Vaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Symptoms of vaginal dryness include itching and stinging around the vaginal opening and in the lower third of the vagina. Vaginal dryness also makes intercourse uncomfortable.

A thin layer of moisture always coats your vaginal walls. Hormonal changes during your menstrual cycle and as you age affect the amount and consistency of this moisture.

Most vaginal lubrication consists of clear fluid that seeps through the walls of the blood vessels encircling the vagina. When you're sexually aroused, more blood flows to your pelvic organs, creating more lubricating vaginal fluid. But the hormonal changes of menopause, childbirth and breast-feeding may disrupt this process.

Signs and symptoms of vaginal dryness include:

• Dryness
• Itching
• Burning
• Pain or light bleeding with sex
• Urinary frequency or urgency

As many as four in 10 women who have reached menopause experience signs and symptoms related to vaginal dryness.

When to see a doctor
Make an appointment with your doctor if you have vaginal burning, itching or soreness or painful sexual intercourse that doesn't improve with self-care measures, such as using a vaginal moisturizer or water-based lubricant.

A variety of conditions can cause vaginal dryness. Determining the cause is key to helping you find an appropriate solution. Potential causes include:

Decreased estrogen levels
Reduced estrogen levels are the main cause of vaginal dryness. Estrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining.

Estrogen levels can fall for a number of reasons:

• Menopause or perimenopause
• Childbirth
• Breast-feeding
• Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy
• Surgical removal of your ovaries
• Immune disorders
• Cigarette smoking

Medications
Allergy and cold medications, as well as some antidepressants, can decrease the moisture in many parts of your body, including your vagina. Anti-estrogen medications, such as those used to treat breast cancer, also can result in vaginal dryness.

Sjogren's syndrome
In this autoimmune disease, your immune system attacks healthy tissue. In addition to causing symptoms of dry eyes and dry mouth, Sjogren's syndrome can also cause vaginal dryness.

Douching
The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated.

If your usual doctor is a family doctor or general practitioner, he or she may refer you to a specialist (gynecologist) to evaluate your condition.

Questions your doctor may ask

• What vaginal symptoms are you experiencing?
• How long have you experienced these symptoms?
• How much distress do your symptoms cause you?
• Are you sexually active?
• Does the condition limit your sexual activity?
• Do you use scented soap or bubble bath?
• Do you douche or use feminine hygiene spray?
• What medications or vitamin supplements do you take?
• Have you tried any over-the-counter moisturizers or lubricants?

Diagnosis of vaginal dryness may involve:

• A pelvic exam, during which your doctor feels (palpates) your pelvic organs and visually examines your external genitalia, vagina and cervix.
• A Pap test, which involves collecting a sample of cervical cells for microscopic examination. Your doctor may also take a sample of vaginal secretions to check for signs of vaginal inflammation (vaginitis) or to confirm vaginal changes related to estrogen deficiency.
• A urine test, which involves collecting and analyzing your urine, if you have associated urinary symptoms.

Vaginal estrogen therapy
In general, treating vaginal dryness is more effective with topical (vaginal) estrogen rather than oral estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal. Vaginal estrogen also doesn't decrease testosterone levels — important for healthy sexual function — the same way oral estrogen can.

Vaginal estrogen therapy comes in several forms:

• Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it, usually a daily regimen for the first few weeks and then two or three times a week thereafter.
• Vaginal estrogen ring (Estring). A soft, flexible ring is inserted into the upper part of the vagina by you or your doctor. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months.
• Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet, for instance daily for the first two weeks and then twice a week thereafter.

If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches, gel or a higher dose estrogen ring along with a progestin. Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you.

Use a lubricant or moisturizer
If vaginal dryness makes sexual intercourse uncomfortable, try over-the-counter products such as:

• Lubricants (Astroglide, K-Y). Water-based lubricants like these lubricate your vagina for several hours. Apply the lubricant to your vaginal opening or to your partner's penis before intercourse.
• Moisturizers (Replens, Lubrin). These products imitate normal vaginal moisture and relieve dryness for up to three days with a single application.

Pay attention to sexual needs
Occasional vaginal dryness during intercourse may mean that you aren't sufficiently aroused. Make time to be intimate with your partner and allow your body to become adequately aroused and lubricated. It may help to talk with your partner about what feels good. Having intercourse regularly also may help promote better vaginal lubrication.

Avoid certain products
Though you may be willing to try just about anything to relieve your discomfort, avoid using the following products to treat vaginal dryness, because they may irritate your vagina:

• Vinegar, yogurt or other douches
• Hand lotions
• Soaps
• Bubble baths