Vaginal Dryness and Pain During Sex: Treatment Options that Work

Vaginal dryness is something many women experience at some point in their lives, although it’s not always openly discussed. The truth is, this common issue can cause uncomfortable symptoms like burning, itching, and soreness, and may even make intimacy painful. Whether it’s triggered by menopause, certain medications, or other underlying causes, vaginal dryness isn’t something that you just have to “put up with.” Understanding what’s happening and knowing your treatment options can help you regain comfort, confidence, and a healthier sex life.

If vaginal dryness continues, worsens, or doesn’t improve with over-the-counter products, it’s important to reach out to your healthcare provider. With the right guidance, you can find relief and solutions tailored to your needs.

Unfortunately, many women hesitate to talk about these concerns, either because of embarrassment or because they assume it’s an unavoidable part of aging. In reality, vaginal dryness is a medical issue with many possible causes, and there are safe and effective ways to treat it. There are a variety of non-hormonal treatments, vaginal moisturizers, hormone therapy, and even lifestyle changes available to ease symptoms and improve your quality of life. By learning what to look out for and exploring both hormonal and non-hormonal options, you can take control of your health and restore comfort during daily life and intimacy.

What Causes Vaginal Dryness

Vaginal dryness typically happens when estrogen levels drop. Estrogen is the hormone that keeps the vaginal lining thick, elastic, and naturally lubricated. When the amount of estrogen in your body starts to decline, the result is thinner, drier vaginal tissue through a process often referred to as vaginal atrophy or thinning vaginal walls. This is especially common during and after menopause, but can also occur during breastfeeding or perimenopause when hormone levels fluctuate.

During menopause, declining estrogen levels are one of the main factors that contribute to vaginal dryness and painful intercourse. These changes are sometimes grouped under perimenopause vaginal changes, which may include dryness, irritation, reduced elasticity, and even an altered vaginal pH balance in some cases. Because estrogen also plays a role in protecting against infections, women may notice more frequent urinary tract or vaginal infections as hormone levels shift.

Other causes of vaginal dryness include:

• Pregnancy and breastfeeding – hormone levels change naturally and may lead to temporary dryness.
• Certain medications – including hormonal contraceptives, antidepressants, antihistamines, and some cancer treatments such as chemotherapy or radiation.
• Hysterectomy or surgical menopause – removal of the ovaries causes a sudden drop in estrogen.
• Underlying conditions – such as diabetes or Sjögren’s syndrome, an autoimmune disorder.
• Lifestyle factors – stress, anxiety, and use of perfumed soaps or douches that disrupt the natural vaginal pH balance.

These things all contribute to low estrogen levels or irritation of the vaginal tissues, leading to dryness after menopause and beyond.

Common Symptoms You Shouldn’t Ignore

Recognizing the signs of vaginal dryness is the key to getting help. The most common symptom is a persistent feeling of dryness, but there are often additional issues, including:

• Vaginal itching
• Burning or itching sensations, even when not sexually active
• Irritation and soreness in the vaginal area
• Painful intercourse or pain during penetration (dyspareunia)
• Vaginal discomfort during intimacy, even with lubrication
• Discomfort during physical activity, like exercise or long walks
• Increase frequency of vaginal or urinary tract infections

If your vaginal dryness is caused by low estrogen, other changes may also appear, such as less natural vaginal lubrication, a tightening of the vaginal opening, and narrowing of the vaginal canal. Together, these changes can lead to a cycle of discomfort and an avoidance of intimacy, which may further reduce sexual desire and connection.

When to Seek Help: Is It Just Menopause or Something Else?

It’s natural to wonder if vaginal dryness is simply just a part of menopause symptoms or if it points to another health concern. While menopause and perimenopause are widespread triggers, dryness can also be a result of medication side effects, autoimmune conditions, or other hormonal imbalances.

Seek medical guidance if:

• You are under 45 and experiencing dryness alongside other menopause-like symptoms. This could indicate early or premature menopause.
• You notice dryness after menopause that doesn’t improve with over-the-counter remedies.
• You experience severe vaginal discomfort during intimacy or bleeding not related to your period.
• You have recurrent urinary tract or vaginal infections.

A professional evaluation of your symptoms is important because vaginal dryness can sometimes mask underlying health concerns, such as thyroid issues, diabetes, or other systemic conditions.

Effective Treatment Options for Vaginal Dryness

The good news is that vaginal dryness, painful intercourse, and related symptoms are treatable. For many women, starting with simple solutions makes a big difference.

Vaginal moisturizers and lubricants

Vaginal moisturizers are designed for ongoing hydration. When applied regularly, they help the tissues retain moisture and restore comfort throughout the day. They are especially helpful for women with vaginal atrophy who need longer-lasting relief.

Vaginal lubricants, on the other hand, are best for sexual activity. They provide short-term relief by reducing friction and making intimacy more comfortable. There are many types available (water-based, silicone-based, or oil-based), so it may take some experimentation to find the one that works best for you.

These products are considered non-hormonal treatments and can be considered the first option for many women, especially those who cannot or do not wish to use hormones.

Lifestyle adjustments

Simple changes such as avoiding perfumed soaps, using gentle cleansers, wearing breathable cotton underwear, and staying hydrated can support vaginal health. Stress management and regular sexual activity (whether with a partner or solo) can also encourage natural lubrication and blood flow to vaginal tissues.

Advanced Therapies and What to Know About Hormone Therapy

For women who need a solution that’s more effective than moisturizers or lubricants, advanced therapies are available. One of the most effective advanced therapies is hormone therapy (HRT).

Vaginal estrogen therapy

Local treatments, such as vaginal estrogen cream, vaginal rings, or estrogen tablets, deliver estrogen directly to the vaginal tissues. Unlike systemic hormone therapy, these treatments focus on relieving vaginal atrophy, thinning vaginal walls, and vaginal dryness without circulating high levels of hormones throughout the body. They are highly effective for women experiencing vaginal dryness after menopause.

Systemic hormone replacement therapy

Hormone therapy can also be systemic by replacing estrogen and progesterone to ease a broader range of menopause symptoms like hot flashes, night sweats, mood swings, and sleep problems. Women who still have their uterus will typically use a combination of estrogen and progestogen, while women who have had a hysterectomy may only need estrogen.

Hormone therapy is not for everyone, as women with a history of breast cancer, blood clots, liver disease, or uncontrolled high blood pressure may need non-hormonal treatments instead. For these women, options like selective estrogen receptor modulators (SERMs) or non-hormonal prescription medications may be recommended instead.

Monitoring and adjustments

Most women start hormone therapy at a low dose, with follow-up appointments to monitor effectiveness and track side effects. A healthcare provider may adjust your dosage or change the type of hormone delivery method based on how your body responds to the therapy.

Intimacy After Menopause: Reclaiming Comfort and Confidence

Dealing with vaginal dryness doesn’t mean intimacy has to end. With the right tools and mindset, many women reclaim fulfilling sexual relationships during and after menopause.

Regular sexual stimulation increases blood flow to vaginal tissues and helps maintain elasticity. Even gentle stimulation or non-penetrative intimacy can keep the tissues healthier and promote natural lubrication. This is especially important for women experiencing perimenopause vaginal changes and dryness after menopause.

Some intimacy strategies include:

• Taking more time for foreplay allows the Bartholin’s glands to produce natural lubrication.
• Exploring different forms of intimacy aside from intercourse, such as massage, mutual touch, or oral sex.
• Using vaginal lubricants to reduce friction and vaginal moisturizers for ongoing comfort.

Open communication with your partner can also help rebuild confidence and prevent feelings of embarrassment around vaginal discomfort during intimacy.

You’re Not Alone: When to Talk to a Specialist

A dry vagina is usually not a sign of a serious medical condition, but it should not be ignored, especially if it interferes with your quality of life. Contact your healthcare provider if:

• Vaginal dryness affects your sex life or daily activities.
• Over-the-counter treatments no longer provide relief.
• You experience severe burning or itching, pain, or unusual bleeding.
• You’re not sure whether your symptoms are related to low estrogen, perimenopause, or another health condition.

Before your appointment, note any changes in your menstrual cycle, medications you’re taking, and the severity of your symptoms. Prepare questions to ask your doctor, such as:

• “How will hormone therapy help me?”
• “What are the risks and benefits of using vaginal estrogen cream?”
• “Are there effective non-hormonal treatments I should try first?”
• “How soon will I notice an improvement?”

Book an Appointment with Advantia Health!

If vaginal atrophy, painful intercourse, or dryness after menopause is affecting your comfort and confidence, Advantia Health’s women’s health specialists are here to help. From personalized non-hormonal treatments to advanced options like vaginal estrogen cream or systemic hormone therapy, we’ll work with you to create a treatment plan tailored to your needs.

Book an appointment today and take the first step toward relief, confidence, and renewed intimacy.