Vaginal dryness affects just about every woman at some time. It is almost an universal problem after the menopause, but significant numbers of younger women are affected, too. Vaginal dryness can occur after childbirth, as a side effect of some medications, especially progesterone-containing hormonal contraceptives, or as a result of autoimmune conditions that affect moisture production.

Vaginal dryness is often accompanied by other symptoms such as burning, itching and pain. Yet despite anonymous surveys showing that as many as one in eight females experienced persistent, troublesome vaginal dryness most put up with it as they are too embarrassed to seek help.

What causes vaginal dryness

The vagina has an efficient self-cleansing system which involves glands that produce fluids and mucus to keep the area supple and moist. The female hormone, oestrogen, stimulates secretion of this fluid, especially during the first half of the menstrual cycle, while progesterone hormone thickens mucus and can lead to dryness during the second half of the menstrual cycle.

As oestrogen levels fall to trigger menopause, tissues lining the cervix and vagina naturally thin (unless you are taking oestrogen replacement therapy) and also produce less natural moisture. Known as vaginal atrophy, this leads to persistent dryness, daily discomfort, itching, soreness, pain during sex and urinary symptoms.

Vaginal dryness and related symptoms can also occur in pre-menopausal women with relatively low levels of oestrogen, such as after childbirth, during breastfeeding, and in women who have undergone hysterectomy or received chemotherapy (eg for breast cancer).

Vaginal lubricants

A vaginal lubricant will provide almost instant relief of vaginal dryness and can be used as needed. Most are gels which are water based or silicone based. If your vaginal dryness is not too bothersome, or is just a problem during sex, then a simple gel-based vaginal lubricant may solve the problem. If you have persistent vaginal dryness as a result of menopause or chemotherapy, however, then a cream-based vaginal moisturiser will provide more effective long-term relief.

NB Don’t use mineral oils or petroleum jelly as a vaginal lubricant as they are not designed for use in this delicate area, and can quickly weaken latex condoms. If you are using latex condoms, ensure you select a lubricant that confirms it is compatible.

Vaginal dryness during sex

If vaginal dryness is only a problem during sex, then I recommend using Sylk Natural Intimate Moisturiser. Sylk is based on natural fruit extracts from kiwifruit vine gum and citrus seed extract, with citric acid to provide the correct pH for the vagina.

Sylk Natural Intimate Moisturiser is ideal if dryness is mild and mostly associated with sex. Use as required. Sylk is compatible with condoms and hormone-free.

For more persistent vaginal dryness

Boots Vaginal Moisturising Gel is ideal if you are experiencing more persistent daily dryness (eg after childbirth) and prefer to use a gel rather than a cream.

Boots Vaginal Moisturising Gel contains a hyaluronic acid derivative that sticks to the vaginal wall and attracts up to 1000 times its own weight in water. This provides a natural, longer-lasting source of moisture that can soothe daily vaginal dryness and associated itching and discomfort.

The gel is applied with an applicator, every three days, for thirty days is recommended. It is compatible with lubricated/non-lubricated latex and polyisoprene condoms, but it is not compatible with polyurethane condoms.

Boots Vaginal Moisturising Gel is available via Boots.com.

Menopause-related vaginal Dryness

When oestrogen levels fall at the menopause, vaginal dryness will become a long-term problem. Oestrogen replacement therapy will postpone dryness, but some women are unable or unwilling to take prescribed hormones, and there will eventually come a time when your doctor recommends that HRT is stopped. Vaginal moisturisers will then become a key part of your regular health regime. Topical treatments come in three main forms:

• Non-hormonal gel based products
• Gel based products containing natural plant oestrogens (soy isoflavones)
• Cream based products with additional lipids.

Replens MD Longer Lasting Vaginal Moisturiser Gel

Replens MD is one of the original gel-based vaginal moisturisers that I used to prescribe as a doctor. The product has been updated to provide longer lasting moisturisation and is now more widely available. Replens MD contains bioadhesives (a polycarbophil gel) that attaches to dry, compacted vaginal cells and provides a protective barrier to lock in moisture and allow cells to plump up and regenerate.

Replens MD is available in three sizes: 3 single use prefilled applicators; 6 single use prefilled applicators, or a 35g tube with a reusable applications (allowing 12 applications).

Apply Replens MD every three days to provide long-lasting relief. It can also be applied at least two hours before sex to supplement your body’s natural lubrication. Replens MD is compatible with natural rubber latex, polyisoprene and polyurethane condoms, and is hormone-free. It is ideal of you prefer a gel to a cream, and need a longer-lasting vaginal gel moisturiser.

Phyto Soya Vaginal Gel

If you would like a gel which includes the additional benefit of topical plant oestrogens, try Phyto Soya Vaginal Gel, This contains a concentrated soya extract (with 10% isoflavones) to help reduce vaginal dryness and improve sexual comfort during and after the menopause. The gel base contains moisturising ingredients that hydrate and protect the vaginal mucous membrane, and has a pH of 5.

Apply one 5-ml dose twice a week at bedtime. This will provide long-term relief of vaginal dryness, soothe itching and irritation and improve sexual comfort. The plant oestrogens (isoflavones) help to improve the elasticity and density of vaginal tissues.

Phyto Soya Vaginal Gel with isoflavones is available from Amazon.co.uk.

Vagisan Moisturising Cream (MoistCream)

Vagisan Moisturising Cream (or MoistCream) is the ‘Rolls Royce’ option for women with persistent vaginal dryness and irritation, or for whom a vaginal gel is not enough.

A vaginal cream is more soothing than a gel as it provides moisture plus nourishing lipids that sink in and act just a like the creams you use elsewhere on the body (eg hands or face) to provide deeper relief of dryness. Having worked as a genitourinary medicine doctor in sexual health clinics, Vagisan Moisturising Cream is the vaginal lubricant I recommend most to women with persistent post-menopausal vaginal dryness. In some cases it is as effective as prescribed oestrogen creams but without the need for hormones.

Vagisan Moisturing Cream provides moisture plus lipids, in the form of a hydrophilic oil-in-water blend. It is instantly soothing and has an ideal pH of 4.5 which allows healthy probiotic bacteria to flourish, and discourages the imbalances associated with bacterial vaginosis which often complicate vaginal dryness.

In a clinical study involving 92 women who were unable to use oestrogen cream for vaginal dryness, 84% of women and 92% of their doctors rated the results of using Vagisan cream as good or very good after four weeks of use, significantly more than with a placebo product.

Vagisan Moisturing Cream can improve vaginal dryness, itching, discharge and painful sex, whatever the underlying cause, including medical and surgical menopause, childbirth, hormonal methods of contraception and vaginal dryness associated with breast cancer therapy. As Vagisan Moisturising Cream does not contain hormones, it can also be used alongside hormone replacement therapy.

Vagisan can be used inside the vagina (with an applicator) and on the external genital area. The cream can also be used for vaginal dryness before sexual intercourse and is compatible with condoms.

Vagisan MoistCream is available from Boots.com.

Diet and supplements for vaginal dryness

Following a diet rich in plant oestrogens can help to reduce vaginal dryness. Plant oestrogens (isoflavones and lignans) are found in beans (especially soy beans, beansprouts, chickpeas, lentils, alfalfa and mung beans), exotic members of the cabbage family (eg Chinese leaves, kohl rabi, daikon), celery, fennel and sweet potato. Eat a handful of nuts and seeds per day for their beneficial oils and plant oestrogens – especially flaxseed, sesame seeds, pumpkin seeds, walnuts, macadamias and use cold-pressed nut oils.

Limit your intake of alcohol as drinking over the safe recommended limit can lower oestrogen levels and lead to vaginal dryness as a result.

Cut back on salt intake which has a dehydrating effect.

Sea buckthorn oil

Sea buckthorn oil capsules (taken by mouth) are a traditional remedy for vaginal dryness. Sea Buckthorn oil is a rich source of omega-7 essential fatty acids that help to regenerate mucous membranes and normalise the production of natural secretions. Research involving 116 postmenopausal women with vaginal atrophy (dryness, itching and burning) found that taking sea buckthorn oil supplements significantly improved symptoms compared with placebo.

Sea buckthorn oil capsules also help to improve dry eyes.

Soy isoflavones

Soy isoflavone supplements have an oestrogen-like action to improve menopausal vaginal dryness. A study that compared the effects of an oral soy isoflavone supplement with prescribed oestrogen replacement therapy found that both were equally effective in improving urogenital symptoms such as vaginal dryness.

Black cohosh  

Black cohosh is one of the most widely studied alternatives to prescribed hormone replacement therapy. Studies show that Black cohosh supplements are as effective in relieving menopausal symptoms of hot flushes, vaginal dryness, depression and anxiety as prescribed oestrogens.

Royal jelly

Royal jelly has oestrogen-like effects that can reduce menopausal hot flushes, night sweats and vaginal dryness. While often taken by mouth, the jelly is also used as a topical cream to improve vaginal tissue thinning after the menopause.

A study involving 90 postmenopausal women attending a gynaecology clinic with vaginal dryness were treated with either a vaginal Royal Jelly cream (15% strength), a vaginal oestrogen or a non-hormonal lubricant, for three months.

Surprisingly, the vaginal Royal Jelly cream was significantly more effective in improving symptoms and quality of life than the vaginal oestrogen cream or the lubricant.

The quality of the vaginal lining cells was also better in those using the vaginal Royal Jelly cream than in those receiving the prescribed oestrogen cream, according to medical assessments.

NB Do not take Royal Jelly if you are allergic to bee venom. Two of the proteins in Royal Jelly are also found in bee venom and can trigger allergic reactions in those who are sensitive to bee stings. The oestrogen-like action of Royal Jelly does not appear to stimulate or inhibit breast cancer or endometrial cancer cells in the laboratory. However, do not use Royal Jelly if you have a history of cancer, except under medical advice and supervision.

When to see your doctor

If vaginal symptoms persist, do seek medical advice to diagnose the cause as, in some cases, cell changes may need further investigation. Your doctor can also prescribe a local hormone cream or pessary, hormone replacement patches/gel or tablets. Some non-hormonal vaginal moisturisers are also available on prescription if oestrogen is not needed.

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