Vaginal dryness — symptoms, causes and remedies

Vaginal dryness is a symptom that I discuss with women every week. Typically, it isn’t the main reason that brings a woman to the clinic, but the topic comes up when we discuss other related subjects, such as painful intercourse or persistent pelvic pain. Understandably, the problem of vaginal dryness is more common in menopausal women. Vaginal dryness sometimes can be more distressing for younger women who are still menstruating, because it causes discomfort with daily activities or during sex.

Vaginal dryness can be impacted by a handful of factors. Estrogen probably is the most important hormonal influence on the health of the vulva and vagina. Low estrogen can contribute to dryness. Diet and the use of other medications also are important factors. You can expect any medications that cause dry eyes and dry mouth to have a similar effect on the vagina, as well. An interesting study in 2015 showed that a daily oral soy supplement could improve vaginal dryness.

Estrogen levels in the blood vary during the month and follow a common pattern for each menstrual cycle. For women not on hormonal birth control, levels are lowest in the days just before and after the start of menstrual bleeding. This low level sometimes can contribute to vulvar and vaginal dryness.  Women on combination oral contraceptives containing both estrogen and progestin are unlikely to experience such dryness.

We don’t fully understand why some women develop uncomfortable symptoms, such as vaginal dryness, vulvar pain and itching towards the end of their menstrual cycle, while others have no problems. Most likely, there are additional factors that are made worse by the lower estrogen level expected at the end of the menstrual cycle. There are a lot of interesting theories and ongoing research into these symptoms.

Of course, I would encourage a woman to have a thorough discussion and exam with her provider to determine the most likely causes for these symptoms. An exam also will help ensure that less common, but more serious, conditions are not missed. Your provider will help you determine the best course of treatment. Many times, I meet women who, inadvertently, have made their symptoms worse by having tried multiple different creams or other home treatments before seeing their provider.

Here are a few things you can try to reduce vaginal dryness:

• Consider using a lubricant designed to have the appropriate pH for the vagina. 
• Incorporate more soy into your diet, as well as an oral probiotic supplement that enhances vaginal health.

For vulvar sensitivity during the period, consider a low-oxalate diet during the week prior to the expected bleeding. Some have questioned the effectiveness of a low-oxalate diet, but it does seem to improve pain for some women; and, certainly, there is no harm in trying it for a few menstrual cycles.

Read about some ideas for a low oxalate diet, which also is used to reduce the likelihood of kidney stones.

Robert Lee, M.D., is a physician in the Obstetrics & Gynecology department at Mayo Clinic Health System - Red Cedar in Menomonie.