Several Options Can Relieve Vaginal Dryness and Revive Your Sex Life

The hormone changes that occur during and after menopause often are accompanied by unwelcome changes that affect libido and sex. Margaret Polaneczky, MD, a gynecologist at the Iris Cantor Women’s Health Center at Weill Cornell Medicine, says that vaginal dryness is one of the most common complaints among postmenopausal women.

“One of the consequences of menopause is vaginal dryness—a lack of lubrication that, for many women, means painful sex. Many of my patients ask if there’s anything that can be done to get back the sex life she and her partner once enjoyed. Fortunately, the answer is almost always ‘yes,’” says Dr. Polaneczky.

Start With OTC Products

For most women, the first step is a trial of non-hormonal therapy. You’ll need two things: a moisturizer and a lubricant.

“The menopausal vagina needs moisturizer, just like aging skin does. It doesn’t have to be every day, but it has to be regular and consistent. I don’t promote products, but I do tell my patients about Replens—it’s been studied and shown to be as effective as vaginal estrogen in restoring the premenopausal vaginal mucosa,” advises Dr. Polaneczky.

If you haven’t had sex in a while, don’t expect a lagging libido to disappear once you start using a moisturizer.

“You’re probably not going to be hit with a sudden urge to have sex just because your vagina is ready. Have sex anyway, whether you feel the desire to or not. If all goes well, your body will respond and enjoy the experience,” says Dr. Polaneczky.

Vaginal Estrogen Options

Another possible fix is using vaginal estrogen, which works by restoring and thickening the vaginal mucosa and by increasing vaginal secretions. Vaginal estrogen comes in three forms:

• Estradiol tablets (Vagifem): This is a small tablet that is inserted into the vagina once a night for two weeks, and then twice a week thereafter. For many women, the tablet is the easiest and least messy option.
• Estrogen creams: These include Estrace, its generics, and Premarin. The cream is inserted into the vagina once a night for two weeks, and then twice a week thereafter. “The estrogen doses are highest when the cream is used according to the directions on the package insert; you can adjust the dose by simply using less. This allows for lower maintenance doses once vaginal integrity is restored,” explains Dr. Polaneczky.
• Estradiol vaginal ring (Estring): This is a flexible ring that is inserted into the vagina once every three months and continuously releases small doses of estrogen. Using the ring eliminates the issue of remembering to use a product, but Dr. Polaneczky notes that not all women’s vaginas are large enough to accommodate the ring. In that case, start with the vaginal estrogen tablets or cream. Over time, and with resumption of intercourse, the vaginal capacity may increase enough to accommodate the ring.

Estrogen Worries

Many women become concerned when they hear the word “estrogen” due to study findings that taking hormone replacement therapy (HRT) is associated with a small increase in breast cancer risk. However, Dr. Polaneczky explains that estrogen exposure while using vaginal estrogen is much lower than that with HRT, and blood levels of estrogen remain within the menopausal range.

“The small amounts of estrogen in vaginal products do not carry the same risks of blood clots as does HRT, and there is no increase in uterine cancer rates with vaginal estrogen use for up to five years,” say Dr. Polaneczky. “That said, we do not have long-term data on breast cancer risks from vaginal estrogen, and women at high risk for breast cancer or with a history of breast cancer generally want to avoid even the small amounts of hormone in vaginal estrogen.”

Another Option

Ospemifine (Osphena) is a U.S. Food and Drug Administration-approved medication for treating menopausal vaginal dryness. Ospemifene is a selective estrogen receptor modulator, meaning that it acts like estrogen but it contains no estrogen. In the vagina, ospemifene restores vaginal moisture and the integrity of the vaginal mucosa. Ospemifene carries a small risk of blood clots, although it is lower than the risk associated with hormone replacement therapy.

Ospemifene also can cause hot flashes, so usually, it is not recommended for women who already experience bothersome hot flashes. But Dr. Polaneczky notes that, even if ospemifene does cause hot flashes, you may want to stick with it, since the hot flashes usually only last for about four weeks.

The Bottom Line

Having vaginal dryness doesn’t mean your sex life is over; have a frank discussion with your gynecologist if you need more guidance on the treatment options that are available.

Finally, Dr. Polaneczky says, “Keep having sex. The old adage ‘Use it or lose it’ really does apply.”

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