Vaginal Dryness

Vaginal Dryness is a prevalent symptom experienced by women during the perimenopause and menopause. Regrettably, it’s often a subject of embarrassment, seldom discussed openly, and frequently goes untreated. Unlike earlier menopausal symptoms like hot flushes and night sweats, vaginal dryness, resulting from decreased oestrogen levels, tends to persist and worsen when left unaddressed.

Oestrogen plays a vital role in maintaining the health of the vagina, vulva, bladder, and pelvic floor. During periods of low oestrogen (such as perimenopause, menopause, breastfeeding, or while on the progesterone-only pill), the vagina gradually loses its natural lubrication. This leads to thinning and reduced elasticity of the vaginal walls, causing pain during penetration and an increased risk of tearing during intercourse. Additionally, the bladder and urethra also undergo thinning, leading to more pronounced openings and a higher susceptibility to urinary tract infections. The labia at the vaginal entrance lose fat, become thin and sensitive, and can fuse together, resulting in itching and soreness. Scars from childbirth may lose collagen and elastin, becoming more sensitive and often causing pain during sex.


Symptoms may manifest during the perimenopause or remain dormant for several years, emerging when a woman believes she has completed menopause. Once ovarian function ceases, a woman enters the postmenopausal phase, and oestrogen is no longer produced. This may lead to a lack of awareness that these symptoms are due to decreased oestrogen, causing women to miss the opportunity for straightforward and effective treatment. Addressing these symptoms can not only relieve discomfort but also reduce the risk of urinary tract infections, a common cause of sepsis in elderly women.


The older terms “vaginal atrophy” and “vulvovaginal atrophy” are no longer used to describe these symptoms resulting from reduced oestrogen. Instead, the term “Genitourinary Syndrome of Menopause” is employed to emphasize that the bladder, urinary tract, vulva, and vagina are all affected by the lack of oestrogen.

What can be done to help?

Similar to how we apply moisturiser to our face and body, applying a moisturiser to the vagina and vulva can provide relief to the tissues.

It is crucial to use a moisturiser specifically designed for vaginal use and free from irritant additives.

Products like Yes VM and Sylk Natural Intimate Moisturiser are recommended as they maintain the vaginal acidity and offer the right moisture balance. Sylk can also serve as a lubricant to ease sexual intercourse.

Water-based lubricants (Yes WB) and oil-based lubricants (Yes OB) are available, and they can be used together with the oil-based lubricant applied first, followed by the water-based one. Note that oil-based lubricants should not be used with latex condoms.

Vaginal moisturisers can be applied every 2-3 days or more frequently if needed. When attending cervical smears or vaginal examinations, you can bring your own lubricant for healthcare professionals to use, avoiding potential contact with lubricants that might adversely affect your vagina.

The use of local oestrogen in the vagina is a highly effective solution that typically relieves symptoms of vaginal dryness after about three months. It can be prescribed by your doctor and is generally safe for long-term use. If discontinued, symptoms often return. There are two types of oestrogen—estradiol and estriol—and several methods for its application, allowing you to choose the one that suits your needs best.

Local oestrogen can be administered as a tablet, pessary, cream, gel, or ring:

  • Tablet (e.g., Vagifem, Vagirux): Inserted high into the vagina using an applicator for two weeks, followed by twice-weekly use. Typically inserted at night. While Vagirux has a reusable applicator, Vagifem uses a daily plastic applicator, leading to more plastic waste.
  • Pessary (e.g., Imvaggis): Inserted into the vagina using fingers. Used once daily for three weeks, then continued twice weekly. No applicator means no waste, but it can potentially damage latex condoms and may produce a slight waxy discharge.
  • Cream (e.g., Ovestin): One applicator full inserted into the vagina once daily for two weeks, then continued twice weekly. Can be soothing if the vagina is very dry and can also be used on the vulva if it is dry and sore, but it may be messy.
  • Gel (e.g., Blissel): One applicator full inserted into the vagina once daily for three weeks, then continued twice weekly. The gel is rapidly absorbed, but itching or irritation may occur initially.
  • Ring (Estring): Inserted into the vagina by the woman or a healthcare professional, it remains in place for 90 days. No need for daily or weekly treatment, but it may interfere with sex (although it can be removed and replaced if necessary).

Additionally, Intrarosa is a pessary that does not contain oestrogen but contains prasterone, which is converted to oestrogen and testosterone in the body. It can be used once daily in the vagina to help women experiencing painful intercourse. It is easy to use but may damage latex condoms.

If you have previously experienced pain during a cervical smear, using local vaginal 0estrogen for six weeks before your next smear can help ensure a more comfortable experience during this essential screening procedure.

What should you do if there is no improvement?

Responses to various forms of oestrogen in HRT can vary among women. Therefore, it is crucial to make an individualised choice with the guidance of your healthcare professional. Some women may benefit from estradiol but not estriol, and vice versa. If you do not experience success with your initial choice, it’s worth trying a different preparation.

If you have used your prescribed medication as directed for three months and continue to experience symptoms, you should consult your healthcare professional for examination. Other conditions can affect the vulva and vagina and may require alternative treatments. It’s important to ensure an accurate diagnosis. Any unexpected vaginal bleeding should always be discussed with your clinician.