Vaginal dryness during menopause: causes, symptoms, and care

Vaginal dryness is a frequent complaint during menopause. Yet, many women avoid talking about the subject—whether out of embarrassment, a lack of information, or the belief that the discomfort is simply part of aging and has no solution.

This situation can lead some women to endure dryness, burning, irritation, or pain during sexual intercourse for months or years. However, there are measures that can help alleviate symptoms and improve intimate comfort.

The first step is to identify the source of the complaints. Contrary to what many women think, not all vaginal discomfort is due to an infection (such as the common yeast infection), and not all available products serve the same purpose.

In this article, we discuss why vaginal dryness occurs during menopause, the associated symptoms, how to distinguish a moisturizer from a lubricant, and when to seek medical or pharmaceutical advice.

What is vaginal dryness during menopause?

Vaginal dryness occurs when vaginal tissues lose some of their moisture, elasticity, and lubricating ability. Although it can arise at other stages of life, it is particularly common during perimenopause and after menopause. During this phase, a reduction in estrogen levels causes changes in the tissues of the vagina, vulva, urethra, and bladder.

Vaginal dryness can occur in isolation, but it can also be part of a broader set of symptoms known as genitourinary syndrome of menopause, or GSM.

The GSM encompasses anatomical and functional changes associated with a decline in estrogen and other sex hormones. It can involve the labia, clitoris, vaginal vestibule, vagina, urethra, and bladder.

For this reason, the woman may present vaginal, sexual, and urinary symptoms simultaneously.

Why does vaginal dryness occur during menopause?

During a woman’s reproductive years, estrogens help keep vaginal tissues hydrated, elastic, and well-vascularized.

These hormones also contribute to:

• The production of vaginal lubrication.
• The maintenance of collagen and elasticity.
• The renewal of vaginal epithelial cells.
• The preservation of an acidic vaginal environment.
• The balance of the vaginal microbiota.
• Protection of tissues against irritation and minor injuries.

With the decline in estrogen production during menopause, changes in hormone production occur. Consequently, the vaginal epithelium may become thinner and more fragile, vascularization decreases, and secretion production is reduced.

The loss of collagen and elastic fibers can also make tissues less flexible. The vagina may lose elasticity and the ability to stretch, contributing to discomfort and pain during sexual intercourse.

The decline in estrogens also reduces the glycogen available in the vaginal epithelium. This can lead to a reduction in lactobacilli and an increase in vaginal pH, altering the local microbial balance.

Therefore, all these changes help explain why vaginal dryness can be accompanied by irritation, burning, urinary symptoms, and, in some cases, recurrent urinary tract infections.

What is genitourinary syndrome of menopause?

Genitourinary syndrome of menopause corresponds to a set of signs and symptoms related to a decrease in estrogen and changes in vulvovaginal and urinary tissues.

This designation is broader than the previously used term, vulvovaginal atrophy, because it recognizes that menopausal changes can affect not only the vagina but also the vulva, urethra, bladder, and sexual function.

The symptoms can be divided into three main groups.

Vaginal and vulvar symptoms

• Vaginal dryness.
• Burning.
• Irritation.
• Itching.
• Sensitivity.
• Pain.
• Intimate area discomfort.
• Small cracks.
• Bleeding after contact or sexual intercourse.

Sexual symptoms

• Decreased lubrication.
• Pain during sexual intercourse.
• Pain after sexual intercourse.
• Avoidance of sexual activity.
• Reduced desire associated with the fear of experiencing pain.
• Impact on intimacy and the couple’s relationship.

Urinary symptoms

• Burning or pain upon urination.
• Need to urinate more frequently.
• Urinary urgency.
• Need to urinate during the night.
• Urine leakage.
• Recurrent urinary tract infections.

Dryness, burning, and irritation are among the most frequent vaginal symptoms. However, dyspareunia—pain during sexual intercourse—and decreased sexual desire are also common complaints, even though women often avoid discussing the subject.

What are the most frequent symptoms women present with at the pharmacy?

Each woman experiences this phase differently. Some experience only a slight sensation of dryness. Others have symptoms that affect their sleep, physical activity, work, sex life, or relationship with their partner.

The most frequent symptoms include:

• Sensation of dryness or lack of lubrication.
• Burning or irritation.
• Itching.
• Sensitivity in the vulva or vagina.
• Pain during or after sexual intercourse.
• Slight bleeding after intercourse.
• Burning sensation during urination.
• Frequent or urgent need to urinate.
• Recurrent urinary tract infections.

Keep in mind that these symptoms can begin as early as perimenopause, before the final menstrual period. They can also appear gradually, meaning they are not always associated with hormonal changes.

Unlike hot flashes, which may diminish over time, genitourinary symptoms tend to persist and can worsen if left unidentified and untreated. For this reason, our team always emphasizes that SGUM is considered a chronic condition that may require ongoing monitoring and adjustments to care over time.

Vaginal dryness and vulvovaginal infections

Menopause-related vaginal dryness results, in many cases, from a decrease in estrogen and changes in vaginal tissues. It is not directly caused by fungi or bacteria.

However, some symptoms may appear similar to those of a vaginal infection.

Burning, itching, and irritation can also occur with candidiasis, bacterial vaginosis, sexually transmitted infections, or vulvar skin diseases.

For this reason, do not assume that any intimate discomfort indicates an infection; instead, seek our advice.

Vaginal candidiasis is typically associated with intense itching, irritation, redness, and a thick, white discharge. However, symptoms can vary and should be evaluated if there is any doubt.

It is also important to rule out vulvar dermatoses, persistent inflammation, lesions, abnormal bleeding, and other abnormalities that may require specific care.

Can vaginal dryness be associated with sexual problems?

As we have seen previously, there is a clear connection! Reduced lubrication and elasticity can increase friction during penetration. Tissues may also become thinner, more sensitive, and prone to small tears. Consequently, pain may occur during or after sexual intercourse.

Pain should not be ignored or considered an inevitable consequence of aging. Continuing to have painful sexual intercourse can aggravate irritation, increase pelvic floor muscle tension, and create fear or anxiety regarding intimacy.

It is also important to recognize that not all sexual pain during menopause is caused by vaginal dryness. Other possible causes include pelvic floor changes, vulvar dermatoses, prior surgeries, cancer treatment, and pelvic organ prolapse, among other conditions.

When pain persists, it should be evaluated by a healthcare professional.

What can help relieve vaginal dryness?

The choice depends on the severity of the symptoms, their frequency, their impact on quality of life, and the woman’s medical history.

In mild or moderate cases, non-hormonal treatments may be considered. When symptoms persist, are severe, or affect sexual life and well-being, medical evaluation and the prescription of specific medications may be necessary.

Vaginal moisturizers

Vaginal moisturizers are intended for regular use.

They help maintain tissue hydration and can reduce dryness, burning, and irritation in daily life. Their effect tends to last longer than that of a lubricant.

Depending on the product, they may be applied several times a week, in accordance with the healthcare professional’s instructions.

It is important to choose a product formulated for vaginal use. Body moisturizers, scented oils, or cosmetic creams are not suitable for application inside the vagina.

The composition of moisturizers varies. Some products contain substances with moisturizing properties—such as hyaluronic acid, which helps retain water—or emollients.

Vaginal lubricants

Lubricants are used before or during sexual activity.

Its primary function is to reduce friction and make intercourse more comfortable when there is little natural lubrication.

The effect is temporary and does not replace the regular use of a vaginal moisturizer when dryness is also present in daily life.

Lubricants can be:

• Water-based.
• Silicone-based.
• Oil-based.
• Hybrids.

The choice should take into account tolerability, product composition, and the use of condoms.

In short, lubricants are intended for occasional use and reduce friction during sexual activity. Moisturizers are used regularly and help improve hydration and alleviate daily symptoms.

When can vaginal estrogen be considered?

When symptoms are moderate or severe, or do not improve with moisturizers and lubricants, the doctor may consider the use of low-dose vaginal estrogen. This treatment acts primarily on the tissues of the vagina and vulva.

Local treatment can help improve dryness, lubrication, and pain during sexual intercourse. It may also be considered for some women with urinary symptoms or recurrent urinary tract infections. The use of vaginal estrogen always requires medical evaluation.

And what about vaginal laser treatments?

Some clinics offer vaginal laser treatment as an option for dryness or genitourinary syndrome of menopause.

However, the evidence and recommendations regarding these treatments should be evaluated with caution. They should not be presented as equivalent to treatments with better-established efficacy and safety.

Before undergoing a procedure of this type, it is important to clarify:

• What is the clinical indication?
• What benefits are expected.
• What risks exist.
• How many sessions are needed?
• What alternatives are available?
• What evidence supports the procedure?

The decision should be discussed with a doctor experienced in women’s health and menopause.

Does sexual activity help?

Comfortable sexual activity—whether involving penetration or not—can contribute to maintaining blood circulation and tissue flexibility.

However, there should be no pressure to engage in sexual intercourse when there is pain.

When dryness is present, it can be useful:

• Increase the time spent on arousal.
• Use a suitable lubricant.
• Avoid painful penetration.
• Try positions that allow you to control the depth.
• Stop the activity if pain occurs.
• Talk openly with your partner.
• Seek an evaluation if the discomfort persists.

For some women, pelvic floor physical therapy can also be helpful, especially when there is muscle tension, persistent pain, or difficulty with penetration.

What precautions should you take regarding intimate hygiene?

Excessive hygiene can aggravate dryness and irritation. The vagina has natural protective mechanisms and does not need to be washed internally.

To reduce the risk of irritation:

• Wash only the external genital area.
• Use water or a mild, fragrance-free product.
• Avoid vaginal douches.
• Avoid scented soaps.
• Do not use intimate deodorants.
• Avoid scented wipes.
• Opt for comfortable, breathable underwear.
• Change out of wet clothes after exercising or swimming.
• Avoid wearing very tight clothing for long periods.
• Do not apply body creams inside the vagina.

When there is sensitivity, a simple routine is usually more suitable than using multiple products.

Can vaginal dryness increase the risk of urinary tract infections?

Hormonal changes associated with menopause can alter vaginal and urethral tissues, increase vaginal pH, and modify the local flora.

These changes can contribute to an environment more favorable to the development of urinary tract infections in some women.

However, symptoms such as burning during urination, urgency, or increased urinary frequency do not always indicate an infection.

Genitourinary syndrome of menopause can cause similar symptoms. On the other hand, a true urinary tract infection requires appropriate diagnosis and treatment.

When infections recur, it is important to undergo a medical evaluation. Urinary symptoms can have various causes and do not always result solely from menopause.

And what about a history of breast cancer?

Women with a history of breast cancer may also experience vaginal dryness and other genitourinary symptoms.

In these cases, vaginal moisturizers and lubricants are usually considered first. If these measures are insufficient, the decision regarding other treatments should be individualized.

Some guidelines allow for the consideration of low-dose vaginal estrogen after non-hormonal options have failed; however, this decision requires a risk-benefit assessment and coordination with the responsible medical team.

It may be necessary to involve the family doctor, the gynecologist, and the oncology team. You should never start vaginal hormone therapy without medical advice.

How long does vaginal dryness last?

The duration varies from woman to woman.

Unlike some vasomotor symptoms of menopause, vaginal dryness may not resolve spontaneously. In many women, the symptoms persist or worsen over time.

They may also reappear after local treatment is discontinued. For this reason, some women require regular care.

The treatment plan must be adjusted according to the woman’s response, comfort, and needs.

When should you seek counseling?

Vaginal dryness does not always require an urgent consultation. However, you should consult a healthcare professional when:

• The symptoms last for several weeks.
• The discomfort affects daily life.
• There is pain during or after sexual intercourse.
• Discharge that differs from the usual appears.
• There is an intense odor.
• The itching is intense or persistent.
• Wounds, fissures, or lesions appear.
• Pelvic pain exists.
• Fever develops.
• You have recurrent urinary tract infections.
• The symptoms began after a new sexual partner.
• There is blood after sexual intercourse.
• The treatment used does not improve the symptoms.
• Any bleeding occurs after menopause.

Any vaginal bleeding after menopause should be evaluated by a doctor, even if it occurs only once. An evaluation allows for ruling out infections, cervical abnormalities, and other conditions that may require different care.

Vaginal dryness should not be endured in silence.

In conclusion, vaginal dryness can affect sleep, self-esteem, intimacy, sexual activity, and the relationship between partners. It is not merely a minor inconvenience. Nor should it be considered an inevitable consequence of aging.

At Farmácia Correia Rosa, you can speak privately with a pharmacist. The team can help distinguish between a vaginal moisturizer and a lubricant, explain the correct way to use them, and identify situations that require medical evaluation.

Seeking advice will help you find a suitable solution and regain intimate comfort. Contact us!