Dry vaginal skin is a common problem experienced by most women around the time of menopause. It is also associated with inadequate lubrication, which can occur at any age. Dryness in the vagina is a hallmark of vaginal atrophy or atrophic vaginitis wherein the walls of the vagina become thinner and inflammation occurs due to the decline in levels of estrogen.

Normally the vaginal walls are coated by a thin layer of moisture. During sexual arousal, there is an increase in blood flow to the pelvic organs, which produces more vaginal fluid for lubrication. However, hormonal changes occur during the menstrual cycle and other periods such as childbirth and breast-feeding. Furthermore, aging and menopause may also affect the consistency and amount of your vaginal moisture, resulting in dryness.

Symptoms of Dryness in Vagina

Dryness of the vagina may be accompanied symptoms such as:

• Soreness
• Itching around the lower part of your vagina and its opening
• Burning or stinging sensation
• Pain during sexual intercourse
• Light bleeding during sex
• Frequent or urgent urination
• Recurrent infections in the urinary tract

Vaginal dryness affects many women but only a few would ask their doctors about it. If this affects your sex life and lifestyle, consult your doctor. Uncomfortable vaginal skin dryness does not have to be a burden as you get older.

Causes of Dry Vaginal Skin

Vaginal dryness may be brought about by various factors such as:

1. Decline in Estrogen Levels

Dryness in the vagina is often associated with a decline in estrogen levels. Estrogen is a female hormone that maintains normal lubrication, acidity, and elasticity of the vagina.These factors are part of the female's natural defenses against infections in the vagina and urinary tract. However, as estrogen levels decline, this natural state leads to thinning of the vaginal lining, which becomes more fragile and less elastic, with an increased risk for urinary tract infection (UTI).

There are various reasons why estrogen levels may decrease, including:

• Childbirth
• Breastfeeding
• Perimenopause (transition period before menopause)
• Menopause
• Effects of cancer treatment, including hormone therapy, chemotherapy, and radiation therapy
• Surgical removal of ovaries
• Immune disease
• Tobacco smoking

2. Medications

Certain medications for allergy and colds may contain decongestants that reduce moisture in various parts of the body, including the vagina. Medications used to treat breast cancer can also result in vaginal skin dryness.

3. Autoimmune disorders

Autoimmune diseases like Sjogren's syndrome can lead to dryness of various tissues such as the eyes and the mouth, including the vagina.

4. Vaginal douching

Douching the vagina can disrupt the normal environment and alter the chemical balance in the vagina, leading to vaginitis or inflammation in the organ. This results in vaginal dryness and irritation.

Diagnosis and Tests

The cause of dryness in vagina may be diagnosed by doing the following examinations:

• Pelvic examination. After taking a thorough medical history and physical examination, the doctor may inspect your genitalia, including the vagina and cervix. Your doctor will insert and palpate (feel) your vagina and rectum with gloved fingers to inspect your pelvic organs for any sign of disease.
• Pap test. The doctor obtains a sample of your cervical cells for laboratory examination and may also collect a sample of your vaginal secretions to test for signs of vaginitis (vaginal inflammation) and to check for vaginal changes due to estrogen deficiency.
• Urinalysis. A urine test may be done if you have urinary symptoms.

Treatments for Dry Vaginal Skin

Vaginal skin dryness may be treated with over-the-counter or medically prescribed products. The primary cause or disorder must be addressed, if any, and symptomatic remedy may be obtained using any of these:

Medical Treatments

The best way to treat vaginal dryness is to apply topical or vaginal estrogen preparations instead of taking estrogen orally or using a skin patch. Topical estrogen uses minimal doses of the hormone, which reaches the bloodstream effectively. Low doses of estrogen do not affect one's testosterone levels, which is also important for sexual function. Treatment with topical estrogen also decreases one's likelihood for UTI.

Consult a doctor about vaginal estrogen therapy, which may come in various forms:

• Vaginal estrogen creams such as Premarin or Estrace are placed directly into the vagina using an applicator, preferably at bedtime. Your health provider will instruct you on the proper way to use this preparation.
• Vaginal estrogen rings such as Estring are soft, flexible rings that inserted into the upper portion of the vagina either by yourself or by your doctor. The ring delivers a constant dose of hormone while it stays in place. However, this needs replacement every 3 months.
• Vaginal estrogen tablets like Vagifem are placed into the vagina using a disposable applicator. The doctor will instruct you on how often to properly insert the tablet.

Women experiencing menopause may use systemic estrogen (in the form of pills, gels or patches) and another hormone called progestin. Vaginal estrogen therapy may also be used in women who have breast, cervical or ovarian cancer, and medical consultation must be sought for proper advice on its risks and benefits.

Home Remedies

Use a vaginal lubricant/moisturizer - Over-the-counter products that can help relieve dry vaginal skin are available in pharmacies and groceries, but it is best to talk with your health care provider before using them:

• Water-based vaginal lubricants like Astroglidelubricants can keep the vagina lubricated for many hours. Products that do not contain glycerin are recommended. These lubricants are applied to the vaginal opening or to the partner's penis just before sexual intercourse.
• Vaginal moisturizers like Lubrin and Replens simulate normal vaginal moisture can help relieve vaginal dry skin for up to 3 days with one application. These may be used to maintain protection from irritation due to vaginal dryness.

Consult your doctor before using alternative or complementary treatments such as vitamins or estrogen-containing products to make sure they are safe and effective.

Healthy sexual practices - One of the reasons for vaginal dryness is insufficient sexual arousal. Vaginal lubrication is usually achieved when one is relaxed and sufficiently aroused during intimate sex. Talk to your partner about having enough time to be intimate and about regular intercourse which promotes greater vaginal moisture.

Avoiding certain products - Certain products may irritate the vagina and should be avoided, such as:

• Virginal douches
• Vinegar or yogurt
• Hand lotion
• Fragrant and antibacterial soaps
• Bath oils or bubble baths
• Scented detergents and toilet papers