Vaginal dryness is a common symptom of perimenopause and menopause, often resulting in vaginal irritation and pain during intercourse. Although off-putting, vaginal dryness does not have to mean the end of your sexual pleasure.
Below, we explain what causes vaginal dryness, the best lubricants to relieve pain during sex when going through perimenopause or menopause, and what else you can do to restore your vaginal health.
What Is Vaginal Dryness?
Also referred to as vaginal atrophy or atrophic vaginitis, vaginal dryness is the result of less moisture or natural lubrication produced in the vagina, causing the once naturally lubricated vaginal lining to dry out, lose elasticity, and become thinner.
The lack of moisture and natural lubrication can cause the vagina to narrow and become shorter in some women. This can result in vaginal micro-tears during intercourse, painful sex (dyspareunia), and vaginal bleeding.
The vulva, which includes the outer genitals and vaginal lips, can be affected by vaginal dryness too. In these cases, women may notice a thinning of the vulvar skin, irritation when it touches against underwear, and pain or tightness during penetration.
In more serious cases, the absence of natural lubrication can change the vaginal pH, which makes the vaginal environment more acidic and more susceptible to yeast infections and urinary tract infections (UTIs).
What Causes Vaginal Dryness?
For women in their early-to-mid 40s and older, the most common cause of vaginal dryness is a hormone imbalance during perimenopause or menopause.
Translated as ‘around menopause’, perimenopause occurs 7-12 years before menopause is reached. During this time, the female body begins to produce less estrogen and progesterone in preparation for the end of the reproductive phase of life.
As the production of these hormones fluctuates and declines, lower estrogen in particular can result in symptoms such as irregular menstruation, mood swings, hot flashes, brain fog, and vaginal dryness.
Menopause is reached when women have not menstruated for 12 consecutive months. Although many symptoms of perimenopause subside when menopause is reached and the body customizes to lowered estrogen levels, vaginal dryness can linger into postmenopause for some.
Other causes of vaginal dryness include cancer treatment, some antidepressants, and certain allergy medications.
What is The Genitourinary Syndrome of Menopause?
When vaginal dryness is accompanied by an increased need to pee and/or recurring urinary tract infections (UTIs) during perimenopause or menopause, it is known as the Genitourinary Syndrome of Menopause (GSM).
Closely linked to low estrogen levels, GSM is typically treated with topical estrogen therapy, where an estrogen gel or cream is rubbed onto the skin of the inner thigh.
How to Treat Vaginal Dryness During Perimenopause or Menopause
Treating vaginal dryness depends on how severely it has progressed. Although topical estrogen is an option, female health experts recommend starting with an organic moisturizer for the vaginal skin, supplementing natural lubrication with a personal lubricant, and maintaining or restoring pelvic floor strength.
Organic Moisturizer
The daily application of an organically made vaginal moisturizer is the first recommended step to restore moisture to the vaginal skin. (Organically-made vaginal moisturizers won’t alter the vaginal pH and make you more prone to vaginal infections.)
During perimenopause and menopause, it’s vitally important to avoid any vaginal moisturizers containing fragrances, parabens, synthetic ingredients, or glycerin.
Personal Lubricants
To relieve the pain, friction, and discomfort of vaginal dryness during sex, water-based lubricants are recommended. It’s important to note that all lubricants eventually dry out and don’t moisturize the vagina. However, water-based lubricants can supplement natural lubrication during intercourse for women in perimenopause and menopause without further irritating the skin.
The best water-based lubricants are made from natural ingredients and are unflavored, unscented, and glycerin-free to protect the natural vaginal pH balance and prevent any further irritation.
In addition to protecting the vagina, water-based lubricants are also safe to use with silicone sex toys or pelvic health tools like dilators or Kegel weights (see below). Silicone-based and oil-based lubricants may damage the outer silicone layers on tools like these.
Pelvic Floor Health
When vaginal dryness has progressed to the point that the vagina has shortened and the vaginal opening has narrowed, a set of silicone dilators is helpful to open and stretch the vagina gently. Silicone dilators are made from medical-grade silicone, feel more life-like, than plastic dilators, and don’t contain harmful phthalates that could harm vaginal tissues.
Pelvic floor exercises are also helpful to keep the vaginal muscles healthy and strong. To understand where the pelvic floor is and how to strengthen it with Kegel exercises or Kegel weights, consider scheduling a consultation with a pelvic floor physical therapist.
The 5 Best Lubricants for Menopause Dryness
When perimenopausal or menopausal women are selecting a personal lubricant to relieve vaginal dryness during intercourse, it’s vital to choose lubes that will not alter the vaginal pH or the body’s hormone balance.
This is achieved by avoiding water-based lubricants that contain animal-based glycerin, synthetic fragrances or flavors, and phthalates and parabens.
The following are our top 5 choices for water-based lubricants:
1. Serenity Water-Based Personal Lubricant, From Intimate Rose
Made from high-quality, natural, and safe ingredients, this ultra-smooth and extra-silky lubricant from Intimate Rose provides longer-lasting comfort than most water-based lubes. Made in the USA and FDA-approved, Serenity Water-Based Lubricant is designed by a pelvic health physical therapist to resemble the natural vaginal pH.
It’s glycerin-free and contains no fragrances, flavors, phthalates, or parabens. It’s also non-staining and easily cleaned from skin and bedsheets with water.
At just $13.99 for an 8-oz bottle, it’s our top pick for the most natural, long-lasting, and best-priced water-based lubricants on the market.
2. Natural Sex Lube, From Hello Cake
Made from a selection of organic ingredients, Natural Sex Lube is smooth, non-sticky, and hydrating for vaginal and vulvar skin. Although a small number of clients developed UTIs while using this lube, and others felt it wasn’t as smooth or long-lasting as our top two picks, it is safe and effective for the majority and has a convenient pump dispenser to gauge the right amount for your needs.
At $14.50 for a 3.3-oz bottle, it’s also reasonably priced.
3. Lovehoney Enjoy Water-Based Lubricant, from Womanizer
This water-based lubricant is body-safe, unscented, allergen-free, and well-priced at $14.95 for an 8.45oz bottle. The product description recommends generous application for best results, however, re-application was only required for a minority of our clients. Most found that a little went a long way and provided a smooth and discomfort-free experience during intercourse.
Although non-staining, the consistency is thicker and stickier than other water-based lubricants.
4. Shine Organic Water-Based Lubricant, from Maude
This organic water-based lubricant from Maude includes aloe vera for extra hydrations and is pH balanced to maintain the vaginal microbiome. It’s also fragrance-free and made without glycerin or parabens. Although it might not last as long as others on our list, and some might not appreciate the aloe vera scent, it’s a safe water-based lubricant made from natural ingredients.
At $25.00 for an 8-oz bottle, it’s more costly than our other recommendations but worth it for some.
5. NaturaLove Lubricant, from Jo Organic
Naturalove is free of all harmful ingredients including glycerin, synthetic fragrances, parabens, and phthalates. Although it’s made with over 95% certified organic ingredients, it can be a little stickier than others on the list and the price is quite high in comparison. That said, it’s a soothing, stain-free, and easy-to-clean lubricant.
At $32.95 for a 4 oz bottle, it’s the most expensive lube on our list.
Conclusion
Low estrogen levels and an ensuing decline of natural lubrication are often at the root of vaginal dryness. Although a common and sometimes life-altering symptom of perimenopause and menopause, the good news is vaginal dryness can be relieved and intercourse can become pleasurable and pain-free again.
Organic vaginal moisturizers and water-based lubricants that are pH balanced with the vaginal microbiome in mind can rehydrate vaginal tissues and supplement natural lubrication for more enjoyable sexual experiences well into your elder years.
If vaginal dryness has progressed to the point that the vagina has shortened and narrowed, vaginal dilators are recommended to stretch the vaginal tissues gently and restore elasticity. For guidance on the use of vaginal dilators or other pelvic tools to strengthen the pelvic floor, schedule a consultation with a pelvic floor physical therapist or gynecologist.
References
American College of Obstetricians & Gynecologists – Experiencing Vaginal Dryness: Here’s What you Need to Know - https://www.acog.org/womens-health/experts-and-stories/the-latest/experiencing-vaginal-dryness-heres-what-you-need-to-know
Cleveland Clinic – Vulva - https://my.clevelandclinic.org/health/body/vulva
Johns Hopkins Medicine – Genitourinary Syndrome of Menopause - https://www.hopkinsmedicine.org/health/conditions-and-diseases/genitourinary-syndrome-of-menopause
National Library of Medicine - Phthalates and Their Impacts on Human Health - https://pmc.ncbi.nlm.nih.gov/articles/PMC8157593/
WebMD - Finding Relief From Vaginal Dryness and Pain - https://www.webmd.com/menopause/menopause-vaginal-dryness
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.