What causes vaginal dryness? Menopause and your sex life

What does vaginal dryness feel like in menopause?

This is a subject many women find hard to bring up, even with a doctor. Yet it is very common, and talking about it is completely normal.

The NHS lists vaginal dryness, burning, irritation or itching among menopause symptoms and says they can make sex painful. A lower sex drive is on the same list (NHS, Menopause: symptoms).

The Menopause Society groups these symptoms under a single name: the genitourinary syndrome of menopause (GSM for short). “Genitourinary” means it covers both the genital area and the urinary tract. GSM can include the following symptoms (The Menopause Society, MenoNote: GSM):

• Vaginal dryness and less natural lubrication
• Burning, itching or irritation of the vulva (the external genital area, including the labia)
• Discomfort or pain during sex
• Pain during a gynecological exam
• Discomfort when wiping after peeing or when wearing certain clothes
• Burning when peeing, needing to pee often or urgently, and a higher risk of urinary tract infections

We cover the urinary symptoms separately in frequent urination and UTIs.

What causes vaginal dryness?

Estrogen (the main female sex hormone) helps keep vaginal tissue thick, elastic and moist. When estrogen falls with menopause, vaginal tissue becomes thinner and drier and loses its elasticity and lubrication. This can lead to pain and discomfort during sex and even in daily life (The Menopause Society, MenoNote: GSM).

Symptoms can be more severe in some situations: in menopause brought on by surgical removal of both ovaries (surgical menopause), after chemotherapy for cancer, and in people taking certain hormone-blocking medicines for breast cancer (The Menopause Society, MenoNote: GSM).

How common is vaginal dryness?

Very common. According to The Menopause Society’s 2020 position statement, GSM affects 27 to 84 percent of postmenopausal women. The range is so wide because studies measure different symptoms in different ways. The same statement stresses that GSM is very likely under-recognized and undertreated (NAMS, 2020).

The NHS also describes vaginal dryness as a common problem that many women experience at some point in their lives (NHS, Vaginal dryness). So if you have these symptoms, you are part of a large group. Because people do not talk about it, how common it is often goes unknown.

Does vaginal dryness go away on its own?

Usually not. This is an important feature that sets GSM apart from other menopause symptoms. While hot flashes often ease over the years, GSM usually gets worse over time when it is not treated (The Menopause Society, MenoNote: GSM).

That is why “it will pass with time, I’ll wait” often does not work for these symptoms. Talking about it early means learning about your options early.

Why does sex drive drop in menopause?

A lower sex drive does not come down to a single cause. The Menopause Society stresses that hormones are only one part of a complex set of factors (The Menopause Society, Sexual Health). The main factors that can play a part:

• Physical discomfort. If you expect sex to hurt, wanting it less is an understandable response.
• Sleep. Sleep broken up by night sweats, and the tiredness that follows, can reduce interest in sex.
• Relationship and life events. A partner’s sexual problems, divorce, a new relationship, children leaving home or the work of caring for aging parents can all affect desire.
• Body image and self-confidence. Worries about aging and how you see your body also play a part.
• Illnesses and medicines. Some illnesses and medicines, for example some antidepressants, can affect sexual function.

(The Menopause Society, Sexual Health)

There is no single “normal” for sex drive. In midlife, some women’s desire decreases, some increases and some stays the same (The Menopause Society, Sexual Health). What matters is whether the situation bothers you. Mood changes can also affect desire; for more on this, see mood swings and irritability.

How can it affect your relationship?

The Menopause Society says GSM symptoms can affect your quality of life, sexual satisfaction and even your relationship with your partner (The Menopause Society, MenoNote: GSM). Expecting pain can lead you to avoid closeness, and that can lead to misunderstandings. Your partner may think your lack of interest is about them.

That is why sharing your symptoms with your partner can help. Knowing the problem comes from a physical change opens room for understanding rather than blame on both sides. The Menopause Society reminds us that intimacy is not only intercourse; other forms of closeness such as extended touching and massage can also be part of a sex life (The Menopause Society, MenoNote: GSM).

What else can cause dryness and itching?

Not all dryness or itching is linked to menopause. The NHS says vaginal dryness can also come with breastfeeding, hormonal contraception, some antidepressants, and using perfumed soaps, shower gels or douches around the vagina (NHS, Vaginal dryness). The Menopause Society also points out that yeast infections, allergic reactions and some skin conditions can cause similar symptoms (The Menopause Society, MenoNote: GSM).

Unusual discharge, spotting or bleeding should always be checked (NHS, Vaginal dryness).

What can you track yourself?

• When did your symptoms start: before or after your last period?
• Is the dryness only during sex, or during the day too?
• Is there burning, itching or discharge as well?
• Do you have burning when peeing, need to pee often, or keep getting urinary tract infections?
• Did a soap, pad or new medicine you use start around the same time as the symptoms?

These notes help you describe the issue briefly and clearly at your appointment. There is nothing to be embarrassed about; your clinician hears these questions often.

When should you see a doctor about vaginal dryness, and what should you ask?

The NHS advises seeing your GP if vaginal dryness has lasted a few weeks and what you have tried is not working, if it is affecting your daily life, if you have unusual discharge, or if you have had bleeding after sex, between periods or after menopause (NHS, Vaginal dryness).

The Menopause Society says that talking about sexual problems is hard for many people, but that health professionals are a good resource on this. An assessment can uncover physical or psychological causes behind low desire; counseling or a referral to a specialist is also possible if needed (The Menopause Society, Sexual Health).

Questions you could ask:

• Do my symptoms fit the genitourinary syndrome of menopause?
• Should an infection or another cause be ruled out?
• What options are there, and which are suitable for me?
• Could my urinary symptoms have the same cause?
• Would it help to be referred to a sexual health specialist or a pelvic floor physiotherapist?

This page does not recommend products or medicines and does not describe treatment options. Talk to your clinician about the options that suit you.