Vaginal dryness is common, but it should not be dismissed as something a woman simply has to tolerate. It can cause burning, irritation, pain during sexual intercourse and urinary symptoms, affecting sleep, relationships and quality of life.
Menopause is a frequent cause, but vaginal dryness can occur at any age—including during breastfeeding, while taking certain medicines or after cancer treatment. Similar symptoms may also be caused by infection, a vulvar skin condition or another gynecological problem, so persistent symptoms deserve appropriate assessment.
At Republikas laukuma klīnika in central Riga, our gynecologists can identify the likely cause and recommend treatment suited to the patient’s symptoms and medical history.
What is vaginal dryness?
Healthy vaginal and vulvar tissues depend partly on estrogen, blood flow and natural secretions. When estrogen levels decline, the tissues may become thinner, less elastic and more fragile, and natural lubrication may decrease.
Vaginal dryness is not always limited to a feeling of insufficient moisture. It may occur together with vulvar irritation, pain during penetration or urinary symptoms.
In menopause, this group of symptoms is known as genitourinary syndrome of menopause, or GSM. Unlike hot flushes, GSM symptoms often persist or worsen without treatment.
Symptoms associated with vaginal dryness
Symptoms may include:
- a dry or tight sensation in the vagina;
- burning, stinging or irritation around the vaginal opening or vulva;
- itching;
- discomfort when sitting, walking or exercising;
- insufficient lubrication during sexual activity;
- pain during penetration or a gynecological examination;
- light spotting after sexual intercourse caused by fragile tissue;
- urinary urgency or discomfort when urinating;
- recurrent urinary tract infections;
- reduced sexual desire related to discomfort or fear of pain.
These symptoms are not specific to vaginal dryness. Itching, burning, pain or discharge may also indicate infection, dermatitis, lichen sclerosus, vulvodynia or another condition. Self-treatment should not delay medical assessment when symptoms persist.
What causes vaginal dryness?
Perimenopause and menopause
Declining and fluctuating estrogen levels are among the most common causes. Changes may begin during perimenopause, but some women develop symptoms only several years after their final period.
Breastfeeding and the postpartum period
Estrogen levels can remain low while breastfeeding, leading to temporary dryness and discomfort during sex. Birth-related tissue injury, scar sensitivity, pelvic-floor tension and fatigue may also contribute to pain, so dryness may not be the only issue.
Medicines and medical treatment
Vaginal dryness may be associated with:
- medications that reduce estrogen activity;
- some hormonal contraceptives;
- certain antidepressants and other medicines;
- chemotherapy or pelvic radiotherapy;
- surgical removal of the ovaries;
- endocrine therapy used after hormone-sensitive breast cancer.
Do not stop a prescribed medicine without discussing it with the clinician responsible for your treatment.
Insufficient arousal or relationship factors
Natural lubrication varies and is influenced by sexual stimulation, stress, pain, fatigue, anxiety and relationship factors. Arousal-related dryness can occur at any age and does not necessarily indicate low estrogen.
Irritation and skin conditions
Perfumed intimate products, vaginal douching, fragranced soaps, wipes, deodorants and some detergents can irritate sensitive vulvar tissue. Eczema, contact dermatitis, lichen sclerosus and other vulvar skin conditions may produce symptoms that resemble simple dryness.
Infection and other gynecological conditions
Thrush, bacterial vaginosis, sexually transmitted infections and urinary infections may cause burning, discomfort or pain. Abnormal discharge, odour, sores, blisters or pelvic pain require assessment rather than treatment with a moisturiser alone.
How is the cause diagnosed?
A gynecologist will ask about the symptoms, menstrual cycle, pregnancy and breastfeeding history, sexual pain, medicines, previous cancer treatment and products used in the intimate area.
Depending on the symptoms, assessment may include:
- examination of the vulva and vagina;
- vaginal or cervical samples if infection is suspected;
- urine testing for urinary symptoms;
- cervical screening when due;
- other investigations if bleeding, a visible lesion or pelvic symptoms are present.
Hormone blood tests are usually unnecessary for typical menopausal vaginal dryness. Treatment is generally based on symptoms, examination findings and medical history.
Vaginal dryness treatment
Treatment depends on the cause, severity of symptoms, age, reproductive stage and medical history. A stepwise approach is usually most appropriate.
Lubricants and vaginal moisturisers
Lubricants and moisturisers serve different purposes.
A lubricant is used immediately before or during sexual activity to reduce friction. Water- or silicone-based products may be suitable. A silicone-based lubricant usually lasts longer, while water-based products are often easier to wash away.
A vaginal moisturiser is used regularly, not only before sex. It is designed to improve everyday comfort and maintain moisture for longer periods.
Choose unperfumed products intended for vulvovaginal use. Avoid warming, cooling or fragranced products if the tissue is sensitive. Oil-based products can damage latex condoms, and some products may irritate the vaginal lining.
Vaginal estrogen
Low-dose vaginal estrogen is an effective treatment for genitourinary symptoms related to menopause. It is available in different formulations, such as creams, vaginal tablets, pessaries or rings.
Vaginal estrogen acts mainly on local tissues and has much lower systemic absorption than systemic menopausal hormone therapy. It can improve dryness, burning, tissue fragility and pain during sex. It may also help some postmenopausal women with recurrent urinary tract infections.
Women using systemic menopausal hormone therapy may still require additional local vaginal treatment if dryness or urinary symptoms persist.
The need for treatment and the most suitable formulation should be reviewed with a doctor. Vaginal estrogen is not intended to treat hot flushes or night sweats.
Other prescription treatments
When moisturisers, lubricants or vaginal estrogen are unsuitable or insufficient, other prescription options may be considered. Availability varies by country, and each treatment has its own indications, contraindications and possible adverse effects.
If pain persists after tissue dryness has improved, the cause may include pelvic-floor muscle overactivity, vulvodynia, scar sensitivity or another condition. Pelvic-floor physiotherapy or additional specialist assessment may then be appropriate.
Vaginal dryness after breast cancer
Cancer treatment can cause severe genitourinary symptoms, particularly after ovarian suppression, chemotherapy or endocrine therapy.
Non-hormonal moisturisers and lubricants are generally considered first. If symptoms remain troublesome, low-dose vaginal estrogen may be considered for some patients after an individual discussion of benefits and uncertainties with the gynecologist and the clinician responsible for cancer care.
A history of breast cancer does not mean that every patient receives the same recommendation. The cancer type, receptor status, current treatment, symptom severity and patient preferences all matter. Patients should not stop endocrine cancer treatment because of vaginal symptoms without speaking to their oncology team.
Vaginal dryness after childbirth
Dryness is common during breastfeeding and often improves when lactation decreases and menstrual cycles resume. Lubricants and moisturisers may provide sufficient relief.
Persistent pain after childbirth should not automatically be attributed to dryness. Healing tissue, scar pain, pelvic-floor dysfunction, infection and psychological factors may also contribute. A gynecological assessment is appropriate if pain continues, penetration is difficult or there is bleeding, discharge or concern about healing.
Hyaluronic acid products and injections
Some non-hormonal vaginal moisturisers contain hyaluronic acid and may improve dryness for certain women. Evidence and product formulations vary, and they should not be confused with injectable fillers.
Hyaluronic acid injections into intimate tissues are marketed for hydration or tissue quality, but they are not standard first-line treatment for vaginal dryness. The expected benefit, product used, duration of effect, risks, alternatives and cost should be discussed before treatment.
Potential risks of an injection procedure include pain, swelling, bruising, infection, tissue irregularity and an unsatisfactory result.
What about PRP injections?
Platelet-rich plasma, or PRP, is prepared from a patient’s own blood and contains platelets and growth factors. It has been promoted for vulvovaginal symptoms and sexual function.
However, evidence for vaginal PRP remains limited. Treatment protocols are not standardised, and robust information about effectiveness, duration of benefit and long-term safety is lacking. PRP should not be presented as a proven replacement for established first-line treatments.
If a patient is considering PRP, the diagnosis should first be confirmed and the limitations of the evidence, alternatives, risks and costs should be explained clearly.
Everyday measures that may help
- Wash the vulva gently with water or a mild, unperfumed product if needed.
- Avoid vaginal douching, perfumed intimate washes, deodorants and fragranced wipes.
- Use a suitable lubricant during sexual activity.
- Apply a vaginal moisturiser regularly according to its instructions.
- Do not use ordinary hand or body cream inside the vagina.
- Avoid continuing penetration when it is painful.
- Allow enough time for arousal and communicate about discomfort with your partner.
- Wear breathable underwear and change out of damp clothing promptly if irritation is present.
- Do not use over-the-counter antifungal treatment repeatedly unless thrush has been confirmed or previously diagnosed with the same typical symptoms.
Regular, comfortable sexual activity or vaginal stimulation may help maintain blood flow and tissue flexibility, but it should never be painful or treated as an obligation.
When should you see a gynecologist?
Arrange a consultation if:
- symptoms persist despite using a suitable lubricant or moisturiser;
- pain interferes with sexual activity or a gynecological examination;
- you have recurrent urinary symptoms or urinary tract infections;
- symptoms began after starting a medicine or cancer treatment;
- you notice abnormal discharge, odour, sores, blisters or a vulvar skin change;
- there is bleeding after sex or unexplained bleeding;
- you are considering vaginal estrogen, PRP or an injection procedure;
- you have a history of breast or another hormone-sensitive cancer;
- dryness developed after childbirth and does not improve.
Any vaginal bleeding after menopause—after 12 consecutive months without a period—must be medically evaluated. Most causes are not cancer, but important disease must be excluded.
Seek urgent medical care for heavy bleeding, severe pelvic pain, fever, fainting or rapidly worsening symptoms.
Frequently asked questions
Is vaginal dryness normal during menopause?
It is common, but it does not have to be accepted without treatment. Effective non-hormonal and hormonal options are available.
Is a lubricant the same as a vaginal moisturiser?
No. A lubricant reduces friction during sexual activity, while a vaginal moisturiser is used regularly to improve day-to-day moisture and comfort.
Can vaginal dryness cause painful sex?
Yes. Dry, fragile tissue and reduced lubrication can make penetration painful. Persistent pain can also have other causes, including pelvic-floor dysfunction, infection or a vulvar pain condition.
Can vaginal estrogen be used without systemic hormone therapy?
Yes. Low-dose vaginal estrogen can be used on its own when symptoms are mainly vaginal or urinary. It does not treat hot flushes or other whole-body menopausal symptoms.
Is vaginal estrogen the same as systemic HRT?
No. Low-dose vaginal treatment acts mainly on local tissue and results in much lower systemic exposure than tablets, patches or gels used for systemic menopausal symptoms.
How quickly does treatment work?
This depends on the cause and treatment. Lubricants work at the time of use, while moisturisers and vaginal estrogen generally require regular use. Some improvement may occur within weeks, but the full response can take longer.
Can vaginal dryness cause urinary tract infections?
Postmenopausal tissue and microbiome changes can contribute to recurrent urinary tract infections. However, urinary burning and urgency can have several causes, so infection should be confirmed when appropriate.
Can I use vaginal estrogen if I have had breast cancer?
This requires an individual discussion. Non-hormonal options are usually tried first. For persistent symptoms, low-dose vaginal estrogen may be considered for some patients in consultation with the gynecologist and oncology team.
Are PRP injections proven to treat vaginal dryness?
Current evidence is limited, treatment methods are not standardised and long-term safety data are insufficient. PRP is not a replacement for established first-line treatment.
Vaginal dryness consultation in Riga
Vaginal dryness, burning and pain during sex are treatable symptoms. Our gynecologists can identify the likely cause, exclude infection or a vulvar condition and recommend an individual treatment plan.
Book a gynecologist appointment
Address: Republikas laukums 3–18, Riga
