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by Women's Health Updated 10/2021

Menopause is full of bothersome symptoms. Hot flashes usually get all the glory, but there is another menopausal symptom that is just as uncomfortable but not as often discussed—vaginal dryness.

If you’re dealing with vaginal dryness, you may be hoping that this too shall pass—but unlike hot flashes, vaginal symptoms don’t fade over time. Instead, they can actually grow worse due to aging and a prolonged lack of estrogen.

Menopause and the Vagina

The drop in estrogen during menopause can lead to a condition called vaginal atrophy, which can include symptoms such as vaginal dryness, itching, burning, discomfort, and pain during intercourse. Here’s what can happen during and after menopause:

  • Vaginal tissues become thin, dry, and less elastic—and can become so fragile and inflamed that they may tear and bleed
  • Vaginal secretions decrease
  • Vaginal infections increase
  • Vaginal changes can result in pain during intercourse, which can lead to less frequent intercourse, which can cause the vagina to become shorter, narrower, and less elastic

In other words, vaginal atrophy can significantly affect quality of life, sexual satisfaction, and relationships.

Treating Vaginal Symptoms

The vaginal symptoms associated with menopause are no fun, but the good news is that there are a variety of treatment options available.

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Vaginal lubricants: Vaginal lubricants such as K-Y jelly reduce discomfort during intercourse by decreasing friction. There are a variety of non-prescription vaginal lubricants available in most drugstores. Look for water-soluble lubricants because the oil in some products can cause more vaginal irritation.

Vaginal moisturizers: Vaginal moisturizers are different from lubricants. These products are designed to line the wall of the vagina and maintain moisture. Just as you apply lotion to the rest of your body, you may want to apply a special moisturizer to the vagina on a regular basis. There are a variety of non-prescription products available, including Replens and K-Y Liquibeads.

Vaginal estrogen therapy: Applying low-dose estrogen directly to the vagina can increase the thickness and elasticity of vaginal tissues, increase vaginal secretions, and relieve vaginal dryness and discomfort. Vaginal estrogen therapy is available by prescription only and comes in three options:

  • Vaginal cream (used 2-3 nights per week)
  • Vaginal estradiol tablet (used twice per week)
  • Estradiol vaginal ring (changed every 3 months)

As with any hormonal therapy, it’s important to weigh the risks and benefits associated with the treatment. Women with a history of breast or uterine cancer may want to avoid vaginal estrogen therapy or use it as a very short-term treatment option.

Vaginal exercise: Keeping the vagina active can help address the symptoms of vaginal atrophy. The vagina is like other muscles—if you don’t use it, you lose it. There are several ways to “exercise” the vagina:

  • Sexual activity: Regular sexual stimulation can promote blood flow and secretions to the vagina. Sexual activity can be alone, with a partner, or with a device.
  • Vaginal dilator: A vaginal dilator is a device inserted into the vagina that can help stretch and enlarge it. Vaginal dilators are available in pharmacies and medical supply stores. A gynecologist or physical therapist can provide guidance on how to use it.
  • Work on the pelvic floor: Exercises for the pelvic floor can help strengthen weak vaginal muscles and relax tight ones. Work with a physical therapist to learn how to exercise the pelvic floor.