June 1, 2023

A couple in their fifties sitting close together on a sofa, talking in warm evening light

When you’re young and healthy, so is your vagina. As soon as you become sexually aroused, your vaginal walls secrete moisture to reduce the friction of sexual intercourse so that it’s pleasurable and exciting.

As you age, or if you’ve recently given birth or have a medical condition, your vagina may not be able to lubricate itself as well anymore. Vaginal dryness makes sex painful and can sometimes cause physical damage, such as tears and bleeding. It can also damage your sex life.

At Elite Gynecology, our expert gynecologists, including Tamara Guichard, MD, want to help you feel good about sex and intimacy again. If your vagina is dry and sex hurts, you can’t fully experience your own sexuality and may have trouble with your romantic relationship, too.

When it hurts to have sex— a condition known as dyspareunia — you may avoid intimacy altogether. Has your vagina, your sex life, or both, dried up? Following are some of the factors that lead to vaginal dryness (which, after menopause, is part of what doctors now call genitourinary syndrome of menopause, or GSM, previously known as vaginal atrophy) and what you can do to restore your lubrication and your romantic life.

You’re in perimenopause or menopause

One of the most common causes of vaginal atrophy and dryness is the downward shift in estrogen levels that occurs during perimenopause and menopause. On average, women are about 51 when they hit menopause, which means they haven’t had a period for 12 consecutive months.

However, in the years before that moment—often beginning in your 40s—your estrogen levels start to fluctuate and fall, a time known as perimenopause. If both of your ovaries are removed during surgery, you go into menopause right away.

When you’re in perimenopause and menopause, the lack of estrogen makes it more difficult for your vagina to produce lubricants. In fact, your entire vaginal area, including your vulva, becomes thinner, smaller, and less elastic.

Just as lack of estrogen causes your facial skin to thin out, wrinkle, and sag, it has a similar effect on your vagina. In addition to producing less lubrication, the vaginal wall is not as thick and is less able to “snap back” into shape after being stretched or stressed.

Hormone-related vaginal atrophy also affects your clitoris. It may take you longer to climax. Your orgasms may be much less intense than they once were. In addition, you may also experience a drop in your libido, which could also affect how you relate to your partner.

If we determine that a lack of estrogen is causing your vaginal dryness, we may recommend low-dose vaginal estrogen, which treats dryness directly with very little of the hormone reaching the rest of your body. If you also have hot flashes or trouble sleeping, bioidentical hormone therapy (BHRT) taken systemically can relieve those symptoms as well; for most healthy women under 60 or within 10 years of menopause, its benefits outweigh its risks.

Medications and cancer treatments

Certain medications may affect your vaginal health. During our exam, we ask you about prescription and nonprescription drug use to determine if you may need an adjustment to your medication. Even cold medicines can cause vaginal dryness.

Another cause of vaginal atrophy is chemotherapy and radiation treatments for cancer. These can also affect your hormones and ovaries, creating an early menopause. In some cases, BHRT is not safe after cancer.

Depending on your needs, we may recommend topical hormones that you apply to your vagina. Or, if hormones aren’t right in your case, we recommend vaginal moisturizers used regularly and lubricants (like K-Y jelly) that help ease friction during sex. After breast cancer, even low-dose vaginal estrogen may be an option, decided together with your oncologist.

Childbirth and breastfeeding

After giving birth, many women notice vaginal dryness or pain during sex for months, especially while breastfeeding. Pregnancy, childbirth, and breastfeeding all affect your hormones, which in turn affect your vaginal walls.

You may benefit from hormone therapy, topical therapies, or lubricants. You and your partner may also find that extended foreplay is what you need to get your juices flowing again.

Don’t put up with vaginal dryness : Get the relief you need to restore your sex life and vaginal health by contacting our office nearest you — in Midtown East, Murray Hill, New York City, or Forest Hills, New York — or use our online appointment button.