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Three quite different groups of cause, one shared symptom, and why the treatment that works depends entirely on which group you are in.
Reviewed by Dr. Grishma Ranjangaonkar, MBBS, DGO, ICOG Fellowship in Gynecological Endoscopy · Eva WomanCare Clinic, Vashi, Navi Mumbai
This is one of the most common symptoms in gynecology and one of the least often mentioned. It causes soreness, itching, burning, bleeding after intercourse and repeated urine infections, and it is highly treatable. What decides whether treatment works is establishing which of three quite different causes is behind it, which is exactly the step usually skipped.
The short version
Vaginal dryness is common, treatable, and almost never raised. Women wait an average of years before mentioning it, usually because it feels like a complaint about sex rather than a medical symptom, and because nobody asks.
It is a medical symptom. It causes soreness, itching, burning when passing urine, bleeding after intercourse and repeated urine infections, none of which have anything to do with intimacy. And the treatment is simple once somebody has established which of three quite different things is causing it.
Nearly every case falls into one of three groups, and the group decides the treatment. This is why a cream bought on somebody else’s recommendation so often does nothing.
The vaginal lining depends on estrogen to stay thick, elastic and lubricated. When estrogen falls, the tissue thins and produces less moisture. The commonest points in life for that are not the ones people expect.
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When
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What is happening
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How long it lasts
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This group is the most satisfying to treat, because the treatment is subtraction rather than addition. The vagina is self-cleaning. Nearly everything marketed for cleaning it makes matters worse.
Less common, and worth ruling out when the first two groups do not explain things or treatment is not working.
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Cause
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The clue
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Option
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What it does
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Who it suits
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Myth
“It is just part of getting older, so nothing can be done.”
What is actually true
It is common with age and it is not something to accept. Unlike hot flushes it does not settle on its own; without treatment it usually worsens. Treatment works well at any age.
Myth
“Washing more thoroughly will help.”
What is actually true
It reliably makes it worse. The vagina is self-cleaning, and soaps, washes and douches strip the natural protection. Plain water on the outside is the whole hygiene routine.
Myth
“Only menopausal women get it.”
What is actually true
Breastfeeding is one of the commonest causes we see, and it affects women in their twenties and thirties. Certain contraceptives, medications and skin conditions all cause it too.
Myth
“Lubricant is the treatment.”
What is actually true
Lubricant helps at the time. A vaginal moisturiser used regularly treats the tissue between times, and where the cause is low estrogen, local estrogen treats the tissue itself. Using lubricant alone is why many women conclude that nothing works.
Myth
“Vaginal estrogen carries the same risks as HRT tablets.”
What is actually true
Absorption from a low-dose local preparation is very small, and it is considered appropriate for many women who cannot take systemic hormones. It is a conversation to have with your doctor rather than a reason to avoid it.
The description of vaginal atrophy, the distinction between local and systemic estrogen, and the advice against soaps and douching reflect standard gynecological practice. The rule that any bleeding a year or more after the last period requires assessment follows NICE guidance on suspected cancer recognition and referral. This article is general information and does not replace advice from your own doctor, who can examine you.
Dr. Grishma Ranjangaonkar
MBBS, DGO · ICOG Fellowship in Gynecological Endoscopy · Maharashtra Medical Council Reg. No. 2014041327
Dr. Grishma has more than fifteen years of clinical experience and practises at Eva WomanCare Clinic in Vashi, seeing women from across Navi Mumbai including Kopar Khairane and Turbhe. Her work spans fertility and pregnancy care, PCOS and menstrual health, and keyhole gynecological surgery.
What is normal, what is not, and why bleeding after menopause always needs assessment.
Including which methods affect lubrication, and how to switch without leaving a gap.
Dryness while breastfeeding is common and rarely mentioned at the six-week check.
If you are unsure how urgently what you are experiencing needs to be seen.
Most women who raise this tell us afterwards that they wish they had done it years earlier. An examination establishes which group you are in, and treatment usually starts at the same visit. If it is easier to write it down beforehand, that is completely fine.
