risk factors, like a history of smoking, talk with your healthcare professional about whether using estrogen pills for vaginal dryness is safe for you.

Estrogen patches

Estrogen patches stick to the skin like a Band-Aid, and you replace them every few days. They deliver estrogen through the skin into the bloodstream. Because of this, estrogen patches have a lower risk of side effects compared to estrogen pills.  

Estrogen and progestin patches

There are also patches that deliver both estrogen and progestin hormones through the skin. Combining estrogen and progestin MHT is a good option for people with a higher-than-normal risk of uterine (endometrial) cancer. 

Topical estrogen

These treatments deliver estrogen to the skin, much like a patch. But they may be less likely to cause skin irritation than the patches. They include estradiol (a type of estrogen) gels, creams, and sprays that you rub onto the skin. They get absorbed into the bloodstream. 

Vaginal estrogen

You can also apply estrogen directly to the vaginal lining. These applications include estrogen creams, capsules, and a small, flexible ring that stays inside the vagina. 

This type of treatment is especially helpful when vaginal and urinary symptoms are your only menopause symptoms. That’s because vaginal estrogen stays locally and doesn’t really spread throughout the body. 

Prescription supplements

Dehydroepiandrosterone (DHEA) is a natural hormone involved in the production of estrogen  that decreases naturally with age. It’s available as a prescription-strength pessary (a small device that you place inside the vagina). It can help improve vaginal symptoms like dryness. 

Other prescription pills

Osphena (ospemifene) is not an estrogen. It’s a tablet medication that works by mimicking estrogen and activating estrogen receptors. It can help improve painful sex and vaginal dryness caused by menopause. Because of the way it works, it comes with some of the same risks as estrogen pills (stroke, blood clots, uterine cancer), especially if you take it for longer than a year.      

What about natural remedies for vaginal dryness?

Many people turn to over-the-counter (OTC) and natural treatments for menopause symptoms, including vaginal dryness.  

Vaginal moisturizers and lubricants

OTC vaginal moisturizers and lubricants are a good first step: 

• Moisturizers: These help the vaginal tissue stay moist. 

• Lubricants: These reduce friction during sex. They come in four main types (based on oil, water, silicone, or aloe vera). For vaginal dryness associated with menopause, water-based options may be the least irritating and the closest to natural lubricant. It’s also a good idea to avoid irritants, like perfumes and propylene glycol. So check the ingredients before you use a new product.  

Other ways to increase natural female lubrication 

Regular sexual stimulation may increase blood flow to the vagina and clitoris and help prevent dryness. You can do this with a partner or a vibrator during self-masturbation. If you think stress is contributing to vaginal dryness during sex, finding ways to manage it may also help increase vaginal lubrication and pleasure during sex. 

Can herbs and supplements increase natural lubrication?

To treat menopause symptoms, many people try out natural treatments. But, so far, the science is mixed about how effective these treatments are. 

Before starting any supplement, be sure to talk with a healthcare professional. Taking too many — or the wrong supplements — may interfere with medications you take and cause side effects in the stomach or gut. Here are some options that have been reported to improve vaginal dryness:

• Phytoestrogens: These are plant compounds that act like estrogen in the body. Getting them in foods (like soy and beans) or supplements may help improve vaginal dryness. 

• Amino acid arginine: These supplements may help prevent or improve vaginal dryness. 

Can vaginal dryness cause long-term problems?

In general, vaginal dryness isn’t dangerous. But it can cause discomfort, itching, and sexual pain. When vaginal dryness is severe, it can cause friction-related trauma during sex, which can lead to female friction sores and bleeding. 

If you’re nearing or going through menopause, vaginal dryness may be a sign of genitourinary syndrome of menopause (GSM), which includes a whole range of different menopause-related symptoms, like:

• Decreased libido (sexual desire)

• Difficulty or inability to orgasm

• Pain with sexual intercourse

• Painful urination

• Urinary incontinence 

GSM can worsen your quality of life. Without treatment, it tends to worsen over time. 

When to see a healthcare professional about vaginal dryness

If you have vaginal dryness and don’t know why, make an appointment to see your primary care provider or gynecologist. It’s a good idea to make a list of the medications you take, and bring that with you. 

The first step is to find out the underlying cause for your vaginal dryness. If your symptoms are linked to menopause, you can try OTC moisturizers and lubricants. But if those don’t work, you might want to consider hormone replacement.

If your vaginal dryness is associated with visible skin changes — like sores, or a white, red, or brown rash in your vulva — it may be related to an underlying skin condition, like lichen sclerosus. Be sure to let your healthcare professional know so you can get the right diagnosis and treatment.  

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Written by:

Maryann Mikhail, MD

Maryann Mikhail, MD, is a board-certified dermatologist and medical writer based in South Florida. She is the founder of Waverly DermSpa in Fort Lauderdale and holds a voluntary faculty position at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami MIller School of Medicine.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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